{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T04:44:06Z","timestamp":1789879446257,"version":"4.0.1"},"reference-count":91,"publisher":"National Institute for Health and Care Research","issue":"67","license":[{"start":{"date-parts":[[2018,11,1]],"date-time":"2018-11-01T00:00:00Z","timestamp":1541030400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/non-commercial-government-licence\/non-commercial-government-licence.htm"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["09\/55\/06"],"award-info":[{"award-number":["09\/55\/06"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"\n Background<\/jats:title>\n Very late-onset (aged \u2265\u200960 years) schizophrenia-like psychosis (VLOSLP) occurs frequently but no placebo-controlled, randomised trials have assessed the efficacy or risks of antipsychotic treatment. Most patients are not prescribed treatment.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n The study investigated whether or not low-dose amisulpride is superior to placebo in reducing psychosis symptoms over 12 weeks and if any benefit is maintained by continuing treatment thereafter. Treatment safety and cost-effectiveness were also investigated.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Three-arm, parallel-group, placebo-controlled, double-blind, randomised controlled trial. Participants who received at least one dose of study treatment were included in the intention-to-treat analyses.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Secondary care specialist old age psychiatry services in 25 NHS mental health trusts in England and Scotland.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n Patients meeting diagnostic criteria for VLOSLP and scoring >\u200930 points on the Brief Psychiatric Rating Scale (BPRS).<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Participants were randomly assigned to three arms in a two-stage trial: (1) 100\u2009mg of amisulpride in both stages, (2) amisulpride then placebo and (3) placebo then amisulpride. Treatment duration was 12 weeks in stage 1 and 24 weeks (later reduced to 12) in stage 2. Participants, investigators and outcome assessors were blind to treatment allocation.<\/jats:p>\n <\/jats:sec>\n \n Main outcome measures<\/jats:title>\n Primary outcomes were psychosis symptoms assessed by the BPRS and trial treatment discontinuation for non-efficacy. Secondary outcomes were extrapyramidal symptoms measured with the Simpson\u2013Angus Scale, quality of life measured with the World Health Organization\u2019s quality-of-life scale, and cost-effectiveness measured with NHS, social care and carer work loss costs and EuroQol-5 Dimensions.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 101 participants were randomised. Ninety-two (91%) participants took the trial medication, 59 (64%) completed stage 1 and 33 (56%) completed stage 2 treatment. Despite suboptimal compliance, improvements in BPRS scores at 12 weeks were 7.7 points (95% CI 3.8 to 11.5 points) greater with amisulpride than with placebo (11.9 vs. 4.2 points; p<\/jats:italic>\u2009=\u20090.0002). In stage 2, BPRS scores improved by 1.1 point in those who continued with amisulpride but deteriorated by 5.2 points in those who switched from amisulpride to placebo, a difference of 6.3 points (95% CI 0.9 to 11.7 points; p<\/jats:italic>\u2009=\u20090.024). Fewer participants allocated to the amisulpride group stopped treatment because of non-efficacy in stages 1 (p<\/jats:italic>\u2009=\u20090.01) and 2 (p<\/jats:italic>\u2009=\u20090.031). The number of patients stopping because of extrapyramidal symptoms and other side effects did not differ significantly between groups. Amisulpride treatment in the base-case analyses was associated with non-significant reductions in combined NHS, social care and unpaid carer costs and non-significant reductions in quality-adjusted life-years (QALYs) in both stages. Including patients who were intensive users of inpatient services in sensitivity analyses did not change the QALY result but resulted in placebo dominance in stage 1 and significant reductions in NHS\/social care (95% CI \u2013\u00a38923 to \u2013\u00a3122) and societal costs (95% CI \u2013\u00a38985 to \u2013\u00a3153) for those continuing with amisulpride.<\/jats:p>\n <\/jats:sec>\n \n Limitations<\/jats:title>\n The original recruitment target of 300 participants was not achieved and compliance with trial medication was highly variable.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Low-dose amisulpride is effective and well tolerated as a treatment for VLOSLP, with benefits maintained by prolonging treatment. Potential adverse events include clinically significant extrapyramidal symptoms and falls.