The treatment of psychosis in the elderly should ensure effectiveness and avoid side effects from combination therapy. Long acting antipsychotic as paliperidone palmitate facilitates this work. Furthermore, STOPP-START criteria, first published in 2008 (in Spanish in 2009), are being adopted as reference criteria throughout Europe. The Spanish version of the new 2014 edition is also recently published [1]. A descriptive study of a total of 53 institutionalized patients in psychogeriatric residence (> 60 to 97 years) with psychotic disorder diagnosis and treatment with various neuroleptics is done. In total, 26.4% of the sample admitted to treatment with three different antipsychotics, and 47.1% with combination of two antipsychotics. Only 26.4% worked with antipsychotic monotherapy. In these patients, treatment with paliperidone palmitate starts or sets the previous dose. A CGI scale is applied after six months of treatment. Antipsychotic monotherapy in 66.66% of patients on neuroleptic combination therapy was achieved, so that 75% of the sample currently maintains monotherapy with paliperidone palmitate. The paliperidone palmitate has shown effectiveness in the symptomatic control and reducing the risk of inapropiate prescribing in older patients with psicosis. The paliperidone palmitate allows antipsychotic monotherapy in the psychogeriatric patient with severe mental illness polymedicated as the STOPP-START criteria recommends.

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