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Atypical (second generation) antipsychotic treatment response in very late-onset schizophrenia-like psychosis

Published online by Cambridge University Press:  01 December 2010

Jamie Scott ,
Blaine S. Greenwald ,
Elisse Kramer  and
Mitchell Shuwall
Jamie Scott*
Affiliation:
Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, New York, U.S.A.
Blaine S. Greenwald
Affiliation:
Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, New York, U.S.A.
Elisse Kramer
Affiliation:
Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, New York, U.S.A.
Mitchell Shuwall
Affiliation:
Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, New York, U.S.A.
*
Correspondence should be addressed to: Jamie Scott, Zucker Hillside Hospital, North Shore-LIJ Health System, 75-59 263rd Street, Glen Oaks, NY 11004, U.S.A. Phone: +1 718 470-8140; Fax: +1 718 470-9784. Email: jscott2@nshs.edu.
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Abstract

Introduction: Symptom amelioration in older patients with very late onset schizophrenia-like psychosis (VLOSLP) is often difficult, with limited psychotropic response reports yielding variable findings. Information about atypical (second generation) antipsychotic use in this population is scant.

Methods: A consecutive sample of geriatric psychiatry outpatients and inpatients with psychotic disorders were retrospectively identified over a 31-month period based on systematic information abstraction from an electronic medical record (e-record). After exclusion criteria were applied, 8/138 outpatients and 13/362 inpatients met inclusion criteria for VLOSLP and had been naturalistically treated with an atypical antipsychotic during hospitalization or nine months of outpatient care. Mandatorily completed e-record standardized symptom severity response ratings were converted into positive treatment response thresholds.

Results: 38% of outpatients and 77% of inpatients (mean age = 76 years for both groups; mean age of onset of psychosis = 70 years for outpatients and 74 years for inpatients) met criteria for positive treatment response to an atypical antipsychotic (either aripiprazole, olanzapine, quetiapine, or risperidone) with sign/symptom amelioration, rather than eradication.

Conclusions: Various atypical antipsychotics at geriatric doses yielded a positive treatment response in nearly two-thirds of VLOSLP patients. Patients with less chronic, more severe symptoms responded at a higher rate. Prospective, double-blind, placebo-controlled trials with representative subject samples are needed to validate these preliminary findings.

Keywords

atypicalantipsychoticschizophrenialate-onsetpsychosis
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 5 , June 2011 , pp. 742 - 748
Copyright
Copyright © International Psychogeriatric Association 2010

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