Maintenance treatment in older schizophrenics

Numerous studies during the past 35 years have established the efficacy of neuroleptics in the treatment of psychotic symptoms in schizophrenic patients and the ability of these medications to prevent relapse. Longitudinal studies of the course of schizophrenia have found that over time there is a decrease in the positive symptoms such as delusions and hallucinations. There is a need to determine the lowest effective dosage of neuroleptic medication as the disease and the physiology (affecting the pharmacodynamics and pharmacokinetics) of patients changes over time. We evaluated 56 patients, aged 45 years old and over followed in the Geriatric Psychiatry Clinic, diagnosed with schizophrenia or schizoaffective disorder for the possibility of neuroleptic reduction. Patients were screened by their treating physician, the PI of the protocol and a psychiatric nurse for the taper clinic. Only 20 met our criteria for a special neuroleptic medication clinic where patients receive intensive clinical follow-up for neuroleptic reduction. Twenty patients were identified as appropriate for neuroleptic reduction or discontinuation and followed for at least one year. Fifty percent of the patients had an increase in symptoms ranging from mild insomnia to reemergence of positive symptoms over the follow-up period. One-half of the patients with increased symptoms were restabilized on 50% or less of their original neuroleptic dosage. Patient characteristics and clinical ramifications will be discussed. A sizable proportion of older schizophrenic patients can safely undergo neuroleptic reduction if carefully screened and clinically followed.