Centre for Addiction and Mental Health, Multimodal Imaging Group, PET Centre, 250 College Street, Toronto, ON M5T1R8, Canada.
Curr Psychiatry Rep. 2010 Feb;12(1):28-33. doi: 10.1007/s11920-009-0080-3.
Antipsychotic medications are widely used to manage psychotic and behavioral disorders in older adults, including primary psychotic disorders such as schizophrenia, and psychosis and behavioral disturbances associated with dementia. These two broad diagnostic indications are associated with contrasting recommended treatment durations, with the former requiring indefinite treatment across the life span. Antipsychotic drug dosing for schizophrenia is based primarily on studies of younger patients and thus may not apply to older adults. It is critically important to address the effects of aging on antipsychotic dosing given the recent emergence of data that suggest a critical role for age-related sensitivity to these drugs. Antipsychotic drugs are not only associated with somatic and neurological adverse effects but also increased all-cause mortality and sudden cardiac death in this vulnerable population. This review focuses on the sensitivity of older adults to adverse effects from antipsychotic medications and the current pharmacokinetic and pharmacodynamic explanatory models of susceptibility. Implications of recent research findings for individualized pharmacotherapy are discussed.
抗精神病药物被广泛用于治疗老年人的精神病和行为障碍，包括原发性精神病，如精神分裂症，以及与痴呆相关的精神病和行为障碍。这两种广泛的诊断指征与对比推荐的治疗持续时间相关，前者需要在整个生命周期内进行无限期治疗。精神分裂症的抗精神病药物剂量主要基于对年轻患者的研究，因此可能不适用于老年人。鉴于最近有数据表明，年龄与这些药物的敏感性有很大关系，因此非常重要的是要解决抗精神病药物剂量与衰老相关的问题。抗精神病药物不仅与躯体和神经不良反应有关，而且在这一脆弱人群中还会增加全因死亡率和心源性猝死。这篇综述主要关注老年人对抗精神病药物不良反应的敏感性，以及目前对易感性的药代动力学和药效学解释模型。讨论了最近研究结果对个体化药物治疗的影响。
