[Clozapine and olanzapine in the treatment of the psychotic disorders in Parkinson's disease].
OBJECTIVE
The most important and serious neuropsychiatric disorders in Parkinson's disease (PD) are the medication-induced psychoses. They are remarkably frequent and are linked to a dopaminergic over-stimulation caused by the drugs administered over a long period of time. This complication increases the morbidity and mortality rates in PD and in the past it was very difficult to treat. Yet, the atypical antipsychotics have transformed its prognosis.


METHODS
We review the general pharmacology of the atypical antipsychotics, in particular clozapine and olanzapine, which we have wide experience with. We present two series in which these drugs were used with the psychosis in PD. Our studies were performed using a strict prospective methodology, with scales that are valid for psychosis, and the patients' motor signs. Both atypical antipsychotics were seen to improve the positive and negative symptoms of the patients, giving rise to no or scarce improvement of the motor signs of PD. The side effects of the two drugs were not important. Our two series are compared with others from the literature, with similar results as regards the improvements in the psychoses and the absence or only slight deterioration of Parkinson's disease.


CONCLUSIONS
The psychoses induced by medication in PD are frequent and severe. The appearance of the atypical antipsychotics has come as a true 'revolution' in their treatment, owing to the good results obtained in the treatment of the psychoses and the scant deterioration of the motor signs of PD.
Chacón
J
J
Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, Spain. jchacon@supercable.es
D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D003024:Clozapine / Q000627:therapeutic use*; D006801:Humans; D000077152:Olanzapine; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000209:etiology
D000978:Antiparkinson Agents; D014150:Antipsychotic Agents; D001569:Benzodiazepines; D003024:Clozapine; D000077152:Olanzapine