Risperidone in the treatment of dopamine-induced psychosis in Parkinson's disease: An open pilot trial

Mohr, Erich; Mendis, Tilak; Hildebrand, Kathleen; Deyn, Peter Paul De

doi:10.1002/1531-8257(200011)15:6<1230::aid-mds1026>3.0.co;2-9

Cited by 81 publications

(23 citation statements)

References 39 publications

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“…No information regarding the motor exam was provided for the remaining 17 patients in the study. In the most recent report, Mohr et al [37] treated 17 patients with 0.5 to 2.0 mg/d over 12 weeks and found a substantial improvement in psychotic symptoms and no statistical worsening in the UPDRS motor subscale. However, because 10 of the 17 patients reported hypokinesia as an adverse event, the authors' conclusion that risperidone does not adversely effect the symptoms of PD is suspect.…”

Section: Risperidonementioning

confidence: 99%

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Parkinson’s disease: The treatment of drug-induced hallucinations and psychosis

Molho

Factor

2001

Curr Neurol Neurosci Rep

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Drug-induced psychosis is one of the most disabling complications of advancing Parkinson's disease. It has also been one of the most difficult to treat. Clozapine was the first medication shown to be safe and effective in this setting, and it remains the standard by which newer atypical antipsychotics are measured. However, due to the small but significant risk of agranulocytosis and the need for frequent blood testing, alternatives have been sought. Risperidone, olanzapine, and quetiapine are new atypical antipsychotics that have each been proposed as an alternative to clozapine, but the literature concerning their use in Parkinson's disease is conflicted and confusing. Although quetiapine appears to be the best current choice, none of these medications have equaled clozapine's ability to safely treat drug-induced psychosis without the risk of worsening parkinsonism.

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Section: Risperidonementioning

confidence: 99%

“…A summary of the studies with risperidone is shown in Table 2 [29][30][31][32][33][34][35][36][37]. The first report of its effect in PD psychosis was an open-label trial in only six patients [29].…”

Section: Risperidonementioning

confidence: 99%

Parkinson’s disease: The treatment of drug-induced hallucinations and psychosis

Molho

Factor

2001

Curr Neurol Neurosci Rep

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“…Several small open-label studies demonstrated improvement in PDP with risperidone, but results were inconsistent regarding the worsening of motor symptoms. [31][32][33][34] However, in a double-blind study in which risperidone was compared to clozapine, there was improvement in PDP with both treatments, but motor symptoms were worsened more with risperidone. 35 In a single-blind, openlabel study, ziprasidone was shown to improve PDP without worsening PD symptoms; 36 however, due to prolonged QT interval it has limited use and is not recommended for use in PDP.…”

Section: Antipsychotic Treatments To Avoidmentioning

confidence: 99%

“…[38][39][40] It should be noted that effective dosages for PDP are significantly lower than those used in the treatment of schizophrenia which are typically 300-900 mg/day. Clozapine has a minimal risk of agranulocytosis which can be fatal; therefore, specialized monitoring is required consisting of weekly blood draws for the first six months, followed by every other week for the next six months and then Aripiprazole Inconsistent efficacy and worsening of PD symptoms [25][26][27] Olanzapine No efficacy and worsening of PD symptoms [28][29][30] Risperidone Some efficacy but worsening of PD symptoms [31][32][33][34][35] Ziprasidone Insufficient evidence for efficacy and tolerability, but has limited use due to cardiac side effects and should be avoided …”

Section: Treatment Options For Parkinson's Disease Psychosis Clozapinementioning

confidence: 99%

A New Perspective in the Treatment of Parkinson’s Disease Psychosis

Pahwa¹,

Lyons²

2016

US Neurology

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N europsychiatric symptoms, such as psychosis, are well described in Parkinson's disease (PD); most appear to be due to disease pathology with exacerbation caused by dopaminergic treatment. More than 50% of patients with PD develop psychosis at some point throughout their disease course. Clinicians need to routinely assess patients with PD for psychotic symptoms, particularly hallucinations. Treatment of psychotic symptoms in PD is an unmet need as there are currently no US Food and Drug Administration (FDA) approved medications specifically for PD psychosis (PDP). Current treatments for PDP have been adapted from dopamine antagonists used to treat psychosis in other conditions, such as schizophrenia. Typical antipsychotics, as well as some atypical antipsychotics, worsen PD motor symptoms due to blockade of dopamine D2 receptors. Quetiapine and clozapine have been studied in PDP and are the most commonly used treatments for PDP. Clozapine has been shown to be effective; however, regular bloodwork is required, while data for quetiapine are inconsistent. Pimavanserin, a highly selective serotonin (5HT2A subtype) receptor inverse agonist, is not associated with motor worsening in PDP patients due to the absence of dopamine blockade. In a double-blind, placebo-controlled study, pimavanserin showed significant improvement in moderate to severe psychosis compared to placebo, with good tolerability and without worsening of PD motor symptoms. These data suggest that pimavanserin is a safe and efficacious treatment for PDP psychosis and could be a potential new treatment option for PDP.

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“…Unfortunately, olanzapine produced similar results in all studies: the drug was ineffective for the psychosis and worsened Parkinson motor features. Open label trials, published after the double blind trials began reported results similar to the double blind, controlled trials [78]Results for risperidone [79][80][81][82], ziprasidone [83,84] and aripiprazole [85][86][87] have all been open label and conflicting in their outcomes, with some demonstrating worsened parkinsonism [81,83,88,89] and others reporting good tolerance [79,80,[90][91][92], without worsening of motor function. Some reports have found "non-inferiority" of drugs compared to clozapine [93][94][95].…”

Section: Managementmentioning

confidence: 99%

Parkinson Disease Psychosis: Update

Friedman

2013

Behavioural Neurology

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Abstract. Psychotic symptoms are common in drug treated patients with Parkinson's disease (PD). Visual hallucinations occur in about 30% and delusions, typically paranoid in nature, occur in about 5%. These problems, particularly the delusions, cause great distress for patient and caregivers, and are among the most important precipitants for nursing home placement. Psychotic symptoms carry a poor prognosis. They often herald dementia, and are associated with increased mortality. These symptoms often abate with medication reductions, but this may not be tolerated due to worsened motor function. Only clozapine has level A evidence to support its use in PD patients with psychosis (PDP), whether demented or not. While quetiapine has been recommended by the American Academy of Neurology for "consideration," double blind placebo controlled trials have demonstrated safety but not efficacy. Other antipsychotic drugs have been reported to worsen motor function and data on the effectiveness of cholinesterase inhibitors is limited. PDP remains a serious problem with limited treatment options.

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Risperidone in the treatment of dopamine-induced psychosis in Parkinson's disease: An open pilot trial

Cited by 81 publications

References 39 publications

Parkinson’s disease: The treatment of drug-induced hallucinations and psychosis

Parkinson’s disease: The treatment of drug-induced hallucinations and psychosis

A New Perspective in the Treatment of Parkinson’s Disease Psychosis

Parkinson Disease Psychosis: Update

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