Use of atypical antipsychotic drugs in old age psychiatry

2002 ◽  
Vol 8 (1) ◽  
pp. 49-58 ◽  
Author(s):  
Walter Pierre Bouman ◽  
Gill Pinner
Keyword(s):  
Mood Disorders ◽  
Elderly People ◽  
Old Age ◽  
Atypical Antipsychotic ◽  
Antipsychotic Drugs ◽  
Psychotic Disorders ◽  
Psychotropic Medications ◽  
Psychotic Symptoms ◽  
Organic Psychoses ◽  
Old Age Psychiatry

Antipsychotic drugs are among the most widely prescribed psychotropic medications for elderly people, particularly for the 5–8% of patients who are in institutions. The antipsychotics are indicated for treating psychotic disorders, including schizophrenia, delusional disorder, psychotic symptoms in mood disorders and for a number of organic psychoses.

Antipsychotic and anticholinergic drugs

2012 ◽  
pp. 1208-1231
Author(s):  
Herbert Y. Meltzer ◽  
William V. Bobo
Keyword(s):  
Atypical Antipsychotic ◽  
Antipsychotic Drugs ◽  
Antipsychotic Agents ◽  
Psychotic Symptoms ◽  
Anticholinergic Drugs ◽  
Typical Antipsychotic ◽  
Drug Induced ◽  
Atypical Antipsychotic Drugs ◽  
Normal Limits ◽  
Psychotic Features

The discovery by Delay and Denicker in 1953 that chlorpromazine was highly effective in alleviating delusions, hallucinations, and disorganized thinking, was the seminal breakthrough in the treatment of schizophrenia, the first agent to produce sufficient relief of core psychotic symptoms to permit life outside of institutions for many patients with schizophrenia, and even a return to a semblance of function within normal limits. Chlorpromazine and the other related typical antipsychotic drugs which were introduced over the next 30 years have proven to be of immense benefit to vast numbers of people who experience psychotic symptoms as a component of a diverse group of neuropsychiatric and medical disorders, as well as drug-induced psychoses. These drugs have been invaluable in providing clues to the aetiology of schizophrenia and other forms of mental illness with psychotic features and as tools in understanding fundamental neural processes, especially those involving dopamine, a key neurotransmitter involved in psychosis. This class of drugs has now been supplanted by the so-called atypical antipsychotic drugs, of which clozapine is the prototype. This chapter will describe the various classes of antipsychotic agents, with emphasis on the atypical antipsychotic drugs, their benefits and adverse effects, recommendations for use in clinical practice, and mechanism of action. The drugs used to treat the extrapyramidal side-effects (EPS) produced mainly by the typical antipsychotic drugs are also considered.

scholarly journals Acute psychotic disorders induced by topiramate: report of two cases

2002 ◽  
Vol 60 (2A) ◽  
pp. 285-287 ◽  
Author(s):  
Florindo Stella ◽  
Dorgival Caetano ◽  
Fernando Cendes ◽  
Carlos A.M. Guerreiro
Keyword(s):  
Antipsychotic Drugs ◽  
Psychotic Disorders ◽  
The Other ◽  
Psychotic Symptoms ◽  
Acute Psychosis ◽  
Visual Hallucinations ◽  
Psychomotor Agitation ◽  
Full Remission ◽  
Epileptic Patients ◽  
Severe Anxiety

We report on two epileptic patients who developed acute psychosis after the use of topiramate (TPM). One patient exhibited severe psychomotor agitation, heteroaggressiveness, auditory and visual hallucinations as well as severe paranoid and mystic delusions. The other patient had psychomotor agitation, depersonalization, derealization, severe anxiety and deluded that he was losing his memory. Both patients had to be taken to the casualty room. After interruption of TPM in one patient and reduction of dose in the other, a full remission of the psychotic symptoms was obtained without the need of antipsychotic drugs. Clinicians should be aware of the possibility of development of acute psychotic symptoms in patients undergoing TPM treatment.

scholarly journals Psychiatry and the geriatric syndromes – creating constructive interfaces

2017 ◽  
Vol 41 (2) ◽  
pp. 71-75 ◽  
Author(s):  
Simon Thacker ◽  
Mike Skelton ◽  
Rowan Harwood
Keyword(s):  
Integrated Care ◽  
Elderly People ◽  
Old Age ◽  
Continuity Of Care ◽  
Frail Elderly ◽  
Geriatric Medicine ◽  
Geriatric Syndromes ◽  
Coordinated Care ◽  
Frail Elderly People ◽  
Old Age Psychiatry

SummaryIntegrating mental and physical healthcare is difficult to achieve because of professional and organisational barriers. Psychiatrists recognise the problems resulting from fragmentation of services and want continuity of care for patients, but commissioning and service structures perpetuate these problems. One way forward may be to follow the syndromic model employed by geriatricians as a means of avoiding over-emphasis on diagnosis above the pragmatics of implementing multi-component, coordinated care. Commissioners need to be made aware of the overlap and complementarity of skills possessed by old age psychiatry and geriatric medicine to create joint services for people vulnerable to dementia and delirium. A re-forged alliance between the two specialties will be necessary to turn integrated care for frail, elderly people from rhetoric into reality.

