Safety caution over antipsychotics in older patients

While antipsychotic drugs are approved primarily for schizophrenia and bipolar disorder, they are commonly used off-label for other psychotic disorders, according to the authors.

They said their use in older psychotic patients presented a major clinical dilemma because there were few, if any, evidence-based alternatives.

The study, funded by the US National Institute of Mental Health, looked at aripiprazole, olanzapine, quetiapine and risperidone in 332 patients aged older than 40 with psychosis associated with schizophrenia, mood disorders, post-traumatic stress disorder or dementia.

After a follow-up period of two years they found there was a high discontinuation rate after relatively short treatment duration – a median of six months. Quetiapine was discontinued midway through the trial due to a higher incidence of adverse events.

There was a lack of significant improvement in psychopathology as measured by the Brief Psychiatric

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