Antipsychotic drug treatment for elderly people with late-onset schizophrenia

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The Cochrane Database of Systematic Reviews 2006 Issue 1

Copyright © 2006 The Cochrane Collaboration. Published by Wiley & Sons,

Ltd.

Antipsychotic drug treatment for elderly people with late-onset

schizophrenia

Arunpongpaisal S, Ahmed I, Aqeel N, Paholpak S

Plain language summary

A significant proportion of the world's growing elderly population suffers

from schizophrenia that started very late in life. Antipsychotic drugs are

often used to treat this distressing and severe illness. In this review we

attempted to find any good quality trial-based evidence to support this

practice but found none. Currently this vulnerable group is not well served

by the research community.

Abstract

Background

At least 0.1% of the world's elderly population have a diagnosis of

schizophrenia that started late in life and prognosis may be made worse by

delay and avoidance of treatment.

Objectives

To assess the effects of antipsychotic drugs for elderly people with

late-onset schizophrenia.

Search strategy

We searched the Cochrane Schizophrenia Group trials register (September

2002). This register is compiled by methodical searches of BIOSIS, Cochrane

Central Register of Controlled Trials (CENTRAL), CINAHL, Dissertation

Abstracts, EMBASE, LILACS, MEDLINE, PSYNDEX, PsycINFO, RUSSMED, Sociofile,

supplemented with hand searching of relevant journals and numerous

conference proceedings. References of all identified studies were also

inspected for more trials.

Selection criteria

All relevant randomised controlled trials that compared atypical

antipsychotic drugs with other treatments for elderly people (at least 80%

of whom should be over 65 years of age) with a recent (within five years)

diagnosis of schizophrenia or schizophrenia like illnesses such as

delusional disorder, schizoaffective disorder, schizophreniform psychosis or

paraphrenia.

Data collection and analysis

All citations were inspected by the principal reviewer (SA) and papers

ordered and re-inspected (by IA, NAQ, SP) to ensure reliable selection.

Methodological quality of trials would have been assessed using the Cochrane

Reviewers' Handbook criteria and data would have been independently

extracted. Data were to have been excluded if loss to follow up was greater

than 50%. For homogenous dichotomous data the relative risk (RR), 95%

confidence interval (CI), and the number needed to treat (NNT) and number

needed to harm (NNH), were to have been calculated based on an

intention-to-treat basis.

Main results

Electronic searching produced 119 references, 65 of which were selected for

examination of the full text. These referred to 38 studies. Not one study

met the entry criteria for this review. Most were randomised but involved

elderly people with chronic schizophrenia. Four trials involved people with

schizophrenia, and did include a minority who suffered from paraphrenia.

Outcomes for this sub-group, however, were not reported. One randomised

study (n=18) did focus on late onset schizophrenia, but unfortunately the

two treatments under evaluation, remoxipride and thioridazine, have both

been withdrawn from use.

Authors' conclusions

There is no trial-based evidence upon which to base guidelines for the

treatment of late onset schizophrenia. This review highlights the need for

good quality controlled clinical trials to address the effects of

antipsychotic drugs for this group. Such trials are possible. Until they are

undertaken people with late onset schizophrenia will be treated by doctors

using clinical judgement and habit to guide prescribing.

This is an abstract and plain language summary of a regularly updated,

systematic review prepared and maintained by The Cochrane Collaboration. The

full text of the review is available in The Cochrane Library (ISSN

1464-780X).

Regards,

" Every science touches art at some points while

every art has its scientific side; the worst man

of science is he who is never an artist, and the

worst artist is he who is never a man of science. "

[Armand Trousseau]