Psychosis in advanced Parkinson's disease

  title={Psychosis in advanced Parkinson's disease},
  author={Joseph Zoldan and G. Friedberg and Miron Livneh and Eldad Melamed},
  pages={1305 - 1308}
Psychosis, linked to chronic levodopa and other antiparkinsonian drug treatments, is a common and incapacitating complication of advanced Parkinson's disease (PD). The psychosis may be due, in part, to overstimulation of central serotonergic (5-HT) receptors. We treated 16 PD patients who had psychosis of 6 to 60 months' duration with the 5-HT3 receptor antagonist ondansetron (12 to 24 mg daily) in an open-label, short-term (4 to 8 weeks) trial. There was marked to moderate improvement (p < 0… 
Treatment Possibilities for Psychosis in Parkinson's Disease with An Emphasis on the Newly Approved Drug: Pimavanserin.
A selective 5-HT2A inverse agonist, pimavanserin, has been developed, investigated and has gained approval in April 2016 in the US for the treatment of hallucinations and delusions in PD.
Parkinson Disease Psychosis: Update
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  • Psychology, Medicine
    Behavioural neurology
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Only clozapine has level A evidence to support its use in PD patients with psychosis (PDP), whether demented or not, and other antipsychotic drugs have been reported to worsen motor function and data on the effectiveness of cholinesterase inhibitors is limited.
Pathophysiology and Treatment of Psychosis in Parkinson’s Disease
Case reports suggest that electroconvulsive therapy has the potential to reduce psychotic symptoms and may be considered in cases involving concurrent depression and/or medication-refractory psychosis, and case reports also suggest that specific antidepressants may improve psychosis in depressed patients.
Drug-Induced Psychosis in Parkinson’s Disease
Treatment with atypical antipsychotic agents, such as clozapine and risperidone, presents such an avenue and nonpharmacological treatments, including electroconvulsive therapy (ECT), may also play a role in the management of these patients.
Psychosis in Parkinson’s Disease
This article reviews what is known about the epidemiology, risk factors, pathophysiology, and treatment of PD-related psychosis and suggests that an atypical antipsychotic agent is presently the treatment of choice.
Psychosis in Parkinson's disease: therapeutic options.
There is a considerable need to further study the existing drugs and explore other pharmacotherapies in Parkinson's disease psychosis to ensure sound methodological quality and control for confounding variables to provide results that could be used reliably in clinical practice.
Treatment of Psychosis in Parkinson’s Disease
Electroconvulsive treatment is generally reserved for the patient with psychotic depression who is unable to tolerate any pharmacological therapy, and cumulative reports involving >200 Parkinson’s disease patients strongly suggest that quetiapine is well tolerated and effective.
Evidence for the use of pimavanserin in the treatment of Parkinson’s disease psychosis
Pimavanserin, a 5HT2A receptor inverse agonist, has been shown to reduce psychosis in PD without worsening motor symptoms, making it a welcome therapeutic option for this devastating NMS.
Mirtazapine improves visual hallucinations in Parkinson's disease: a case report
A patient with PDPsy who was treated with one of the new‐generation antidepressants, mirtazapine, improved the patient's refractory psychotic symptoms, especially her visual hallucinations, without worsening her motor symptoms.


Clozapine: a 2-year open trial in Parkinson's disease patients with psychosis.
It is demonstrated that clozapine therapy can be effective in treating psychosis in PD patients over 1 to 2 years, and the decline in efficacy in the second year was most likely related to an increase in daily levodopa dose, progression of dementia, and an inability of PD patients to tolerate higher doses of clozAPine.
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This topic is reviewed for four principal classes of new, established, and potential antipsychotics:Antipsychotics such as sulpiride and remoxipride that block a subgroup of dopamine D2/D3 receptors produce a relatively low level of side effects, including EPS, and have an antipsychotic effect equal to or slightly weaker than traditional neuroleptics.
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It is proposed that direct infusion of zacopride and other 5-HT 3 antagonists into these mesolimbic areas in the rat inhibits dopaminergically mediated locomotor behavior without the overall depression of the central nervous system or rebound hyperlocomotion produced by conventional neuroleptic srugs.
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The NOSIE-30, especially designed for use by subprofessional personnel, provides an economical and accurate means of systematically assessing patient status and change and cross-validation of these six factor scores and a composite score, Total Patient Assets, were obtained.
Nonaminergic striatal neurons convert exogenous l‐dopa to dopamine in parkinsonism
It has been suggested that, after degeneration of nigrostriatal pathways, decarboxylation of administered L‐dopa may occur mainly at such striatal sites as surviving dopaminergic terminals, serotonergic neurons, or capillaries; but currently available data do not favor these hypotheses.
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Direct evidence for the existence of 5-HT3 receptors in rat brain tissue and their distribution is reported, based on high affinity binding of the potent 5- HT3 receptor antagonist 3H-GR65630 to homogenates of rat entorhinal cortex.
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