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Acute Neuroleptic Treatment in Elderly Patients Without Dementia

Received January 27, 1997; revised August 10, 1997; accepted October 8, 1997. From the Departments of Psychiatry and Laboratory Medicine, Yale University School of Medicine. Address correspondence to Dr. Mazure, Yale-New Haven Hospital, 10-507 EP, 20 York Street, New Haven, Connecticut 06504.

Low doses of neuroleptics are the standard for treating psychosis in elderly patients because of concern about inducing adverse effects. The authors found that fixed, low-dose neuroleptic treatment (0.15 mg/kg/day) for 10 days resulted in low perphenazine levels and low rates of acute response (25%) in elderly patients with primary psychotic illness (without dementia). Increase in initial dose did not speed acute response and induced adverse effects that were absent or minimal with low-dose treatment. With higher-dose treatment, drug blood levels rose disproportionately, and level-to-dose ratios were higher than those observed in non-elderly adults. Naturalistic follow-up suggested that response may take longer to develop than in non-elderly adults and that low doses for a longer duration may provide effective treatment.

Key Words: Neuroleptics • Geriatric • Pharmacotherapy