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Before the second-generation (atypical) antipsychotics, with their superior side-effect profiles, became available, first-generation antipsychotics (FGAs; sometimes called conventional or typical antipsychotics), especially haloperidol, were the mainstay of treatment of late-life agitation. Extrapyramidal side effects (EPS), however, are common with haloperidol, especially in the elderly, limiting its usefulness. Tardive dyskinesia, a late-appearing EPS, develops more rapidly and at lower antipsychotic doses in elderly patients than in younger ones (Caligiuri et al. 1999; Jeste et al. 1999; Karson et al. 1990; Lieberman et al. 1984; Saltz et al. 1989). Tardive dyskinesia is also more common in patients with evidence of cortical atrophy and in dementia patients (Sweet and Pollock 1992). When antipsychotics are discontinued, tardive dyskinesia symptoms are less likely to disappear in older patients than in younger adults (Smith and Baldessarini 1980; Yassa et al. 1984), although the symptoms may not increase in severity (Yassa et al. 1992). These concerns regarding tardive dyskinesia and other EPS have contributed to the switch in clinical preference for the newer antipsychotic drugs.

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