The introduction of chlorpromazine and other neuroleptic medications opened a new window for the understanding and treatment of patients with schizophrenia. Unfortunately, """"""""typical"""""""" neuroleptics are not always effective for psychosis and are also associated with a number of troublesome side-effects, including acute extrapyramidal signs (EPS) and persistent tardive dyskinesia (TD). This is of particular importance to he elderly because it has been well documented that the risk of EPS and TD increases with age and neuroleptic exposure. Recently, experience with serotonin- dopamine antagonists, or """"""""atypical"""""""" antipsychotic medications such as clozapine and risperidone, has shown that is possible to better dissociate the antipsychotic effects of medications from EPS and TD. Nevertheless, relatively little is known about the us f antipsychotic medication, typical or atypical, in older patients. We plan to compare (randomized, double-blind, parallel group study for 1 2 weeks) the most commonly described """"""""typical"""""""" antipsychotic, haloperidol, with the most commonly prescribed """"""""atypical"""""""" antipsychotic, risperidone, in older patients with schizophrenia. Treatment will be titrated in a forced upward titration fashion until a defined study outcome (Optimal Treatment Response Dosage) is identified. The optimal treatment response dosage will be maintained for the remainder of the study. Specifically, we will: (1) Compare the outcome of older schizophrenia subjects treated with optimal doses of haloperidol risperidone. Outcome will be assessed across three specific domains including: clinical response (reduction in psychopathology and presence and severity of acute EPS); cognitive performance (as measured by a battery of neuropsychological tests); and health-related quality of life. (2) Explore the relationship between plasma levels of antipsychotics (haloperidol and risperidone) in older schizophrenia subjects and clinical outcome (reduction in psychopathology and side effects).
| Dolder, Christian; Lacro, Jonathan; Dolder, Nicole et al. (2003) Pharmacists' use of and attitudes and beliefs about alternative medications. Am J Health Syst Pharm 60:1352-7 |
| Lacro, Jonathan P; Dunn, Laura B; Dolder, Christian R et al. (2002) Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. J Clin Psychiatry 63:892-909 |
