Managing Apathy in Geriatric Psychiatric Patients

Assessment and Treatment

• The American Academy of Family Physicians recommends considering whether the underlying psychiatric condition still requires antipsychotic treatment, and if the antipsychotic is no longer essential, attempt gradual discontinuation while monitoring for symptom recurrence 1
• The American Academy of Family Physicians suggests avoiding typical antipsychotics due to higher risk of extrapyramidal symptoms in elderly patients, with a 50% risk of tardive dyskinesia after 2 years of continuous use 1
• The American Academy of Family Physicians advises monitoring for extrapyramidal symptoms, even with atypical agents, such as risperidone which causes EPS at doses ≥2 mg/day 1
• The American Academy of Family Physicians recommends monitoring for orthostatic hypotension, especially with quetiapine 1
• The American Academy of Family Physicians suggests avoiding benzodiazepines for chronic management in geriatric patients with psychiatric disorders due to risk of tolerance, addiction, cognitive impairment, and paradoxical agitation, which occurs in 10% of patients 1
• The American Academy of Child and Adolescent Psychiatry recommends not using antipsychotics as a substitute for appropriate psychosocial services 2