Treatment of Special Populations With the Atypical Antipsychotics

Atypical antipsychotics have become the treatment of choice for patients experiencing a first episodeof schizophrenia. In addition, they are often prescribed for conditions such as bipolar disorderand dementia. While clinical trials have not yet established the efficacy of the atypical antipsychoticsfor these uses, a number of reports offer preliminary evidence that the atypical antipsychotics may bebeneficial for affective disorders, substance abuse disorder, senile dementia, and pathologic aggression.Atypical agents may be particularly effective and tolerable in elderly patients who are especiallysusceptible to the adverse effects of conventional antipsychotic medication. Lower dosages are morenecessary for the elderly than for younger adults. Current evidence suggests that clozapine is the mosteffective atypical antipsychotic for neuroleptic-resistant patients. Risperidone, olanzapine, and quetiapinemay also be effective in a subset of these patients.