High doses of depot neuroleptics in elderly patients are significantly associated with extrapyramidal side-effects, with notable practice variations observed across psychiatric services.
May warrant lower neuroleptic doses in elderly patients to reduce extrapyramidal side-effects; leaves open causality and needs prospective confirmation.
A survey of psychiatric services across a city revealed 98 elderly patients who were receiving depot neuroleptics. Most had a diagnosis of schizophrenia, affective illness or paraphrenia and the majority received ‘depot’ as their only psychotropic medication. Extrapyramidal side-effects as judged by psychiatric nurse key workers were significantly associated with high total neuroleptic dose (100 mg ‘chlorpromazine equivalent’ or more). Those with a diagnosis of paraphrenia were maintained on a lower median dose of ‘depot’ than their schizophrenic of affectively ill counterparts. Large differences in practice, not readily explained by case mix, but perhaps understandable in view of large variations in nursing workload, were observed.
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Simon Thacker (1996) studied this question.