Antipsychotic drug effective and safe in paranoid older people who usually aren't treated

Lead author Professor Rob Howard (UCL Psychiatry) says these findings are encouraging him to prescribe antipsychotics more frequently for older adults in his own practice, and to urge patients to take them, and he expects other clinicians will follow suit.

Very late-onset schizophrenia-like psychosis is the third-most common condition seen by older people's mental health services, after dementia and depression, and yet only one in four patients with this diagnosis are taking antipsychotic drugs for it.*

Professor Howard said, "Many people develop a type of paranoid illness late in life that resembles schizophrenia. For example, a socially isolated elderly woman might complain that her neighbours are entering her flat while she's out or that some bizarre persecution is directed against her.

"Because sufferers do not usually accept that they have an illness it is very hard to persuade them to take treatment. In the absence of evidence that antipsychotic treatment helped to reduce symptoms in this group, most patients have gone untreated."

The study was a double blind randomised controlled trial with 92 participants, the first such trial of antipsychotic medication for elderly patients.

The patients were either given a 100mg dose of amisulpride daily, or a placebo. The dosage was very low (400-800mg is recommended for younger patients) to ensure its safety for older patients who could be more susceptible to side effects.

After 12 weeks, participants taking amisulpride scored an average of 7.7 points better on a 108-point psychiatric rating scale than those on the placebo, which was maintained if they stayed on for a further 12 weeks.

The dosage was found to be tolerable; while some patients experienced symptoms similar to Parkinson's disease, the number affected was below the standard safety threshold, and Professor Howard says an even lower dosage may have mitigated the side effects in those patients.

He added, "As most people with late-onset psychosis aren't receiving the treatment they need, we're hopeful that this solid evidence of its benefit and safety will encourage clinicians to make sure their patients access this treatment."

The study was funded by the National Institute for Health Research.

*2016 study also involving Prof Howard

Links

• Full article in Lancet Psychiatry
• UCL Psychiatry
• Professor Rob Howard's research profile
• National Institute for Health Research