title: Patterns and trends in antipsychotic prescribing for Parkinson disease psychosis.
abstract: BACKGROUND
  Antipsychotic (AP) use is common in Parkinson disease (PD), but APs can worsen parkinsonism, evidence for efficacy is limited, and use in patients with dementia increases mortality.
  
  
  OBJECTIVE
  To examine the frequency and characteristics, including changes over time, of AP use in a large cohort of patients with PD.
  
  
  METHODS
  Using Veterans Affairs data from fiscal year (FY) 2008, rates and predictors of AP prescribing were determined for patients with PD and psychosis stratified by dementia status (N = 2597) and a comparison group of patients with dementia and psychosis without PD (N = 6907). Fiscal year 2008 and FY2002 data were compared to examine changes in AP prescribing over time.
  
  
  METHODS
  Department of Veterans Affairs outpatient facilities.
  
  
  METHODS
  Outpatients with PD and psychosis and outpatients without PD with dementia and psychosis, all receiving care at Veterans Affairs facilities in FY2002 and FY2008.
  
  
  METHODS
  Antipsychotic prescribing, including overall, class, and specific medications.
  
  
  RESULTS
  In FY2008, 50% of patients with PD having a diagnosis of psychosis were prescribed an AP. Among treated patients, the atypical AP quetiapine was most frequently prescribed (66%), but approximately 30% received high-potency APs. Clozapine was rarely prescribed (<2%). In multivariate models, diagnoses of PD and dementia were associated with AP use. Comparing FY2008 with FY2002, AP use in PD was unchanged, with decreases in risperidone and olanzapine use offset by an increase in quetiapine prescribing and the introduction of aripiprazole.
  
  
  CONCLUSIONS
  Half of the patients with PD and psychosis receive APs, not uncommonly high-potency agents associated with worsening parkinsonism, and frequency of use has been unchanged since the "black box" warning for AP use in patients with dementia was issued. Recent trends are a shift to quetiapine use and the common use of aripiprazole. As psychosis and dementia are frequently comorbid in PD, safety risks associated with AP use in this population need to be assessed.
authors: Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA. daniel.weintraub@uphs.upenn.edu
authors: Daniel
authors: D
authors: Weintraub
authors: Peijun
authors: P
authors: Chen
authors: Rosalinda V
authors: RV
authors: Ignacio
authors: Eugenia
authors: E
authors: Mamikonyan
authors: Helen C
authors: HC
authors: Kales
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000145:classification / Q000600:supply & distribution / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy*; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000150:complications / Q000188:drug therapy*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
chemical_list: D014150:Antipsychotic Agents