March 08, 2018
A recent review article published in Expert Opinion of Pharmacotherapy examined the therapeutic approaches to Parkinson disease (PD) psychosis (PDP), focusing on drug treatments used once contributory factors have been removed.
Psychosis is a common problem in those treated for PD, with hallucinations being the most common, followed by delusions. While the hallucinations are generally not bothersome to patients, the delusions are typically paranoid in nature. Treatment is often, but not always, required.
Joseph H Friedman, MD, Warren Alpert Medical School of Brown University (Providence, RI), reviewed the current evidence supporting the use of clozapine and, most recently, pimavanserin (the first drug with antipsychotic efficacy that has no effect on dopamine). Treatment with second-generation antipsychotic drugs and cholinesterase inhibitors was also reviewed.
According to Dr Friedman’s expert opinion of the reviewed literature, clozapine and pimavanserin have proven efficacy for PDP without impairing motor function. In terms of benefits associated with clozapine, its antipsychotic benefits were seen within 1 week, and it is quite effective in improving tremor in PD. However, this is counterbalanced by the need for blood monitoring, despite the extremely low doses used, and sedation (published online February 22, 2018; doi:10.1080/14656566.2018.1445721).
Benefits regarding pimanvanserin includes that it is well tolerated, without sedation or other significant side effects. Its onset of benefit, however, takes 4-6 weeks. While quetiapine is also frequently used, its efficacy is not supported by double blinded, randomized trials.
—Amanda Del Signore
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