![]() These patients frequently have psychotic symptoms that are treated without a specialist's aid. Although a family physician is less likely to manage schizophrenia in elderly patients, it is quite common for family physicians to treat patients who have Alzheimer's disease and Parkinson's disease. 1 Psychotic symptoms in elderly patients always should be investigated thoroughly, and underlying medical conditions should be identified and treated. Negative symptoms include anhedonia, flattened affect, apathy, and social withdrawal. Positive symptoms include hallucinations, delusions, thought disorders (manifested by marked incoherence, derailment, tangentiality), and bizarre or disorganized behavior. Psychotic symptoms are classified as either positive or negative. Antipsychotic drugs effectively treat psychosis caused by a variety of conditions ( Table 1). Most family physicians are comfortable prescribing antidepressants, but anti-psychotic medications are less commonly prescribed and therefore less familiar. Informed use of atypical antipsychotic drugs allows family physicians to greatly improve quality of life in elderly patients with dementia and behavior disturbances. Clozapine's potentially lethal side effects limit its use in the primary care setting. ![]() Drug interactions, especially those involving the cytochrome P450 system, must be considered. To minimize side effects, these medications should be started at low dosages that are increased incrementally. Additional research is needed for a recently approved agent, ziprasidone. Quetiapine and clozapine are recommended for treatment of psychosis in patients with Parkinson's disease. Current guidelines recommend using risperidone and olanzapine to treat psychosis in patients with Alzheimer's dementia. Although nonpharmacologic treatments for behavioral disturbances should be tried first, medications often are needed to enable the patient to be adequately cared for. As the average age of Americans increases, the prevalence of Alzheimer's disease and Parkinson's disease will rise accordingly. These symptoms often occur in patients with Alzheimer's disease, other dementias, or Parkinson's disease. PubMed PMID: 12823080.Increasingly, atypical antipsychotic drugs are prescribed for elderly patients with symptoms of psychosis and behavioral disturbances. Dose equivalents for second generation long-acting injectable antipsychotics: The minimum. How to compare doses of different antipsychotics: a systematic review of methods. Chlorpromazine Equivalent Doses for the Newer Atypical Antipsychotics. Patel MX, Arista IA, Taylor M, Barnes TRE. Manual of Clinical Psychopharmacology, American Psychiatric Publishing 7th Edition, 2010. Schatzberg AF, Cole JO, and DeBattista C.The Maudsley Prescribing Guidelines in Psychiatry, Wiley-Blackwell 11th Edition, 2011. Dose equivalents for second generation long-acting injectable antipsychotics: The minimum effective dose method. Patel MX, Arista IA, Taylor M, Barnes TRE.Dose equivalents for second-generation antipsychotic drugs: the classical mean dose method. ![]() Dose equivalents for second-generation antipsychotics: the minimum effective dose method.
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