Antipsychotic Use in Parkinson`s Disease
Pp. 273-286 (14)
The prevailing psychotic symptoms in Parkinson’s Disease (PD) are
hallucinations and delusions. Hallucinations are sensory phenomena that are not
induced by physical stimuli, and occur in each sensory modality. Visual hallucinations
are the most common psychotic symptoms in PD followed by auditory hallucinations.
Before treating psychotic symptoms in PD, it is important to rule out an underlying
medical illness as the cause of the symptoms, like urinary and pulmonary infections,
metabolic and endocrine imbalances, cerebral hypoperfusion states and psychosocial
stressors. Antipsychotics medications lower brain dopaminergic transmission and can
cause or worsen parkinsonism by diminishing dopaminergic transmission in the
nigrostriatal pathways. Prior to the introduction of clozapine there was no effective
treatment, and by the time being, is the only antipsychotic that has level I evidence to
support its use in PD patients. Several open label studies on quetiapine for the treatment
of psychosis in PD have been reported. Some of them showed quetiapine to be effective
without worsening motor function while in others it was reported as ineffective
although well tolerated.
Adverse Drug Reactions, Aripiprazole, Cholinesterase Inhibitors,
Clozapine, Delusions, Drug Holidays, Elderly, Electroconvulsive Therapy, First
Generation Antipsychotics, Hallucinations, Melperone, Olanzapine, Parkinson’s
Disease, Pimavanserine, Psychosis, Quetiapine, Risperidone, Second Generation
Antipsychotics, Strategies, Ziprasidone.
Pharmacy Service, Alto Deba Integrated Health Organization, Avda, Nafarroa, 16, 20500 Arrasate Gipuzkoa/Guipuzcoa, Spain.