Neuroleptic treatment of elderly patients

Data from an ongoing longitudinal study of the development of tardive dyskinesia were analyzed to examine the indications for neuroleptic treatment, continuity of treatment and dosage, and the effects of treatment on ratings of psychopathology and cognitive functioning during the first year of followup. Subjects were 266 elderly patients who had just begun neuroleptic treatment. Patients were predominantly (75%) female; their mean (+/- SD) age was 76.9 (+/- 9.2) years. A psychiatric diagnosis was recorded for 44 percent, primarily major depressive disorder; organic mental syndrome was diagnosed in 65 percent of the patients. Symptom ratings indicated 82 percent of the patients had psychosis, with or without agitation. Haloperidol was prescribed for 68 percent of the patients. Most were on neuroleptic medication continuously during the first month of followup; the average starting dose was 80 mg/day in chlorpromazine equivalent units. Symptom ratings at 1 month and 6 months showed significant improvement from baseline; ratings of dementia were unchanged.