Psychosis in Parkinson Disease: A Review of Etiology, Phenomenology, and Management.
Parkinson disease psychosis (PDP) is a common phenomenon in Parkinson disease (PD) patients treated with dopaminergic drugs, and is associated with high morbidity and mortality. It also correlates with depression and dementia, and can contribute to considerable caregiver stress and burnout. While symptoms can be relieved by decreasing doses or number of anti-PD medications, this may lead to an unacceptable worsening of motor function. When general medical or psychiatric conditions have been ruled out, and decreasing dopaminergic agents is not effective in treating psychosis, therapies include atypical antipsychotics, primarily clozapine and quetiapine. Of these, clozapine is effective but is associated with a poor side-effect profile and the necessity for frequent blood draws. Clinicians prefer quetiapine for its theoretically better safety profile, although there is no evidence for efficacy in treating psychosis. All atypical antipsychotics are associated with increased mortality in this patient population. Cholinesterase inhibitors can ameliorate psychosis symptoms. The serotonin 5-HT2Areceptor inverse agonist pimavanserin was recently approved by the US FDA for the treatment of PDP and may prove to be a more targeted therapy without the downsides of atypical antipsychotics.
Department of Neurology and Neurotherapeutics, Neurology Clinic, University of Texas Southwestern Medical Center, 5303 Harry Hines Blvd, 4th Floor, Suite 108, Dallas, TX, 75390-8869, USA.
Niyatee
N
Samudra
Department of Neurology, Henry Ford Hospital, West Bloomfield, MI, USA.
Neepa
N
Patel
Department of Neurology and Neurotherapeutics, Neurology Clinic, University of Texas Southwestern Medical Center, 5303 Harry Hines Blvd, 4th Floor, Suite 108, Dallas, TX, 75390-8869, USA.|Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.
Kyle B
KB
Womack
Department of Neurology and Neurotherapeutics, Neurology Clinic, University of Texas Southwestern Medical Center, 5303 Harry Hines Blvd, 4th Floor, Suite 108, Dallas, TX, 75390-8869, USA.
Pravin
P
Khemani
Department of Neurology and Neurotherapeutics, Neurology Clinic, University of Texas Southwestern Medical Center, 5303 Harry Hines Blvd, 4th Floor, Suite 108, Dallas, TX, 75390-8869, USA. Shilpa.chitnis@utsouthwestern.edu.
Shilpa
S
Chitnis
D014150:Antipsychotic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002800:Cholinesterase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D003024:Clozapine / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D058990:Molecular Targeted Therapy; D018377:Neurotransmitter Agents / Q000378:metabolism; D010300:Parkinson Disease / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D010880:Piperidines / Q000494:pharmacology / Q000627:therapeutic use; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D000069348:Quetiapine Fumarate / Q000494:pharmacology / Q000627:therapeutic use; D014508:Urea / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use
D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors; D018377:Neurotransmitter Agents; D010880:Piperidines; D000069348:Quetiapine Fumarate; D014508:Urea; D003024:Clozapine; C510793:pimavanserin