<\/jats:p>\n <\/jats:sec>\n \n Future work<\/jats:title>\n Trials should examine the longer-term effectiveness and safety of antipsychotic treatment in this patient group, and assess interventions to improve their appreciation of potential benefits of antipsychotic treatment and compliance with prescribed medication.<\/jats:p>\n <\/jats:sec>\n \n Trial registration<\/jats:title>\n Current Controlled Trials ISRCTN45593573 and EudraCT2010-022184-35.<\/jats:p>\n <\/jats:sec>\n \n Funding<\/jats:title>\n This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment<\/jats:italic>; Vol. 22, No. 67. See the NIHR Journals Library website for further project information.<\/jats:p>\n <\/jats:sec>","DOI":"10.3310\/hta22670","type":"journal-article","created":{"date-parts":[[2018,12,3]],"date-time":"2018-12-03T15:53:20Z","timestamp":1543852400000},"page":"1-62","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Amisulpride for very late-onset schizophrenia-like psychosis: the ATLAS three-arm RCT"],"prefix":"10.3310","volume":"22","clinical-trial-number":[{"clinical-trial-number":"isrctn45593573","registry":"10.18810\/isrctn","type":"results"},{"clinical-trial-number":"2010-022184-35","registry":"10.18810\/euctr","type":"results"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3071-2338","authenticated-orcid":true,"given":"Robert","family":"Howard","sequence":"first","affiliation":[{"name":"Department of Old Age Psychiatry, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7143-4346","authenticated-orcid":true,"given":"Elizabeth","family":"Cort","sequence":"additional","affiliation":[{"name":"Department of Old Age Psychiatry, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0758-4905","authenticated-orcid":true,"given":"Rosie","family":"Bradley","sequence":"additional","affiliation":[{"name":"Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5651-6258","authenticated-orcid":true,"given":"Emma","family":"Harper","sequence":"additional","affiliation":[{"name":"Nuffield Department of Population Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1936-0842","authenticated-orcid":true,"given":"Linda","family":"Kelly","sequence":"additional","affiliation":[{"name":"Nuffield Department of Population Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6443-3353","authenticated-orcid":true,"given":"Peter","family":"Bentham","sequence":"additional","affiliation":[{"name":"Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6202-6906","authenticated-orcid":true,"given":"Craig","family":"Ritchie","sequence":"additional","affiliation":[{"name":"West London Mental Health NHS Trust, Southall, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8053-7024","authenticated-orcid":true,"given":"Suzanne","family":"Reeves","sequence":"additional","affiliation":[{"name":"Department of Old Age Psychiatry, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0082-5355","authenticated-orcid":true,"given":"Waleed","family":"Fawzi","sequence":"additional","affiliation":[{"name":"East London NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6741-5516","authenticated-orcid":true,"given":"Gill","family":"Livingston","sequence":"additional","affiliation":[{"name":"Division of Psychiatry, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8895-7055","authenticated-orcid":true,"given":"Andrew","family":"Sommerlad","sequence":"additional","affiliation":[{"name":"Division of Psychiatry, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7797-9091","authenticated-orcid":true,"given":"Sabu","family":"Oomman","sequence":"additional","affiliation":[{"name":"Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2313-2850","authenticated-orcid":true,"given":"Ejaz","family":"Nazir","sequence":"additional","affiliation":[{"name":"South Staffordshire and Shropshire Healthcare NHS Foundation Trust, Stafford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9801-183X","authenticated-orcid":true,"given":"Ramin","family":"Nilforooshan","sequence":"additional","affiliation":[{"name":"Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9464-8446","authenticated-orcid":true,"given":"Robert","family":"Barber","sequence":"additional","affiliation":[{"name":"Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9480-5704","authenticated-orcid":true,"given":"Chris","family":"Fox","sequence":"additional","affiliation":[{"name":"Norwich Medical School, University of East Anglia, Norwich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5197-4727","authenticated-orcid":true,"given":"Ajay","family":"Macharouthu","sequence":"additional","affiliation":[{"name":"NHS Ayrshire & Arran, Ayr, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4142-948X","authenticated-orcid":true,"given":"Pranathi","family":"Ramachandra","sequence":"additional","affiliation":[{"name":"Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9991-9695","authenticated-orcid":true,"given":"Vivek","family":"Pattan","sequence":"additional","affiliation":[{"name":"NHS