Psychosis in Parkinson Disease: A Review of Etiology, Phenomenology, and Management

Samudra, Niyatee; Patel, Neepa; Womack, Kyle; Khemani, Pravin; Chitnis, Shilpa

doi:10.1007/s40266-016-0416-8

Cited by 45 publications

(47 citation statements)

References 104 publications

(102 reference statements)

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“…Additional risk factors include pre‐existing rigidity and AIDS. Treatment of psychosis in patients with Parkinson's disease is complex, and reviewed elsewhere.…”

Section: Specific Adverse Effectsmentioning

confidence: 99%

Management of common adverse effects of antipsychotic medications

2018

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The benefits of antipsychotic medications are sometimes obscured by their adverse effects. These effects range from relatively minor tolerability issues (e.g., mild sedation or dry mouth) to very unpleasant (e.g., constipation, akathisia, sexual dysfunction) to painful (e.g., acute dystonias) to disfiguring (e.g., weight gain, tardive dyskinesia) to life-threatening (e.g., myocarditis, agranulocytosis). Importantly, adverse effect profiles are specific to each antipsychotic medication and do not neatly fit into first- and second-generation classifications. This paper reviews management strategies for the most frequent side effects and identifies common principles intended to optimize net antipsychotic benefits. Only use antipsychotics if the indication is clear; only continue antipsychotics if a benefit is discernible. If an antipsychotic is providing substantial benefit, and the adverse effect is not life-threatening, then the first management choice is to lower the dose or adjust the dosing schedule. The next option is to change the antipsychotic; this is often reasonable unless the risk of relapse is high. In some instances, behavioral interventions can be tried. Finally, concomitant medications, though generally not desirable, are necessary in many instances and can provide considerable relief. Among concomitant medication strategies, anticholinergic medications for dystonias and parkinsonism are often effective; beta-blockers and anticholinergic medications are useful for akathisia; and metformin may lead to slight to moderate weight loss. Anticholinergic drops applied sublingually reduce sialorrhea. Usual medications are effective for constipation or dyslipidemias. The clinical utility of recently approved treatments for tardive dyskinesia, valbenazine and deutetrabenazine, is unclear.

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“…Additional risk factors include pre‐existing rigidity and AIDS. Treatment of psychosis in patients with Parkinson's disease is complex, and reviewed elsewhere.…”

Section: Specific Adverse Effectsmentioning

confidence: 99%

Management of common adverse effects of antipsychotic medications

2018

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“…Recent meta-analysis of trials on treatment of psychotic symptoms in PD concluded that only clozapine can be fully recommended [44]. We have to point out that pimavanserin, 5-hydroxytryptamine receptor serotonin 2A inverse agonist was recently approved by the United States Food and Drug Administration for the treatment of PD psychosis and may prove to be a more targeted therapy without the downsides of atypical antipsychotics [45,46].…”

Section: Resultsmentioning

confidence: 99%

Psychotic symptoms in Parkinson’s disease: Etiology, prevalence and treatment

Knežević¹,

Knežević²,

Simić³

et al. 2019

Med pregl

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Introduction. Parkinson's disease is the second most common neurodegenerative disease with as many as 50-70% of patients experiencing psychotic symptoms during the course of the illness. Our aim was to provide an evidence-based review on the etiology, prevalence and management of psychotic symptoms in Parkinson's disease. Material and Methods. We used references from the "Medline" database published from 1999 to 2019. Results. The most common psychotic symptoms in Parkinson's disease are visual hallucinations, which occur in 25-30% of patients, acoustic hallucinations in about 20%, and delusions in around 5% of these patients. The etiology of psychotic symptoms is not fully clarified, but researchers suggest a complex interrelationship of factors associated with the disease itself and the factors associated with antiparkinsonian medications. After exclusion of other etiologic causes of psychotic symptoms, it is necessary to revise the type and dose of antiparkinsonian drugs. Although pimavanserin has recently been approved by the United States Food and Drug Administration, the current treatment of choice for psychotic symptoms in Parkinson's disease is still quetiapine. Only patients who do not tolerate or do not respond to quetiapine are treated with clozapine, which has been proven more effective, but with significant side effects. Conclusion. Timely diagnosis and adequate treatment of psychotic symptoms in Parkinson's disease are essential, because they dramatically affect the quality of life of patients and their families. Therefore, it is necessary to establish more effective tools for screening and treatment of psychotic symptoms in Parkinson's disease.

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“…As mentioned previously, the prevalence of psychosis in the course of PD varies widely in the literature. Psychosis itself represents a relevant burden in PD, involving their caregivers and health professionals, since it has been associated with a higher morbidity and mortality [ 73 ]. Additionally, together with depression and dementia, it poses one of the most prevalent nonmotor features in PD [ 74 ], accounting for up to one-fifth of the complications arising over time [ 75 ].…”

Section: Pathophysiology and Potential Biomarkers Of Psychosis In mentioning

confidence: 99%

“…Clinical trials to assess the potential benefit of the widely used cholinesterase inhibitors for the treatment of dementia have been studied in PD psychosis due to its close relationship but have shown no beneficial effect on PD psychosis to date [ 73 ]. A randomized, placebo-controlled trial of donepezil in cognitive impaired PD patients showed a beneficial effect in memory, with no differences in psychiatric status or motor function [ 146 ] and an overall reduced tolerability with the recommendation of careful monitoring when used in PD patients.…”

Section: Management Of Pd Psychosismentioning

confidence: 99%

Management of Psychosis in Parkinson’s Disease: Emphasizing Clinical Subtypes and Pathophysiological Mechanisms of the Condition

Taddei

Çankaya

Dhaliwal

et al. 2017

Parkinson's Disease

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Investigation into neuropsychiatric symptoms in Parkinson's disease (PD) is sparse and current drug development is mainly focused on the motor aspect of PD. The tight association of psychosis with an impaired quality of life in PD, together with an important underreporting of this comorbid condition, contributes to its actual insufficient assessment and management. Furthermore, the withdrawal from access to readily available treatment interventions is unacceptable and has an impact on PD prognosis. Despite its impact, to date no standardized guidelines to the adequate management of PD psychosis are available and they are therefore highly needed. Readily available knowledge on distinct clinical features as well as early biomarkers of psychosis in PD justifies the potential for its timely diagnosis and for early intervention strategies. Also, its specific characterisation opens up the possibility of further understanding the underlying pathophysiological mechanisms giving rise to more targeted therapeutic developments in the nearer future. A literature review on the most recent knowledge with special focus on specific clinical subtypes and pathophysiological mechanisms will not only contribute to an up to date practical approach of this condition for the health care providers, but furthermore open up new ideas for research in the near future.

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Psychosis in Parkinson Disease: A Review of Etiology, Phenomenology, and Management

Cited by 45 publications

References 104 publications

Management of common adverse effects of antipsychotic medications

Management of common adverse effects of antipsychotic medications

Psychotic symptoms in Parkinson’s disease: Etiology, prevalence and treatment

Management of Psychosis in Parkinson’s Disease: Emphasizing Clinical Subtypes and Pathophysiological Mechanisms of the Condition

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