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Antipsychotics for the management of psychosis in Parkinson's disease: systematic review and meta-analysis

  • Ketan Dipak Jethwa (a1) and Oluwademilade A. Onalaja (a2)
Abstract
Background

Antipsychotics can exacerbate motor symptoms in Parkinson's disease psychosis.

Aims

To systematically review the literature on the efficacy and acceptability of antipsychotics for Parkinson's disease psychosis.

Method

Randomised controlled trials comparing an antipsychotic with placebo were systematically reviewed.

Results

The final selection list included nine studies using quetiapine (3), clozapine (2), olanzapine (3) and pimavanserin (1). A narrative synthesis and meta-analyses (where appropriate) were presented for each antipsychotic. Clozapine demonstrated superiority over placebo in reducing psychotic symptoms. Quetiapine and olanzapine did not significantly improve psychotic symptoms. All three antipsychotics may exacerbate motor symptoms. Quetiapine studies were associated with high drop-out rates due to adverse events. Pimavanserin is a novel treatment that warrants further investigation.

Conclusions

Further research is needed. Clozapine and pimavanserin appear to be a promising treatment for Parkinson's disease psychosis.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Dr K.D. Jethwa, Queen's Medical Centre, Nottingham NG7 2UH, UK. Email: ketan.jethwa@nuh.nhs.uk
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Aarsland, D, Larsen, JP, Cummins, JL, Laakek, . Prevalence and clinical correlates of psychotic symptoms in Parkinson disease: a community-based study. Arch Neurol 1999; 56: 595601.
2 Fénelon, G, Mahieux, F, Huon, R, Ziégler, M. Hallucinations in Parkinson's disease: prevalence, phenomenology and risk factors. Brain 2000; 123: 733–45.
3 Aarsland, D, Larsen, JP, Tandberg, E, Laake, K. Predictors of nursing home placement in Parkinson's disease: a population-based, prospective study. J Am Geriatr Soc 2000; 48: 938–42.
4 Goetz, CG, Stebbins, GT. Mortality and hallucinations in nursing home patients with advanced Parkinson's disease. Neurology 1995; 45: 669–71.
5 Cummings, JL. Managing psychosis in patients with Parkinson's disease. N Engl J Med 1999; 340: 801–3.
6 Fernandez, HH, Trieschmann, ME, Burke, MA, Jacques, C, Friedman, JH. Long-term outcome of quetiapine use for psychosis among parkinsonian patients. Mov Disord 2003; 18: 510–14.
7 Targum, SD, Abbott, JL. Efficacy of quetiapine in Parkinson's patients with psychosis. J Clin Psychopharmacol 2000; 20: 5460.
8 Aarsland, D, Larsen, JP, Lim, NG, Tandberg, E. Olanzapine for psychosis in patients with Parkinson's disease with and without dementia. J Neuropsych Clin Neurosci 1999; 11: 392–94.
9 Ford, B, Lynch, T, Greene, P. Risperidone in Parkinson's disease. Lancet 1994; 344: 681.
10 Meco, G, Alessandri, A, Giustini, P, Bonifati, V. Risperidone in levodopa-induced psychosis in advanced Parkinson's disease: an open-label, long-term study. Mov Disord 1997; 12: 610–12.
11 Friedman, JH, Factor, SA. Atypical antipsychotics in the treatment of drug-induced psychosis in Parkinson's disease. Mov Disord 2000; 15: 201–11.
12 Fernandez, HH, Aarsland, D, Fénelon, G, Friedman, JH, Marsh, L, Tröster, AI, et al. Scales to assess psychosis in Parkinson's disease: critique and recommendations. Mov Disord 2008; 23: 484500.
13 Higgins, JP, Altman, DG, Gøtzsche, PC, Jüni, P, Moher, D, Oxman, AD, et al. The Cochrane collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343: D5928.
