The treatment of behavioral disturbances, including psychosis, in the elderly requires different differential diagnostic and pharmacologic approaches than in younger patients. The elderly are at greater risk for comorbid medical illness, take more concomitant medications, and are more sensitive to extrapyramidal and cognitive side effects of antipsychotic drugs. In recent years, the use of atypical antipsychotics for treating psychosis in the elderly has increased enormously. This use appears to be based less on rigorous comparisons of the efficacy of atypical and typical drugs than on the clinical experience that the atypicals as a class are associated with fewer extrapyramidal symptoms and other adverse events. This presentation will review the scientific evidence for the efficacy and safety advantages of atypical over typical antipsychotics and will offer an initial risk-benefit assessment of the use of the two antipsychotic classes.
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