Forth Valley, Stirling, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9657-0099","authenticated-orcid":true,"given":"John","family":"Sykes","sequence":"additional","affiliation":[{"name":"Derbyshire Healthcare NHS Foundation Trust, Derby, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6041-5214","authenticated-orcid":true,"given":"Valerie","family":"Curran","sequence":"additional","affiliation":[{"name":"Black Country Partnership NHS Foundation Trust, West Bromwich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7451-0167","authenticated-orcid":true,"given":"Cornelius","family":"Katona","sequence":"additional","affiliation":[{"name":"Division of Psychiatry, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3387-4241","authenticated-orcid":true,"given":"Tom","family":"Dening","sequence":"additional","affiliation":[{"name":"Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1427-0215","authenticated-orcid":true,"given":"Martin","family":"Knapp","sequence":"additional","affiliation":[{"name":"Department of Health Policy, London School of Economics and Political Science, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3871-9697","authenticated-orcid":true,"given":"Renee","family":"Romeo","sequence":"additional","affiliation":[{"name":"Health Service and Population Research Department, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4440-574X","authenticated-orcid":true,"given":"Richard","family":"Gray","sequence":"additional","affiliation":[{"name":"Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6221","published-online":{"date-parts":[[2018,11]]},"reference":[{"key":"key20181129155034228_ref1-bib1","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1016\/S2215-0366(18)30141-X","article-title":"Antipsychotic treatment of very late-onset schizophrenia-like psychosis (ATLAS): a randomised, controlled, double-blind trial","volume":"5","author":"Howard","year":"2018","journal-title":"Lancet Psychiatry"},{"key":"key20181129155034228_ref1-bib2","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1192\/bjp.98.410.66","article-title":"Problems in the diagnosis and classification of mental disorder in old age; with a study of case material","volume":"98","author":"Roth","year":"1952","journal-title":"J Ment Sci"},{"key":"key20181129155034228_ref1-bib3","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1007\/BF00790654","article-title":"Increasing age is a risk factor for psychosis in the elderly","volume":"30","author":"van Os","year":"1995","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"key20181129155034228_ref1-bib4","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1192\/bjp.107.449.649","article-title":"Environmental and hereditary factors in the schizophrenias of age (\u2018late paraphrenia\u2019) and their bearing on the general problem of causation in schizophrenia","volume":"107","author":"Kay","year":"1961","journal-title":"J Ment Sci"},{"key":"key20181129155034228_ref1-bib5","volume-title":"Dementia Praecox and Paraphrenia","author":"Kraepelin","year":"1971"},{"key":"key20181129155034228_ref1-bib6","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1007\/BF02897397","article-title":"\u00dcber paraphrene psychosen","volume":"71","author":"Mayer","year":"1921","journal-title":"Ze Neurol Psychiatr"},{"key":"key20181129155034228_ref1-bib7","volume-title":"Persistent Persecutory States of the Elderly","author":"Post","year":"1966"},{"key":"key20181129155034228_ref1-bib8","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1176\/appi.ajp.157.2.172","article-title":"Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: an international consensus. The International Late-Onset Schizophrenia Group","volume":"157","author":"Howard","year":"2000","journal-title":"Am J Psychiatry"},{"key":"key20181129155034228_ref1-bib9","doi-asserted-by":"publisher","first-page":"1112","DOI":"10.1002\/gps.2437","article-title":"Ageism in first episode psychosis","volume":"25","author":"Mitford","year":"2010","journal-title":"Int J Geriatr Psychiatry"},{"key":"key20181129155034228_ref1-bib10","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1002\/gps.1084","article-title":"The effect of ethnicity and gender on first-contact rates for schizophrenia-like psychosis in Bangladeshi, Black and White elders in Tower Hamlets, London","volume":"19","author":"Mitter","year":"2004","journal-title":"Int J Geriatr Psychiatry"},{"key":"key20181129155034228_ref1-bib11","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1192\/bjp.179.2.172","article-title":"Increased first-contact rates for very-late-onset schizophrenia-like psychosis in African- and Caribbean-born elders","volume":"179","author":"Reeves","year":"2001","journal-title":"Br J Psychiatry"},{"key":"key20181129155034228_ref1-bib12","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1192\/bjp.113.498.461","article-title":"Late