Home assessment in old age psychiatry: a practical guide

2012 ◽  
Vol 18 (6) ◽  
pp. 400-407 ◽  
Author(s):  
Bradley Ng ◽  
Martin Atkins
Keyword(s):  
Risk Management ◽  
Elderly People ◽  
Old Age ◽  
Clinical Aspects ◽  
Psychiatric Assessment ◽  
Psychiatric Interview ◽  
Practical Guide ◽  
Old Age Psychiatry ◽  
Safety Considerations ◽  
At Home

SummaryAn initial psychiatric assessment of elderly people at home is an important component of many old age psychiatry services. This article explores the clinical aspects of conducting such assessments and the skills required in addition to those brought to a standard psychiatric interview. Safety considerations and risk management when conducting home assessments are also discussed.

scholarly journals Mechanism of Action of Atypical Antipsychotic Drugs in Mood Disorders

2020 ◽  
Author(s):  
Daniil Grinchii ◽  
Eliyahu Dremencov
Keyword(s):  
Mood Disorders ◽  
Atypical Antipsychotic ◽  
Atypical Antipsychotics ◽  
Antipsychotic Drugs ◽  
Antidepressant Drugs ◽  
Dopamine Neurons ◽  
Atypical Antipsychotic Drugs ◽  
Experimental Drugs ◽  
Catecholamine Neurons ◽  
Typical Antipsychotics

Atypical antipsychotic drugs were introduced in the early 1990th. Unlike typical antipsychotics, which are effective only against positive symptoms of schizophrenia, atypical antipsychotics show effectiveness against negative and cognitive symptoms as well. Furthermore, they are effective not only in psychotic, but also in affective disorders, by their own or as adjuncts to antidepressant drugs. While typical antipsychotics act, almost exclusively, via dopamine-2 (D2) receptors, atypical target serotonin-1A/1B/2A/2C (5-HT1A/1B/2A/2C), α1/2-adrenergic, and/or histamine-1 (H1) receptors as well. Blocking of 5-HT1A/1B autoreceptors, inducing their early desensitization, and/or activation of α1-adrenoceptors, allow some atypical drugs to enhance 5-HT transmission. Blocking of 5-HT2A/2C and/or α2-adrenoceptors enable some atypical antipsychotics to stimulate catecholamine transmission and/or diminish the inhibition of catecholamine neurons induced by some antidepressants. It is possible, that the activation of H1 and/or blocking of H3 boost monoamine transmission as well, via a mechanism involving stimulation of firing activity of dopamine neurons. The experimental drugs with antipsychotic potential, acting on adenosine and trace amino associated (TAAR) receptors, might be effective in mood disorders as well, because of the ability to modulate the excitability of monoamine-secreting neurons and to potentiate extracellular concentrations of monoamines in the limbic areas of the brain.

Assessing Diagnosis and Symptoms Profiles of Late-Life Psychosis

GeroPsych ◽  
2013 ◽  
Vol 26 (4) ◽  
pp. 205-209 ◽  
Author(s):  
Ali Javadpour ◽  
Maryam Sehatpour ◽  
Arash Mani ◽  
Ali Sahraian
Keyword(s):  
Differential Diagnosis ◽  
Mood Disorders ◽  
Psychotic Disorders ◽  
Late Onset ◽  
Late Life ◽  
Psychotic Symptoms ◽  
Elderly Persons ◽  
Visual Hallucinations ◽  
Symptom Profiles ◽  
Symptom Profile

Background: There are many controversies with regard to the nosology and conditions causing psychosis in old age people. This study defines a symptom profile and differential diagnosis of late-onset psychosis. Method: 201 elderly persons with psychotic symptoms were recruited. All patients were interviewed based on SCID-1 to confirm the possible diagnosis. Results: The most delusional symptom reported by the subjects was persecutory delusion, and visual hallucinations were the most common hallucination. The most repeated diagnosis was dementia, followed by psychosis due to mood disorders, primary psychotic disorders, delirium, and psychosis due to medical conditions. Conclusions: Results from the current study indicate that late-life psychoses form a heterogeneous group of disorders with varying symptom profiles and etiologies.

The North Dublin Old Age Psychiatry service — survey of patients referred in the first six months

1990 ◽  
Vol 7 (2) ◽  
pp. 135-137 ◽  
Author(s):  
Margo M. Wrigley ◽  
Miriam A. Gannon
Keyword(s):  
Elderly People ◽  
Old Age ◽  
Government Policy ◽  
Community Setting ◽  
The Elderly ◽  
General Hospitals ◽  
Demographic Pressure ◽  
The North ◽  
Old Age Psychiatry ◽  
The Republic

AbstractIn Ireland, the demographic pressure of greater numbers of elderly people surviving longer with an attendant increase in the prevalence of dementia and depression compounded by the running down of old mental hospitals and the closure of smaller general hospitals has provoked debate on the need for Old Age Psychiatry (Psychogeriatric) Services.The first Old Age Psychiatry service in the Republic of Ireland started in North Dublin in January 1989. Detailed information on all referrals (173) assessed in the first six months of operation was collected and is presented. The findings are discussed in the context of the stated government policy of caring for the elderly within the community setting.

Pharmacological approaches to treatment

2020 ◽  
pp. 487-495
Author(s):  
Stefan Leucht ◽  
Andrea Cipriani ◽  
Toshi A. Furukawa
Keyword(s):  
Psychotic Disorder ◽  
Mechanism Of Action ◽  
Pharmacological Treatment ◽  
Antipsychotic Drugs ◽  
Psychotic Disorders ◽  
Psychotic Symptoms ◽  
Dopamine Antagonists ◽  
Partial Agonists ◽  
The Common

Antipsychotic drugs should be efficacious for all psychotic symptoms, whether they occur in schizophrenia, depression, mania, or any other psychotic disorder. All currently marketed antipsychotic drugs are dopamine antagonists or partial agonists, making the role of dopamine blockade in this context the most likely mechanism of action. Antipsychotics show efficacy in treatment and in maintenance across the common psychosis diagnoses, especially when looking across large metanalyses. Yet, there is an important imbalance as to how well the pharmacological treatment of the different psychotic disorders have been addressed in the literature, with schizophrenia being predominant.

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