Pharmacologic management of psychosis in the elderly.

Antipsychotic medications are the pharmacologic agents of choice for treating psychosis in elderly persons. Age-related physiological 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. Existing data suggest that atypical antipsychotics are at least as efficacious as and better tolerated than the conventional agents. For elderly persons, important adverse effects of antipsychotics include sedating, anticholinergic, and cardiovascular effects, extrapyramidal symptoms, and tardive dyskinesia. Some atypical antipsychotics appear to carry a risk of metabolic changes. Clinical recommendations include a thorough diagnostic evaluation followed by treatment with atypical antipsychotics at low dosages. It is essential that medication be combined with an appropriate psychosocial intervention in order to optimize its effect. Non-antipsychotic medications may provide useful adjunctive or alternative treatment and should be considered on a case-by-case basis.