paraphrenia","volume":"113","author":"Herbert","year":"1967","journal-title":"Br J Psychiatry"},{"key":"key20181129155034228_ref1-bib13","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1192\/bjp.165.4.474","article-title":"Quantitative magnetic resonance imaging volumetry distinguishes delusional disorder from late-onset schizophrenia","volume":"165","author":"Howard","year":"1994","journal-title":"Br J Psychiatry"},{"key":"key20181129155034228_ref1-bib14","doi-asserted-by":"publisher","first-page":"719","DOI":"10.1002\/gps.930071006","article-title":"Permeable walls, floors, ceilings and doors. Partition delusions in late paraphrenia","volume":"7","author":"Howard","year":"1992","journal-title":"Int J Geriatr Psychiatry"},{"key":"key20181129155034228_ref1-bib15","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1002\/(SICI)1099-1166(199607)11:7<653::AID-GPS380>3.0.CO;2-9","article-title":"Insight and paranoid disorders in late life (late paraphrenia)","volume":"11","author":"Almeida","year":"1996","journal-title":"Int J Geriatr Psychiatry"},{"key":"key20181129155034228_ref1-bib16","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1212\/01.WNL.0000118301.92105.EE","article-title":"Behavioral symptoms in mild cognitive impairment","volume":"62","author":"Feldman","year":"2004","journal-title":"Neurology"},{"key":"key20181129155034228_ref1-bib17","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1176\/appi.ajp.2014.13060821","article-title":"Baseline neuropsychiatric symptoms and the risk of incident mild cognitive impairment: a population-based study","volume":"171","author":"Geda","year":"2014","journal-title":"Am J Psychiatry"},{"key":"key20181129155034228_ref1-bib18","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1016\/j.jalz.2015.05.017","article-title":"Neuropsychiatric symptoms as early manifestations of emergent dementia: provisional diagnostic criteria for mild behavioral impairment","volume":"12","author":"Ismail","year":"2016","journal-title":"Alzheimers Dement"},{"key":"key20181129155034228_ref1-bib19","doi-asserted-by":"publisher","first-page":"1546","DOI":"10.1016\/S0140-6736(96)10203-8","article-title":"Auguste D and Alzheimer\u2019s disease","volume":"349","author":"Maurer","year":"1997","journal-title":"Lancet"},{"key":"key20181129155034228_ref1-bib20","doi-asserted-by":"publisher","first-page":"2274","DOI":"10.1016\/j.neubiorev.2012.08.001","article-title":"Origins of delusions in Alzheimer\u2019s disease","volume":"36","author":"Reeves","year":"2012","journal-title":"Neurosci Biobehav Rev"},{"key":"key20181129155034228_ref1-bib21","doi-asserted-by":"publisher","first-page":"902","DOI":"10.1212\/WNL.53.5.902","article-title":"Report of the second dementia with Lewy body international workshop: diagnosis and treatment. Consortium on Dementia with Lewy Bodies","volume":"53","author":"McKeith","year":"1999","journal-title":"Neurology"},{"key":"key20181129155034228_ref1-bib22","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1097\/JGP.0b013e3180cc1fdf","article-title":"Classification of psychotic symptoms in dementia with Lewy bodies","volume":"15","author":"Nagahama","year":"2007","journal-title":"Am J Geriatr Psychiatry"},{"key":"key20181129155034228_ref1-bib23","doi-asserted-by":"publisher","first-page":"2458","DOI":"10.1093\/brain\/aws126","article-title":"Pareidolias: complex visual illusions in dementia with Lewy bodies","volume":"135","author":"Uchiyama","year":"2012","journal-title":"Brain"},{"key":"key20181129155034228_ref1-bib24","doi-asserted-by":"publisher","first-page":"485","DOI":"10.3233\/JAD-140312","article-title":"Psychosis in frontotemporal dementia","volume":"42","author":"Shinagawa","year":"2014","journal-title":"J Alzheimers Dis"},{"key":"key20181129155034228_ref1-bib25","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1016\/j.biopsych.2015.03.028","article-title":"Psychiatric symptoms in frontotemporal dementia: epidemiology, phenotypes, and differential diagnosis","volume":"78","author":"Galimberti","year":"2015","journal-title":"Biol Psychiatry"},{"key":"key20181129155034228_ref1-bib26","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1093\/brain\/awr355","article-title":"Distinct clinical and pathological characteristics of frontotemporal dementia associated with C9orf72 mutations","volume":"135","author":"Snowden","year":"2012","journal-title":"Brain"},{"key":"key20181129155034228_ref1-bib27","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1136\/jnnp-2015-310441","article-title":"Psychosis associated with expansions in the C9orf72 gene: the influence of a 10 base pair gene deletion","volume":"87","author":"Snowden","year":"2016","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"key20181129155034228_ref1-bib28","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/j.psychres.2015.12.007","article-title":"C9orf72 