Drug treatment

The drug treatment of very-late-onset cases is essentially the same as for young patients, except that the effective dose of a drug may only need to be around 10 per cent of what the formulary recommends for young adults. Hence, 1 to 2 mg of trifluoperazine or 0.5 to 2.0 mg of riperidone daily may control symptoms. The effectiveness of such low doses cannot be explained by the advanced age of the patients alone, since those with early-onset schizophrenia who have grown old (sometimes referred to as 'graduates') will often need doses that are 50 to 100 per cent of those given to their younger counterparts.

The choice of individual antipsychotic medication is determined more by consideration of undesirable side-effects than particular therapeutic advantage, with the exception of risperidone and olanzapine whose 5-hydroxytryptamine-2 receptor blocking action seems to be effective in the treatment of visual hallucinations. These newer drugs are also less likely to produce extrapyramidal side-effects in a group particularly vulnerable to such problems. (19>

The route of drug delivery is important in determining treatment success. Many of these patients are insightless and live alone, so compliance with oral medication is often doubtful. Extremely low doses of depot antipsychotic medication (e.g. fluphenazine decanoate 12.5 mg every 3 weeks), are well tolerated and effective, and can be given by a community psychiatric nurse who over a period of months to years can build up a close relationship with the patient.

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