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Psychosis in Parkinson Disease: A Review of Etiology, Phenomenology, and Management

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Abstract

Parkinson disease psychosis (PDP) is a common phenomenon in Parkinson disease (PD) patients treated with dopaminergic drugs, and is associated with high morbidity and mortality. It also correlates with depression and dementia, and can contribute to considerable caregiver stress and burnout. While symptoms can be relieved by decreasing doses or number of anti-PD medications, this may lead to an unacceptable worsening of motor function. When general medical or psychiatric conditions have been ruled out, and decreasing dopaminergic agents is not effective in treating psychosis, therapies include atypical antipsychotics, primarily clozapine and quetiapine. Of these, clozapine is effective but is associated with a poor side-effect profile and the necessity for frequent blood draws. Clinicians prefer quetiapine for its theoretically better safety profile, although there is no evidence for efficacy in treating psychosis. All atypical antipsychotics are associated with increased mortality in this patient population. Cholinesterase inhibitors can ameliorate psychosis symptoms. The serotonin 5-HT2A receptor inverse agonist pimavanserin was recently approved by the US FDA for the treatment of PDP and may prove to be a more targeted therapy without the downsides of atypical antipsychotics.

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Acknowledgements

The authors would like to acknowledge Dr. Samarpita Sengupta for providing critical feedback and editorial assistance. In addition, we would like to acknowledge our patients with PD and psychosis, as we hope to continue to improve in our abilities to help them.

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Authors and Affiliations

  1. Department of Neurology and Neurotherapeutics, Neurology Clinic, University of Texas Southwestern Medical Center, 5303 Harry Hines Blvd, 4th Floor, Suite 108, Dallas, TX, 75390-8869, USA

    Niyatee Samudra, Kyle B. Womack, Pravin Khemani & Shilpa Chitnis

  2. Department of Neurology, Henry Ford Hospital, West Bloomfield, MI, USA

    Neepa Patel

  3. Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA

    Kyle B. Womack

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  1. Niyatee Samudra
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  2. Neepa Patel
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Correspondence to Shilpa Chitnis.

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Niyatee Samudra, Neepa Patel, Kyle B. Womack, Pravin Khemani, and Shilpa Chitnis report no conflicts of interest.

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During the completion of this manuscript, Drs. Khemani and Chitnis were co-investigators on a project funded by a National Institute of Neurological Diseases and Stroke grant (1U01NS082148). In addition, Dr. Womack was supported by a grant from the National Institute of Aging (P30AG012300).

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Samudra, N., Patel, N., Womack, K.B. et al. Psychosis in Parkinson Disease: A Review of Etiology, Phenomenology, and Management. Drugs Aging 33, 855–863 (2016). https://doi.org/10.1007/s40266-016-0416-8

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