repeat expansions that cause frontotemporal dementia are detectable among patients with psychosis","volume":"235","author":"Watson","year":"2016","journal-title":"Psychiatry Res"},{"key":"key20181129155034228_ref1-bib29","doi-asserted-by":"publisher","first-page":"159","DOI":"10.3109\/09540261.2013.769939","article-title":"The overlap of symptomatic dimensions between frontotemporal dementia and several psychiatric disorders that appear in late adulthood","volume":"25","author":"Pose","year":"2013","journal-title":"Int Rev Psychiatry"},{"key":"key20181129155034228_ref1-bib30","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1007\/s11126-011-9189-8","article-title":"Is there evidence for late cognitive decline in chronic schizophrenia?","volume":"83","author":"Shah","year":"2012","journal-title":"Psychiatric Q"},{"key":"key20181129155034228_ref1-bib31","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1192\/bjp.bp.108.060723","article-title":"Age at onset and cognition in schizophrenia: meta-analysis","volume":"195","author":"Rajji","year":"2009","journal-title":"Br J Psychiatry"},{"key":"key20181129155034228_ref1-bib32","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1017\/S1041610211000238","article-title":"Late-onset-psychosis: cognition","volume":"23","author":"Girard","year":"2011","journal-title":"Int Psychogeriatr"},{"key":"key20181129155034228_ref1-bib33","doi-asserted-by":"publisher","first-page":"852","DOI":"10.1016\/j.jagp.2014.10.007","article-title":"Comparative study of clinical and neuropsychological characteristics between early-, late and very-late-onset schizophrenia-spectrum disorders","volume":"23","author":"Hanssen","year":"2015","journal-title":"Am J Geriatr Psychiatry"},{"key":"key20181129155034228_ref1-bib34","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1017\/S0033291700034954","article-title":"Clinical and cognitive diversity of psychotic states arising in late life (late paraphrenia)","volume":"25","author":"Almeida","year":"1995","journal-title":"Psychol Med"},{"key":"key20181129155034228_ref1-bib35","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1097\/00019442-200505000-00011","article-title":"Patients with very-late-onset schizophrenia-like psychosis: a follow-up study","volume":"13","author":"Mazeh","year":"2005","journal-title":"Am J Geriatr Psychiatry"},{"key":"key20181129155034228_ref1-bib36","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1176\/jnp.15.1.45","article-title":"Are late-onset schizophrenia spectrum disorders neurodegenerative conditions? Annual rates of change on two dementia measures","volume":"15","author":"Palmer","year":"2003","journal-title":"J Neuropsychiatry Clin Neurosci"},{"key":"key20181129155034228_ref1-bib37","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/S0006-3223(98)00273-X","article-title":"Cognitive decline in late-life schizophrenia: a longitudinal study of geriatric chronically hospitalized patients","volume":"45","author":"Harvey","year":"1999","journal-title":"Biol Psychiatry"},{"key":"key20181129155034228_ref1-bib38","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1192\/bjp.183.3.213","article-title":"Long-term outcome of late-onset schizophrenia: 5-year follow-up study","volume":"183","author":"Brodaty","year":"2003","journal-title":"Br J Psychiatry"},{"key":"key20181129155034228_ref1-bib39","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"\u201cMini-mental state\u201d. A practical method for grading the cognitive state of patients for the clinician","volume":"12","author":"Folstein","year":"1975","journal-title":"J Psychiatr Res"},{"key":"key20181129155034228_ref1-bib40","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1002\/gps.2075","article-title":"Late and very-late first-contact schizophrenia and the risk of dementia \u2013 a nationwide register based study","volume":"24","author":"K\u00f8rner","year":"2009","journal-title":"Int J Geriatr Psychiatry"},{"key":"key20181129155034228_ref1-bib41","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1176\/ajp.152.3.447","article-title":"Quantitative magnetic resonance imaging of the brain in late-life schizophrenia","volume":"152","author":"Corey-Bloom","year":"1995","journal-title":"Am J Psychiatry"},{"key":"key20181129155034228_ref1-bib42","doi-asserted-by":"publisher","first-page":"954","DOI":"10.1002\/1099-1166(200010)15:10<954::AID-GPS224>3.0.CO;2-O","article-title":"MRI findings differentiate between late-onset schizophrenia and late-life mood disorder","volume":"15","author":"Rabins","year":"2000","journal-title":"Int J Geriatr Psychiatry"},{"key":"key20181129155034228_ref1-bib43","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1192\/bjp.175.5.416","article-title":"Schizophrenia with onset after age 50 years. 