title: Antipsychotic Use and Physical Morbidity in Parkinson Disease.
abstract: OBJECTIVE
  To determine if antipsychotic (AP) use in Parkinson disease (PD) patients is associated with increased physical morbidity.
  
  
  METHODS
  Veterans Health Administration data (1999-2010) was used to examine physical morbidity risk associated with AP use in idiopathic PD patients with stable recent physical health. We compared 180-day morbidity rates in patients initiating an AP with matched non-AP users who survived for 180 days (matched on age, sex, race, index year, presence and duration of dementia, PD duration, delirium, hospitalization, Charlson Comorbidity Index, and new non-psychiatric medications; covarying for psychosis). Outcomes were 180-day emergency department (ED), and inpatient and outpatient visits.
  
  
  RESULTS
  There were 6,679 matched PD pairs. Any AP use was associated with an increased risk of ED visit (HR: 1.64, 95% CI: 1.51, 1.77), inpatient care (HR: 1.58, 95% CI: 1.46, 1.71), and outpatient visits (IRR: 1.08, 95% CI: 1.05, 1.12). The risk was significantly higher for atypical AP use compared with nonuse for all three morbidity outcomes, and was similar for atypical and typical AP use.
  
  
  CONCLUSIONS
  Any AP use, and atypical AP use, are associated with significantly increased physical morbidity risk in PD patients, as evidenced by increased ED, inpatient, and outpatient visits. These findings, which require replication, extend the risk associated with use of APs in this population from mortality to a broader range of adverse outcomes, and further highlight the need to use APs cautiously in PD patients.
authors.affiliation: Parkinson's Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA; Mental Illness Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: daniel.weintraub@uphs.upenn.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Weintraub
authors.affiliation: Department of Veterans Affairs, HSR&D Center for Clinical Management Research, Ann Arbor, MI, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Chiang
authors.affiliation: Department of Veterans Affairs, HSR&D Center for Clinical Management Research, Ann Arbor, MI, USA; Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Hyungjin Myra
authors.initials: HM
authors.lastname: Kim
authors.affiliation: Parkinson's Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jayne
authors.initials: J
authors.lastname: Wilkinson
authors.affiliation: Morton and Gloria Shulman Movement Disorder Centre and the Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Canada.
authors.forename: Connie
authors.initials: C
authors.lastname: Marras
authors.affiliation: Department of Veterans Affairs, HSR&D Center for Clinical Management Research, Ann Arbor, MI, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Stanislawski
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Mamikonyan
authors.affiliation: Department of Veterans Affairs, HSR&D Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Geriatric Research, Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
authors.forename: Helen C
authors.initials: HC
authors.lastname: Kales
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data; D014150:Antipsychotic Agents / Q000009:adverse effects*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009017:Morbidity; D010300:Parkinson Disease / Q000453:epidemiology*; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data
chemical_list: D014150:Antipsychotic Agents
keywords: Antipsychotic; Parkinson disease; morbidity; psychosis