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Treatment of Schizophrenia and Delusional Disorder

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Pharmacotherapy for older adults with schizophrenia and delusional disorder can be challenging. Although few randomized, placebo-controlled, double-blind clinical trials have been conducted in this population, some information has become available. Maintenance pharmacotherapy is usually required for older patients with schizophrenia due to risk of relapse. Because older patients are at higher risk of adverse antipsychotic effects, due to age-related pharmacokinetic and pharmacodynamic factors (Hammerlein et al. 1998), coexisting medical illnesses, and concomitant medications, the recommended starting and maintenance doses of antipsychotics in older adults are much lower than the usual doses in younger adults (American Psychiatric Association 1997). Patients with late-onset schizophrenia respond well to low-dose antipsychotic medication, requiring about 50% of the dose typically taken by older patients with early-onset schizophrenia and 25%–33% of the dose used in younger patients with schizophrenia.

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