(HealthDay News) – For patients over the age of 40 with psychosis, treatment with one of the four most commonly used atypical antipsychotic (AAP) drugs (aripiprazole, olanzapine, quetiapine, and risperidone) may lack effectiveness and is associated with a high incidence of side effects, according to a study published online Nov. 27 in the Journal of Clinical Psychiatry.

Hua Jin, MD, of the University of California in San Diego, and colleagues evaluated the long-term safety and effectiveness of the four most commonly used AAPs. Participants included 332 adults >40 years with psychosis associated with schizophrenia, mood disorders, posttraumatic stress disorder, or dementia; all were followed for up to two years. An equipoise-stratified randomization method was used to allow physicians or patients to exclude study drugs based on past experience or anticipated risk.

The researchers found that there were no significant differences in metabolic parameters or most other outcome measures between the groups. There was a high rate of discontinuation and many experienced a lack of significant improvement in psychopathology. The incidence of metabolic syndrome was 36.5% in one year, and the cumulative incidence of adverse events was also high for all AAPs (serious, 23.7%; non-serious, 50.8%).

“We found a lack of effectiveness and a high incidence of side effects with four commonly prescribed AAPs across diagnostic groups in patients >40, with relatively few differences among the drugs,” the authors write. “Caution in the use of these drugs is warranted in middle-aged and older patients.”

One author disclosed financial ties to pharmaceutical companies that manufacture the drugs used in this study. Study medications were donated by AstraZeneca, Bristol-Myers Squibb, Eli Lilly, and Janssen Scientific Affairs.

Full Text (subscription or payment may be required)