2: Neurological, neuropsychological and MRI investigation","volume":"175","author":"Sachdev","year":"1999","journal-title":"Br J Psychiatry"},{"key":"key20181129155034228_ref1-bib44","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1176\/jnp.9.2.251","article-title":"Lack of clinically significant gross structural abnormalities in MRIs of older patients with schizophrenia and related psychoses","volume":"9","author":"Symonds","year":"1997","journal-title":"J Neuropsychiatry Clin Neurosci"},{"key":"key20181129155034228_ref1-bib45","doi-asserted-by":"publisher","first-page":"1958","DOI":"10.1176\/ajp.156.12.1958","article-title":"Quantitative study of signal hyperintensities on T2-weighted magnetic resonance imaging in late-onset schizophrenia","volume":"156","author":"Sachdev","year":"1999","journal-title":"Am J Psychiatry"},{"key":"key20181129155034228_ref1-bib46","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/0006-3223(94)00248-2","article-title":"White matter signal hyperintensities in the brains of patients with late paraphrenia and the normal, community-living elderly","volume":"38","author":"Howard","year":"1995","journal-title":"Biol Psychiatry"},{"key":"key20181129155034228_ref1-bib47","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1097\/00019442-200512000-00009","article-title":"A diffusion tensor magnetic resonance imaging study of frontal cortex connections in very-late-onset schizophrenia-like psychosis","volume":"13","author":"Jones","year":"2005","journal-title":"Am J Geriatr Psychiatry"},{"key":"key20181129155034228_ref1-bib48","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/S0304-3940(02)00189-1","article-title":"Neurofibrillary tangles in elderly patients with late onset schizophrenia","volume":"324","author":"Bozikas","year":"2002","journal-title":"Neurosci Lett"},{"key":"key20181129155034228_ref1-bib49","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1007\/s00401-001-0468-6","article-title":"Disentangling the pathology of schizophrenia and paraphrenia","volume":"103","author":"Casanova","year":"2002","journal-title":"Acta Neuropathol"},{"key":"key20181129155034228_ref1-bib50","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1080\/00048670903001984","article-title":"Abnormal hippocampal distribution of TDP-43 in patients with late-onset psychosis","volume":"43","author":"Velakoulis","year":"2009","journal-title":"Aust N Z J Psychiatry"},{"key":"key20181129155034228_ref1-bib51","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1007\/s00406-013-0472-6","article-title":"Argyrophilic grain disease as a neurodegenerative substrate in late-onset schizophrenia and delusional disorders","volume":"264","author":"Nagao","year":"2014","journal-title":"Eur Arch Psychiatry Clin Neurosci"},{"key":"key20181129155034228_ref1-bib52","doi-asserted-by":"publisher","first-page":"CD004162","DOI":"10.1002\/14651858.CD004162","article-title":"Antipsychotic drug treatment for elderly people with late-onset schizophrenia","volume":"2","author":"Arunpongpaisal","year":"2003","journal-title":"Cochrane Database Syst Rev"},{"key":"key20181129155034228_ref1-bib53","doi-asserted-by":"publisher","first-page":"CD004162","DOI":"10.1002\/14651858.CD004162.pub2","article-title":"Antipsychotic drug treatment for elderly people with late-onset schizophrenia","volume":"2","author":"Essali","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"key20181129155034228_ref1-bib54","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1097\/JGP.0b013e318172b42d","article-title":"Effects of age and age of onset on prescribed antipsychotic dose in schizophrenia spectrum disorders: a survey of 1,418 patients in Japan","volume":"16","author":"Uchida","year":"2008","journal-title":"Am J Geriatr Psychiatry"},{"key":"key20181129155034228_ref1-bib55","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1017\/S1041610210002188","article-title":"Atypical (second generation) antipsychotic treatment response in very late-onset schizophrenia-like psychosis","volume":"23","author":"Scott","year":"2011","journal-title":"Int Psychogeriatr"},{"key":"key20181129155034228_ref1-bib56","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1002\/gps.614","article-title":"Service contact and psychopathology in very-late-onset schizophrenia-like psychosis: the effects of gender and ethnicity","volume":"17","author":"Reeves","year":"2002","journal-title":"Int J Geriatr Psychiatry"},{"key":"key20181129155034228_ref1-bib57","first-page":"185","article-title":"Service and treatment engagement of people with very late-onset schizophrenia-like psychosis","volume":"20","author":"Sin Fai Lam","year":"2016","journal-title":"Br J Psych Bull"},{"key":"key20181129155034228_ref1-bib58","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1002\/gps.4333","article-title":"Psychiatric