Neuropsychiatric adverse effects of antiparkinsonian drugs. Characteristics, evaluation and treatment.
Parkinson's disease (PD) is a progressive neurological condition that causes considerable disability in the elderly. Drugs used to treat PD, such as levodopa, offer symptomatic relief but often have neuropsychiatric adverse effects, most prominently psychosis and delirium. Aged patients and those with dementia are particularly vulnerable to these adverse effects. Evaluating PD patients with drug-induced neuropsychiatric adverse effects is made difficult by their complex clinical presentations. The treatment of drug-induced psychosis and delirium begins with manipulating the antiparkinsonian drug regimen, but this frequently worsens motor function. Atypical antipsychotics such as clozapine have been successfully employed to treat the psychosis without worsening the motor disability. Patient intolerance of clozapine therapy has prompted open-label studies with newer agents such as risperidone, remoxipride, zotepine, mianserin and ondansetron.
Young
B K
BK
Mental Health Division, Portland Veterans Affairs Medical Center, Oregon, USA.
Camicioli
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Ganzini
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D000375:Aging / Q000473:pathology; D017109:Akathisia, Drug-Induced / Q000188:drug therapy / Q000628:therapy; D000547:Amantadine / Q000009:adverse effects; D000978:Antiparkinson Agents / Q000009:adverse effects*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000009:adverse effects*; D003693:Delirium / Q000139:chemically induced / Q000188:drug therapy / Q000628:therapy; D003704:Dementia / Q000139:chemically induced / Q000188:drug therapy / Q000628:therapy; D003863:Depression / Q000139:chemically induced / Q000188:drug therapy / Q000628:therapy; D018491:Dopamine Agonists / Q000009:adverse effects*; D004565:Electroconvulsive Therapy; D006801:Humans; D007980:Levodopa / Q000009:adverse effects*; D008559:Memantine / Q000009:adverse effects; D008996:Monoamine Oxidase Inhibitors / Q000009:adverse effects*; D011605:Psychoses, Substance-Induced / Q000188:drug therapy / Q000628:therapy; D012307:Risk Factors; D012702:Serotonin Antagonists / Q000008:administration & dosage / Q000627:therapeutic use
D000978:Antiparkinson Agents; D014150:Antipsychotic Agents; D018680:Cholinergic Antagonists; D018491:Dopamine Agonists; D008996:Monoamine Oxidase Inhibitors; D012702:Serotonin Antagonists; D007980:Levodopa; D000547:Amantadine; D008559:Memantine