Atypical antipsychotics in the treatment of drug-induced psychosis in Parkinson's disease

摘要: Our experience with atypical antipsychotics in patients PD is that their motor effects are not predictable. The multiple reports concerning clozapine's beneficial on tremor, dystonia, nocturnal akathisia, and dyskinesias all underscore this observation. However, the appearance of even minor degrees parkinsonism normal volunteers or schizophrenics should suggest an antipsychotic will be well-tolerated PD. treatment probably most stringent test a drug's freedom from parkinsonian side effects. data trials schizophrenia cannot always confidently interpreted. Virtually subjects these have been treated typical neuroleptics until shortly before study entry. Because drugs may persist for several months, still show declining levels when placed drug induces it if effect milder than induced by pre-study neuroleptic. Depending used duration study, distinguishing placebo low-potency neuroleptic impossible. Furthermore, standard measure psychiatric studies Simpson-Angus scale which heavily weighted toward rigidity bradykinesia, gait, posture abnormalities. prolactin response to turn out good predictor its That would fit presented above clozapine quetiapine having less effects, olanzapine more but variable risperidone being poorly tolerated. With above, comprising current review use we could locate, can say little certainty. only confirmed benefit without worsening clozapine. Open-label involving over 400 two multicenter, placebo-controlled, double-blind demonstrated effective treating psychosis. It improves does worsen other functions any significant extent, safe at low doses. Limited provide conflicting information both olanzapine. Quetiapine seems some, definitely less, features Based literature, our personal experience, anecdotal specialists solicited, venture own interpretation recommendations. We think tolerated as last resort; better will, majority PD, function. optimistic, yet convinced, prove require cumbersome monitoring because induce blood dyscrasia. therefore recommend DP following manner. First, anti-PD medications simplified reduced much think, general, multiply increasing numbers dose, so likely tolerate higher dose levodopa lower combined adjunctive medications. In reducing medications, tapering stopping, necessary, highest risk-to-benefit ratio first. Anticholinergics stopped first, then selegiline, dopamine agonists, amantadine, finally COMT inhibitors, no psychotomimetic action own. Finally, reduced. Generally, point reached jeopardizing If psychosis persists point, added. (ABS