hospital admission and long-term care in patients with very-late-onset schizophrenia-like psychosis","volume":"31","author":"Talaslahti","year":"2016","journal-title":"Int J Geriatr Psychiatry"},{"key":"key20181129155034228_ref1-bib59","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1002\/gps.4490","article-title":"Comparison of social functioning in community-living older individuals with schizophrenia and bipolar disorder: a catchment area-based study","volume":"32","author":"van Liempt","year":"2017","journal-title":"Int J Geriatr Psychiatry"},{"key":"key20181129155034228_ref1-bib60","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1002\/gps.4159","article-title":"Patients with very-late-onset schizoprhenia-like psychosis have higher mortality rates than elderly patients with earlier onset schizophrenia","volume":"30","author":"Talaslahti","year":"2015","journal-title":"Int J Geriatr Psychiatry"},{"key":"key20181129155034228_ref1-bib61","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1002\/gps.2146","article-title":"Amisulpride for the treatment of very-late-onset schizophrenia-like psychosis","volume":"24","author":"Psarros","year":"2009","journal-title":"Int J Geriatr Psychiatry"},{"key":"key20181129155034228_ref1-bib62","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890423349","volume-title":"Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision","author":"American Psychiatric Association (APA)","year":"2000"},{"key":"key20181129155034228_ref1-bib63","first-page":"221","article-title":"Training and quality assurance with the Brief Psychiatric Rating Scale: \u2019The drift busters.\u2019","volume":"3","author":"Ventura","year":"1993","journal-title":"Int J Meth Psych Res"},{"key":"key20181129155034228_ref1-bib64","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1016\/j.phymed.2013.01.007","article-title":"Yokukansan (TJ-54) for treatment of very-late-onset schizophrenia-like psychosis: an open-label study","volume":"20","author":"Miyaoka","year":"2013","journal-title":"Phytomedicine"},{"key":"key20181129155034228_ref1-bib65","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1097\/01.JGP.0000200589.01396.6d","article-title":"Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials","volume":"14","author":"Schneider","year":"2006","journal-title":"Am J Geriatr Psychiatry"},{"key":"key20181129155034228_ref1-bib66","doi-asserted-by":"publisher","first-page":"1497","DOI":"10.1056\/NEJMoa1114058","article-title":"Relapse risk after discontinuation of risperidone in Alzheimer\u2019s disease","volume":"367","author":"Devanand","year":"2012","journal-title":"N Engl J Med"},{"key":"key20181129155034228_ref1-bib67","doi-asserted-by":"publisher","first-page":"1934","DOI":"10.1001\/jama.294.15.1934","article-title":"Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials","volume":"294","author":"Schneider","year":"2005","journal-title":"JAMA"},{"key":"key20181129155034228_ref1-bib68","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1034\/j.1600-0447.2001.00185.x","article-title":"A structured interview guide increases Brief Psychiatric Rating Scale reliability in raters with low clinical experience","volume":"103","author":"Crippa","year":"2001","journal-title":"Acta Psychiatr Scand"},{"key":"key20181129155034228_ref1-bib69","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1111\/j.1600-0447.1970.tb02066.x","article-title":"A rating scale for extrapyramidal side effects","volume":"212","author":"Simpson","year":"1970","journal-title":"Acta Psychiatr Scand Suppl"},{"key":"key20181129155034228_ref1-bib70","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/0168-8510(90)90421-9","article-title":"EuroQol \u2013 a new facility for the measurement of health-related quality of life","volume":"16","author":"EuroQol Group","year":"1990","journal-title":"Health Policy"},{"key":"key20181129155034228_ref1-bib71","volume-title":"WHOQoL-BREF: Introduction, Administration, Scoring and Generic Version of the Assessment","author":"Orley","year":"1996"},{"key":"key20181129155034228_ref1-bib72","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.archger.2007.07.002","article-title":"Geriatric psychiatry home treatment (GHT): a pilot study on outcomes following hospital discharge for depressive and delusional patients","volume":"47","author":"Klug","year":"2008","journal-title":"Arch Gerontol Geriatr"},{"key":"key20181129155034228_ref1-bib73","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1002\/gps.1446","article-title":"A comparison of the efficacy and safety of olanzapine and risperidone in the treatment of elderly patients with schizophrenia: an open study of six months duration","volume":"21","author":"Ritchie","year":"2006","journal-title":"Int J Geriatr