Sable J A, Jeste D V
Department of Psychiatry, University of California, San Diego and the VA San Diego Healthcare System, CA 92161, USA.
J Nutr Health Aging. 2003;7(6):421-7.
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.
抗精神病药物是治疗老年人精神病的首选药物。与年龄相关的生理变化使老年人对抗精神病药物的治疗作用和毒性作用更为敏感。关于抗精神病药物在老年人中疗效的对照研究较少。现有数据表明，非典型抗精神病药物至少与传统药物一样有效，且耐受性更好。对抗精神病药物而言，老年人的重要不良反应包括镇静、抗胆碱能和心血管效应、锥体外系症状以及迟发性运动障碍。一些非典型抗精神病药物似乎有代谢改变的风险。临床建议包括进行全面的诊断评估，然后以低剂量使用非典型抗精神病药物进行治疗。药物治疗必须与适当的心理社会干预相结合，以优化其效果。非抗精神病药物可能提供有用的辅助或替代治疗，应根据具体情况考虑使用。
