Psychosis in elderly patients: classification and pharmacotherapy.
Psychosis in elderly patients is a growing clinical concern because psychotic symptoms most frequently occur as noncognitive manifestations of Alzheimer's disease, as side effects of drug therapy for Parkinson's disease, or as the primary abnormalities in schizophrenia, and the clinical characteristics of psychosis are distinct for each. In planning antipsychotic pharmacotherapy for elderly patients, age-related pharmacokinetic changes, polypharmacy for comorbid diseases, and concerns about the underlying conditions responsible for the psychotic symptoms must be considered. Traditional antipsychotic agents bind to dopamine receptors and effectively relieve positive schizophrenic symptoms but frequently cause tardive dyskinesia and other extrapyramidal symptoms, a problem for elderly patients, particularly for those with Parkinson's disease. Atypical antipsychotics bind to dopamine and serotonin receptors, relieving both positive and negative symptoms, and are less likely to cause extrapyramidal symptoms. The authors review common diagnostics associated with psychosis in the elderly and clinical guidelines to selecting antipsychotic pharmacotherapy.
Mintzer
Jacobo
J
Medical University of South Carolina, Institute of Psychiatry, Charleston 29406, USA. mintzerj@musc.edu
Targum
Steven D
SD
D000367:Age Factors; D000368:Aged; D000544:Alzheimer Disease / Q000150:complications; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001480:Basal Ganglia Diseases / Q000139:chemically induced; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004409:Dyskinesia, Drug-Induced / Q000209:etiology; D006801:Humans; D010300:Parkinson Disease / Q000150:complications; D019338:Polypharmacy; D011618:Psychotic Disorders / Q000145:classification / Q000150:complications / Q000188:drug therapy; D011954:Receptors, Dopamine / Q000378:metabolism; D012559:Schizophrenia / Q000150:complications / Q000175:diagnosis; D012701:Serotonin / Q000378:metabolism
D014150:Antipsychotic Agents; D011954:Receptors, Dopamine; D012701:Serotonin