Treatment of psychotic symptoms in patients with Parkinson disease
| Autor: | Jack J. Chen |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Psychosis Pimavanserin Antiparkinson medication 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Psychopharmacology Pearls pimavanserin Internal medicine medicine Haloperidol Pharmacology (medical) 030212 general & internal medicine psychosis General Pharmacology Toxicology and Pharmaceutics Clozapine clozapine business.industry quetiapine medicine.disease nonmotor symptoms Parkinson disease antipsychotics Neuropsychology and Physiological Psychology chemistry Schizophrenia Delirium Quetiapine movement disorders Neurology (clinical) medicine.symptom business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | The Mental Health Clinician |
| ISSN: | 2168-9709 |
| Popis: | Persistent psychotic symptoms will develop in up to 60% of patients with Parkinson disease (PD). The initial approach to the management of PD psychosis (PDP) begins with addressing concurrent systemic conditions associated with psychotic behavior, such as delirium, medical conditions (eg, infections), psychiatric disorders (eg, major depression with psychotic symptoms, mania, schizophrenia), and substance misuse or withdrawal. A review of current medications is recommended, and medications that may trigger psychotic symptoms should be eliminated. If possible, antiparkinson medications should be reduced to the minimum therapeutic dose or discontinued in a sequential manner. Generally, dose reduction or discontinuation of anticholinergics is attempted first, followed by that of monoamine oxidase B inhibitors, amantadine, dopamine agonists, catechol-O-methyltransferase inhibitors, and lastly carbidopa/levodopa. The aim of antiparkinson medication dose reduction is to achieve a balance between improving drug-related psychotic symptoms and not significantly worsening the motor symptoms of PD. If additional measures are needed for chronic PDP treatment, the use of second-generation antipsychotics, such as clozapine, pimavanserin, or quetiapine, must be considered. The first-generation antipsychotics (eg, fluphenazine, haloperidol) are not recommended. In the patient with comorbid dementia, the addition of a cholinesterase inhibitor might also be beneficial for PDP. The choice of agent is based on patient-specific parameters, potential benefit, and side effects. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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