The clinical characteristics of
schizophrenia in older persons vary to some extent, depending on whether the onset of illness was earlier or later in life. Regardless of age of onset,
antipsychotic medications are the mainstay of treatment. Age-related physiologic changes make older persons more sensitive to the therapeutic and toxic effects of
antipsychotics. There is a paucity of controlled studies on the efficacy of
antipsychotic medications in older persons with
schizophrenia. Existing data suggest that atypical
antipsychotics are at least as efficacious as and better tolerated than the conventional agents. In late-life
schizophrenia, important adverse effects of
antipsychotics include sedating,
anticholinergic and cardiovascular effects, extrapyramidal symptoms, and
tardive dyskinesia. Certain atypical
antipsychotics are associated with a risk of metabolic changes as well as
agranulocytosis. Clinical recommendations include a thorough diagnostic evaluation followed by treatment with low doses of atypical
antipsychotics. Medication alone is likely to be less effective than when it is combined with an appropriate psychosocial intervention.