title: Trigger medications and patient-related risk factors for Parkinson disease psychosis requiring anti-psychotic drugs: a retrospective cohort study.
abstract: BACKGROUND
  Psychoses such as hallucinations are a frequent non-motor problem in patients with Parkinson disease (PD) and serious psychosis requires anti-psychotic medications that worsen Parkinsonism. Although psychosis could be associated with patient-related or biological factors such as cognition, age, and severity of PD, it can also be associated with medications.Therefore we aimed to investigate patient-related and medication-related risks of psychosis requiring anti-psychotic medications (serious psychosis).
  
  
  METHODS
  A retrospective cohort of 331 PD patients was followed for 2 years. Patient-related factors associated with risk of psychosis were identified by a survival time analysis. In patients who developed psychosis, medications during the hazard period (1-14 days before psychosis) were contrasted with those during the control periods (1 and 3 months before psychosis) using a case-crossover analysis to identify medication-related risks of psychosis.
  
  
  RESULTS
  Serious psychosis was detected in 52 patients and the incidence was estimated to be 116 (95% confidence interval [CI], 85-148) per 1,000 person-years. Analyses of baseline characteristics revealed the risk to be higher in patients with a modified Hoehn-Yahr stage of ≥4 (hazard ratio [HR], 2.22; 95% CI, 1.11-4.40), those with a longer duration of PD (HR, 1.25; 95% CI, 1.00-1.55, per 5 years) and those with Mini-Mental State Examination scores of ≤24 (HR, 2.66; 95% CI, 1.37-5.16). The case-crossover analysis revealed that anti-cholinergics use (HR, 19.7; 95% CI, 2.39-162) elevated the risk, while donepezil use reduced it (HR, 0.48; 95% CI, 0.27-0.85).
  
  
  CONCLUSIONS
  Risk of psychosis was elevated by increasing severity of PD, cognitive dysfunction and duration of the disease. It was elevated by use of anti-cholinergic drugs and reduced by use of donepezil. The medication-related risk was higher in patients aged ≥ 70 years. In contrast, there was no significant medication-related risk in younger patients, suggesting different pathomechanisms between young and old patients.
authors.affiliation: Clinical Research Center, 8 Ondoyamacho, Narutaki, Ukyoku Kyoto 616-8255, Japan. sawada@unh.hosp.go.jp.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Sawada
authors.forename: Tomoko
authors.initials: T
authors.lastname: Oeda
authors.forename: Kenji
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Atsushi
authors.initials: A
authors.lastname: Umemura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tomita
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Hayashi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kohsaka
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawamura
mesh_terms: D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000453:epidemiology / Q000523:psychology*; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D013997:Time Factors
chemical_list: D014150:Antipsychotic Agents