Course, prognosis, and management of psychosis in Parkinson's disease: are current treatments really effective?
It is essential to recognize and treat psychosis in Parkinson's disease for several reasons. Studies have shown that psychosis in Parkinson's disease patients is a strong risk factor for nursing home placement. Psychosis may be the greatest source of stress for caretakers of Parkinson's patients; it is often persistent, and its presence markedly increases mortality. Treatment of psychotic symptoms should occur only after potential medical and environmental causes of delirium have been eliminated or addressed. Initial pharmacologic changes should include limiting the patient's antiparkinsonian medications to those that are necessary to preserve motor function. Should that fail, an atypical antipsychotic is presently the treatment of choice. An emerging treatment option is acetylcholinesterase inhibitors. This article reviews what is currently known about the course, prognosis, and treatment strategies in Parkinson's disease psychosis.
Zahodne
Laura B
LB
Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.
Fernandez
Hubert H
HH
D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002800:Cholinesterase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D006801:Humans; D008559:Memantine / Q000009:adverse effects / Q000627:therapeutic use; D010300:Parkinson Disease / Q000188:drug therapy*; D011379:Prognosis; D011605:Psychoses, Substance-Induced / Q000175:diagnosis / Q000209:etiology; D011618:Psychotic Disorders / Q000188:drug therapy*; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors; D008559:Memantine