Psychiatry"},{"key":"key20181129155034228_ref1-bib74","volume-title":"Costing Psychiatric Interventions","author":"Beecham","year":"2001"},{"key":"key20181129155034228_ref1-bib75","volume-title":"A Social Tariff for EuroQol: Results from a UK General Population Survey","author":"Dolan","year":"1995"},{"key":"key20181129155034228_ref1-bib76","volume-title":"British National Formulary","author":"Joint Formulary Committee","year":"2017","edition":"73rd ed"},{"key":"key20181129155034228_ref1-bib77","volume-title":"National Schedule of Reference Costs: The Main Schedule","author":"Department of Health and Social Care","year":"2016"},{"key":"key20181129155034228_ref1-bib78","volume-title":"Unit Costs of Health and Social Care 2016","author":"Curtis","year":"2016"},{"key":"key20181129155034228_ref1-bib79","volume-title":"NHS Terms and Conditions of Service Handbook (Agenda for Change)","author":"NHS Employers","year":"2016"},{"key":"key20181129155034228_ref1-bib80","volume-title":"Unit Costs of Health and Social Care 2013","author":"Curtis","year":"2013"},{"key":"key20181129155034228_ref1-bib81","volume-title":"Essentials of Pharmacoeconomics","author":"Rascati","year":"2013","edition":"2nd edn"},{"key":"key20181129155034228_ref1-bib82","volume-title":"Essentials of Pharmacoeconomics","author":"Rascati","year":"2008","edition":"2nd edn"},{"key":"key20181129155034228_ref1-bib83","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1002\/gps.1792","article-title":"The efficacy and safety of risperidone in the treatment of psychosis of Alzheimer\u2019s disease and mixed dementia: a meta-analysis of 4 placebo-controlled clinical trials","volume":"22","author":"Katz","year":"2007","journal-title":"Int J Geriatr Psychiatry"},{"key":"key20181129155034228_ref1-bib84","doi-asserted-by":"publisher","first-page":"1359","DOI":"10.1001\/jama.2011.1360","article-title":"Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis","volume":"306","author":"Maher","year":"2011","journal-title":"JAMA"},{"key":"key20181129155034228_ref1-bib85","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1038\/nrn1926","article-title":"Neuroleptic drugs in dementia: benefits and harm","volume":"7","author":"Ballard","year":"2006","journal-title":"Nat Rev Neurosci"},{"key":"key20181129155034228_ref1-bib86","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1192\/pb.bp.115.051599","article-title":"Service and treatment engagement of people with very late-onset schizophrenia-like psychosis","volume":"40","author":"Sin Fai Lam","year":"2016","journal-title":"BJPsych Bull"},{"key":"key20181129155034228_ref1-bib87","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen","year":"1988","edition":"2nd edn."},{"key":"key20181129155034228_ref1-bib88","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1038\/sj.mp.4002136","article-title":"How effective are second-generation antipsychotic drugs? A meta-analysis of placebo-controlled trials","volume":"14","author":"Leucht","year":"2009","journal-title":"Mol Psychiatry"},{"key":"key20181129155034228_ref1-bib89","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1002\/gps.4758","article-title":"Therapeutic D2\/3 receptor occupancies and response with low amisulpride blood concentrations in very late-onset schizophrenia-like psychosis (VLOSLP)","volume":"33","author":"Reeves","year":"2018","journal-title":"Int J Geriatr Psychiatry"},{"key":"key20181129155034228_ref1-bib90","doi-asserted-by":"publisher","first-page":"1117","DOI":"10.1093\/brain\/aww359","article-title":"Therapeutic window of dopamine D2\/3 receptor occupancy to treat psychosis in Alzheimer\u2019s disease","volume":"140","author":"Reeves","year":"2017","journal-title":"Brain"},{"key":"key20181129155034228_ref1-bib91","volume-title":"Mental Health Act 1983","author":"Great Britain","year":"1983"}],"container-title":["Health Technology Assessment"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/publications\/hta22670\/hta22670.xml","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2003434","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/publications\/hta22670\/hta22670.xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2021630","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T15:47:21Z","timestamp":1692114441000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/hta\/hta22670"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11]]},"references-count":91,"journal-issue":{"issue":"67","published-online":{"date-parts":[[2018,11]]}},"alternative-id":["10.3310\/hta22670"],"URL":"https:\/\/doi.org\/10.3310\/hta22670","relation":{},"ISSN":["1366-5278","2046-4924"],"issn-type":[{"value":"1366-5278","type":"print"},{"value":"2046-4924","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,11]]},"assertion":[{"value":"This content has been made freely available to all.","name":"free","label":"Free to read"}]}}