Atypical antipsychotic therapy in Parkinson's disease psychosis: A retrospective study.

Mei Yuan,Kiarash Shahlaie,John Olichney,Sarah Farias,Kevin O'Connor,Lin Zhang,Laura Sperry,Vicki Wheelock,Norika Malhado-Chang,Alexandra Duffy

doi:10.1002/brb3.639

Abstract

ObjectiveParkinson's disease psychosis (PDP) is a frequent complication of idiopathic Parkinson's disease (iPD) with significant impact on quality of life and association with poorer outcomes. Atypical antipsychotic drugs (APDs) are often used for the treatment of PDP; however, their use is often complicated by adverse drug reactions (ADRs). In this study, we present patients with PDP who were treated with the most commonly used atypical antipsychotic agents and review their respective ADRs.MethodsA retrospective study was carried out to include a total of 45 patients with iPD who visited a movement disorders clinic between 2006 and 2015. All PDP patients treated with atypical APDs were included in the analysis for their specific ADRs.ResultsForty‐five iPD patients (mean age of onset: 62.67 ± 9.86 years) were included, of those 10 patients had psychosis (mean age of onset: 76.80 ± 4.61 years). Of the 45 patients, 22.2% were found to have psychotic symptoms, of whom 70% had hallucinations, 20% had delusions, and 10% illusions. Seventy percent of psychotic symptoms occurred after ten or more years from diagnosis of iPD. PDP patients were treated with quetiapine, olanzapine, and risperidone separately or in combination, all of which were found to have certain ADRs.LimitationsThis study was limited by its retrospective study design and small sample size and with likely selection bias.ConclusionsThe prevalence of PDP is relatively high in older patients with iPD. The uses of the currently available atypical APDs in this patient population are often complicated by ADRs. The selective 5‐HT 2A inverse agonist, pimavanserin, could be a better alternative in the treatment of PDP.

Highlights

Parkinson’s disease (PD) is a slowly progressive neurodegenerative disease that affects 7–10 million people worldwide and is more common in older people
With a shift in our understanding of Parkinson’s disease over the past two decades, we have developed a greater appreciation for the nonmotor symptoms (NMSs) associated with idiopathic Parkinson’s disease (iPD) including significant psychotic symptoms such as hallucinations
Various clinical features of hallucinations have been described with a prevalence that varies widely from 17 to 72% amongst Parkinson’s disease psychosis (PDP) patients (Meral et al, 2007)

Summary

| INTRODUCTION

Parkinson’s disease (PD) is a slowly progressive neurodegenerative disease that affects 7–10 million people worldwide and is more common in older people. PD is characterized by a progressive loss of motor function and a wide spectrum of nonmotor symptoms (NMSs). There are some studies suggest that increased age, male gender, lower levels of education, older age at onset, longer disease duration and serious medical conditions contribute to the development of PDP (Gama et al, 2015; Zhu, van Hilten, Putter, & Marinus, 2013). SGAs, known as atypical antipsychotic drugs (APDs) are frequently prescribed for patients with PDP. Patients and providers must both be registered with the FDA for clozapine to be prescribed. For these reasons, APDs such as quetiapine, risperidone, and olanzapine are more commonly used. We review patients with PDP who were treated with these three atypical antipsychotic drugs separately or in combination over the past 10 years in an outpatient specialty clinic and their adverse drug reactions (ADRs)

| MATERIAL AND METHODS

| DISCUSSION

Findings

CONFLICTS OF INTEREST