14 Fernandez, HH, Okun, MS, Rodriguez, RL, Malaty, IA, Romrell, J, Sun, A, et al. Quetiapine improves visual hallucinations in Parkinson disease but not through normalization of sleep architecture: results from a double-blind clinical-polysomnography study. Int J Neurosci 2009; 119: 2196–205.
15 Rabey, JM, Prokhorov, T, Miniovitz, A, Dobronevsky, E, Klein, C. Effect of quetiapine in psychotic Parkinson's disease patients: a double-blind labeled study of 3 months' duration. Mov Disord 2007; 22: 313–18.
16 Shotbolt, P, Samuel, M, Fox, C, David, AS. A randomized controlled trial of quetiapine for psychosis in Parkinson's disease. Neuropsych Dis Treat 2009; 5: 327–32.
17 Ondo, WG, Tintner, R, Voung, KD, Lai, D, Ringholz, G. Double-blind, placebo-controlled, unforced titration parallel trial of quetiapine for dopaminergic-induced hallucinations in Parkinson's disease. Mov Disord 2005; 20: 958–63.
18 Pollak, P, Tison, F, Rascol, O, Destée, A, Péré, JJ, Senard, JM, et al. Clozapine in drug induced psychosis in Parkinson's disease: a randomised, placebo controlled study with open follow up. J Neurol Neurosurg Psychiatry 2004; 75: 689–95.
19 Friedman, . Low-dose clozapine for the treatment of drug-induced psychosis in Parkinson's disease. The Parkinson study group. N Engl J Med 1999; 340: 757–63.
20 Breier, A, Sutton, VK, Feldman, PD, Kadam, DL, Ferchland, I, Wright, P, Friedman, JH. Olanzapine in the treatment of dopamimetic-induced psychosis in patients with Parkinson's disease. Biol Psych 52: 438–45.
21 Ondo, WG, Levy, JK, Vuong, KD, Hunter, C, Jankovic, J. Olanzapine treatment for dopaminergic-induced hallucinations. Mov Dis 2002; 17: 1031–35.
22 Nichols, MJ, Hartlein, JM, Eicken, MGA, Racette, BA, Black, KJ. A fixed-dose randomised controlled trail of olanzapine for psychosis in Parkinson disease. F1000 Res 2014; 2: 150.
23 Cummings, J, Isaacson, S, Mills, R, Williams, H, Chi-Burns, K, Corbett, A, et al. Pimavanserin for patients with Parkinson's disease psychosis: a randomised, placebo-controlled phase 3 trial. Lancet 2014; 383: 533–40.
24 Rigler, SK, Shireman, TI, Cook-Wiens, GJ, Ellerbeck, EF, Whittle, JC, Mehr, DR, et al. Fracture risk in nursing home residents initiating antipsychotic medications. J Am Geriatr Soc 2013; 61: 715–22.
25 Citrome, L, Collins, JM, Nordstrom, BL, Rosen, EJ, Baker, R, Nadkarni, A, et al. Incidence of cardiovascular outcomes and diabetes mellitus among users of second-generation antipsychotics. J Clin Psychiatry 2013; 74: 1199–206.
26 Leucht, S, Kane, JM, Etschel, E, Kissling, W, Hamann, J, Engel, RR. Linking the PANSS, BPRS, and CGI: clinical implications. Neuropsychopharmacology 2006; 31: 2318–25.
27 NICE. Parkinson's Disease: Diagnosis and Management in Primary and Secondary Care (Clinical Guideline CG35). NICE, 2006.
28 Wolters, EC, Hurwitz, TA, Mak, E, Teal, P, Peppard, FR, Remick, R, et al. Clozapine in the treatment of Parkinsonian patients with dopaminomimetic psychosis. Neurology 1990; 40: 832–34.
29 Ballanger, B, Strafella, AP, van Eimeren, T. Serotonin 2A receptors and visual hallucinations in Parkinson disease. Arch Neurol 2010; 67: 416–21.
30 Hack, N, Fayad, SM, Monari, EH, Akbar, U, Hardwick, A, Rodriguez, RL, et al. An eight-year clinic experience with clozapine use in a Parkinson's disease clinic setting. PLoS One 2014; 9: E91545.
31 Shulman, LM, Gruber-Baldini, AL, Anderson, KE, Fishman, PS, Reich, SG, Weiner, WJ. The clinically important difference on the unified Parkinson's disease rating scale. Arch Neurol 2010; 67: 6470.
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Antipsychotics for the management of psychosis in Parkinson's disease: systematic review and meta-analysis

  • Ketan Dipak Jethwa (a1) and Oluwademilade A. Onalaja (a2)
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