Abstract
Parkinson's disease psychosis is common and causes substantial caregiver burden, resulting in a high rate of visits to emergency rooms and admission to nursing homes. The symptoms typically consist of illusions, hallucinations, and more bothersome and distressing paranoid delusions. 1 Fenelon G Soulas T Zenasni F Cleret de Langavant L The changing face of Parkinson's disease-associated psychosis: a cross-sectional study based on the new NINDS-NIMH criteria. Mov Disord. 2010; 25: 763-766 Crossref PubMed Scopus (130) Google Scholar Management includes exclusion of medical causes of delirium (especially infection), modification of drug treatment that might be the trigger of psychosis, and use of specific antipsychotic drugs. Notably, treatment of patients with Parkinson's disease with classic dopamine antagonists is not recommended because of a propensity to worsen Parkinson's disease motor symptoms; moreover, this drug class can be life-threatening in individuals with associated dementia (eg, Lewy body dementia). Present reviews of evidence-based medicine suggest that low doses of the atypical antipsychotic clozapine can provide benefit without worsening of Parkinson's disease motor symptoms. 2 Seppi K Weintraub D Coelho M et al. The Movement Disorder Society evidence-based medicine review update: treatments for the non-motor symptoms of Parkinson's disease. Mov Disord. 2011; 26: S42-S80 Crossref PubMed Scopus (640) Google Scholar However, concerns remain about use of antipsychotics in this susceptible population 3 Weintraub D Chen P Ignacio RV et al. Patterns and trends in antipsychotic prescribing for Parkinson disease psychosis. Arch Neurol. 2011; 68: 899-904 Crossref PubMed Scopus (87) Google Scholar and clozapine use requires mandatory blood monitoring. The alternative atypical antipsychotic quetiapine is more widely used because of its ease of use, but this drug has no convincing support for efficacy from randomised controlled trials. 2 Seppi K Weintraub D Coelho M et al. The Movement Disorder Society evidence-based medicine review update: treatments for the non-motor symptoms of Parkinson's disease. Mov Disord. 2011; 26: S42-S80 Crossref PubMed Scopus (640) Google Scholar Pimavanserin for patients with Parkinson's disease psychosis: a randomised, placebo-controlled phase 3 trialPimavanserin may benefit patients with Parkinson's disease psychosis for whom few other treatment options exist. The trial design used in this study to manage placebo response could have applicability to other studies in neuropsychiatric disease. Full-Text PDF
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