Symptom change and extrapyramidal side effects during acute haloperidol treatment in chronic geriatric schizophrenics

Haloperidol (HAL) has been widely used in the elderly. Little is known about the phenomenology of schizophrenia in late life or the response to antipsychotic treatment. We prospectively studied 19 elderly patients treated with HAL for 25 days. They ranged in age from 55 to 83 (mean age = 67.5 +/- 6.4 years). After a washout period in 15 patients (4 patients had been noncompliant with medication for at least 1 month), patients were rated before treatment and at the end of the assessment period with the Positive and Negative Syndrome Scale (PANSS) and Simpson-Angus extrapyramidal side effects rating scale (SA). Baseline PANSS scores were associated with change in SA scores (r = .52, p = .02) and with SA baseline score (r = .45, p = .05). Age was negatively associated with baseline positive subscale (r = -.42, p = .07) and endpoint positive subscale scores of PANSS (r = -.48, p = .04). Age was positively associated with improvement in negative symptoms (r = .53, p = .02). Haloperidol dose was negatively associated with improvement in positive symptoms (r = -.46, p = .04). Although studies with larger samples sizes are needed, these findings may indicate that elderly schizophrenics do not respond to treatment in the same manner as do younger schizophrenics.