Summary
Treatment of psychoses in the elderly is complicated by effects of aging on drug absorption, metabolism, and toxicity. Not all of the effects are well understood and considerable research remains to be done to improve the safety and efficacy of antipsychotic drugs in the elderly.
Neurological side effects, particularly tardive dyskinesia (TD) remain a serious problem. The incidence, prevalence, persistence, and severity of TD all appear to be substantially greater in the elderly, even allowing for the presence of some cases of spontaneous dyskinesias in older-patient polulations.
The possibilities for developing or identifying safer antipsychotic drugs and the clinical strategies needed to test them are discussed.
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References
Baldessarini, R.J., Cole, J.O., Davis, J.M., Gardos, G., Preskorn, S.H., Simpson, G.M., and Tarsy, D.: Tardive dyskinesia: A Task Force Report of the American Psychiatric Association. Washington, D.C.: American Psychiatric Association, 1980.
Borison, R.L., Fields, J.Z., and Diamond, B.I.: Site-specific blockade of dopamine receptors by neuroleptic agents in human brain. Neuropharmacology 20, 1321–1322 (1981).
Campbell, A., and Baldessarini, R.J.: Effects of maturation and aging on behavioral responses to haloperidol in the rat. Psychopharmacology(Berlin) 73, 219–222 (1981).
Cooper, T.B., and Robinson, D.S.: Pharmacokinetics of neuroleptic drugs in the aged. In Raskin, A., Robinson, D.S., and Levine, J. (Eds.), Age and the Pharmacology of Psychoactive Drugs, pp. 181–189. New York: Elsevier, 1981.
Costall, B., and Naylor, R.J.: Detection of the neuroleptic properties of clozapine, sulpiride and thioridazine. Psychopharmacologia 43, 69–75 (1975).
Fann, W.E., Smith, R.C., Davis, J.M., and Domino, E.F. (Eds.), Tardive Dyskinesia: Research and Treatment. New York: Spectrum Publications, 1980.
Friedel, R.O.: Pharmacokinetics in the geropsychiatric patient. In Lipton, M.A., DiMascio, A., and Killam, K.F. (Eds.), Psychopharmacology: A Generation of Progress. New York: Raven, 1978.
Gianutsos, G., and Moore, K.E.: Dopaminergic supersensitivity in striatum and olfactory tubercle following chronic administration of haloperidol or clozapine. Life Sci. 20, 1585–1592 (1977).
Gunne, L.M.: Studies on the pathophysiology of persistent neuroleptic-induced dyskinesia. Paper presented at American College of Neuropsychopharma- cology, San Juan, Puerto Rico, Dec. 12-16, 1983 (unpublished).
Gunne, L.M., and Barany, S.: Haloperidol-induced tardive dyskinesia in monkeys. Psychopharmacology 50, 237–340 (1976).
Jeste, D.V., and Wyatt, R.J.: Understanding and Treating Tardive Dyskinesia. New York: Guilford, 1982.
Kane, J.M., Rifkin, A., Woerner, M., Reardon, G., Sarantakos, S., Schiebel, D., and Ramos-Lorenzi, J.: Low dose neuroeptics in the treatment of outpatient
schizophrenics: I. Relapse rates: preliminary results. Arch. Gen. Psychiatry 40, 893–896 (1983).
Kane, J.M., and Smith, J.M.: Tardive dyskinesia: Prevalence and risk factors 1959-1979. Arch. Gen. Psychiatry 39, 473–481 (1982).
Kane, J.M., Weinhold, P., Kinon, B., Wegner, J., and Leader, M.L.: Prevalence of abnormal involuntary movements (spontaneous dyskinesias) in the normal elderly. Psychopharmacology 77, 105–108 (1982a).
Kane, J.M., Woerner, M., Weinhold, P., Wegner, J., and Kinon, B.: A prospective study of tardive dyskinesia development: Preliminary results. J. Clin. Psychopharmacology 2, 345–349 (1982b).
Kane, J.M., Woerner, M., Weinhold, P., Wegner, J., and Kinon, B.: A prospective study of tardive dyskinesia development: Preliminary results. J. Clin. Psychopharmacology 2, 345–349 (1982b).
Klawans, H.L., and Barr, A.: Prevalence of spontaneous lingual-facial-buccal dyskinesias in the elderly. Neurology 32, 558–559 (1982).
Lieberman, J., Kane, J.M., Woerner, M., and Weinhold, P.: Prevalence of tardive dyskinesia in elderly patients. Psychopharm. Bull. 20: 22–26 (1984).
Prien, R.F., Haber, P.A., and Caffey, E.M.: The use of psychoactive drugs in elderly patients with psychiatric disorders. J. Am. Geriatric Soc. 23, 104-112 (1975).
Reynolds, G.P., Cowey, L., Rossor, M.N., and Iversen, L.L.: Thioridazine is not specific for limbic dopamine receptors. Lancet 2, 499–500 (1982).
Sayers, A.C., Burki, H.R., Ruch, W., and Asper, H.: Neuroleptic-induced hypersensitivity of striatal dopamine receptors in the rat as a model of tardive dyskinesia. Effects of clozapine, haloperidol, loxapine, and chlorpromazine. Psychopharmacologia 41, 97–104 (1975).
Scatton, B.: Differential regional development of tolerance to increased dopamine turnover upon repeated neuroleptic administration. Eur. J. Pharmacol 46, 363–369 (1977).
Smith, J.M., and Baldessarini, R.J.: Changes in prevalence, severity and recovery in tardive dyskinesia with age. Arch. Gen. Psychiatry 37, 1368–1373 (1980).
Smith, R.C., and Davis, J.M.: Behavioral evidence for supersensitivity after chronic administration of haloperidol, clozapine, and thioridazine. Life Sci. 19, 725–732 (1976).
Smith, R.C., and Leelavathi, D.E.: Behavioral and biochemical effects of chronic neuroleptic drugs: Interaction with age. In Fann, W.E., Smith, R.C., Davis, J.M. etal. (Eds.), Tardive Dyskinesia: Research & Treatment. New York: SP Medical and Scientific Books, 1980.
Tanner, R.H., and Domino, E.F.: Exaggerated response to (+) amphetamine in geriatric gerbils. Gerontology 23, 165–173 (1977).
Varga, B., Sugarman, A.A., Varga, V., Zomorodo, A., and Zomorodi, W.: Prevalence of spontaneous oral dyskinesia in the elderly. Am. J. Psychiatry 139, 329–331 (1982).
Waldmeir, P.C., and Maitre, L.: Clozapine: reduction of the initial dopamine turnover increase by repeated treatment. Eur. J. Pharmacol 38, 197–203 (1976).
White, F.J., and Wang, R.Y.: Differential effects of classical and atypical antipsychotic drugs on A 9 and A 10 dopamine neurons. Science 221, 1054–1057 (1983).
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Kane, J.M. (1985). Prospects for the Development of Safer Antipsychotic Agents for the Treatment of the Elderly. In: Gaitz, C.M., Samorajski, T. (eds) Aging 2000: Our Health Care Destiny. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-5058-6_28
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DOI: https://doi.org/10.1007/978-1-4612-5058-6_28
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