Rebound psychosis: Effect of discontinuation of antipsychotics in Parkinson's disease

  title={Rebound psychosis: Effect of discontinuation of antipsychotics in Parkinson's disease},
  author={Hubert H. Fernandez and Martha E. Trieschmann and Michael S. Okun},
  journal={Movement Disorders},
To determine whether psychiatrically stable patients with a history of drug‐induced psychosis could be successfully weaned off their antipsychotic drug, we offered consecutive Parkinson disease (PD) patients on quetiapine or clozapine, who were free of any on‐going psychosis, to be slowly weaned off their antipsychotic drug. Before the study was aborted 6 PD patients (mean age, 78 years) with an average antipsychotic exposure of 20 months (5 on quetiapine, 1 on clozapine) were enrolled. After… 

Combating psychosis in Parkinson’s disease patients: the use of antipsychotic drugs

The current knowledge regarding the clinical manifestations, pathophysiology and risk factors for drug-induced psychosis in patients with PD and treatment, especially with regard to the atypical antipsychotics is summarized.

A Review of the Pathophysiology and Treatment of Psychosis in Parkinson’s Disease

The present article reviews the unique clinical features of psychosis as expressed in PD, associated risk factors, and current theories behind its pathogenesis, including medications, visual processing deficits, sleep disturbances, genetics, and neurochemical and structural abnormalities.

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.

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.

[Treatment of mental disorders in patients with Parkinson's disease].

Patients with Parkinson's disease require an individually optimized therapeutic regimen not only for motor symptoms, but also for frequently occurring psychiatric syndromes since these strongly influence the patients' and their caregivers' quality of life, are predictors for hospitalization and therefore have great economic importance for health care systems.

Psychosis in Parkinson’s Disease

Optimal management includes identification of contributing potential causes, optimization of the environment, antiparkinsonian medication adjustment, and symptomatic management with specific medications such as quetiapine and clozapine, and, in those with cognitive impairment, cholinesterase inhibitors.

Low Persistence of Antipsychotic Therapy in Parkinson Disease – Intolerance, Ineffectiveness, or Inertia?

Over one-third of individuals with PD stop antipsychotic therapy, especially if the initial drug has greater dopamine-receptor blocking activity, which is needed to inform clinical management of psychosis in PD and appropriate antipsychotics use in this population.

Current Understanding of Psychosis in Parkinson’s Disease

The treatment of PD psychosis is an unmet need in PD management and search for suitable agents constitutes an active area of research in PD.

Psychosis in Parkinson’s disease

Management of psychosis in PD requires a multidisciplinary approach and some of the newer atypical antipsychotics are effective against psychosis with no significant worsening of PD.

Low continuation of antipsychotic therapy in Parkinson disease – intolerance, ineffectiveness, or inertia?

Over one-third of individuals with PD discontinued antipsychotic therapy, especially if the initial drug has greater dopamine-receptor blocking activity, which is more likely for those who initiated medications with known dopamine-recept blocking activity.



Quetiapine for the treatment of drug-induced psychosis in Parkinson's disease.

Quetiapine is useful and well-tolerated as a first drug to treat DIP in Parkinson's disease but must be used cautiously to replace other atypical antipsychotic drugs.

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.

The Role of Atypical Antipsychotics in the Treatment of Movement Disorders

A review of the available data strongly suggests that clozapine has substantially less risk of inducing tardive dyskinesia as compared with conventional antipsychotic agents.

Low-dose clozapine for the treatment of drug-induced psychosis in Parkinson's disease.

  • Medicine, Psychology
    The New England journal of medicine
  • 1999
Clozapine, at daily doses of 50 mg or less, is safe and significantly improves drug-induced psychosis without worsening parkinsonism.

Longitudinal outcome of Parkinson’s disease patients with psychosis

It appears the prognosis has improved with atypical antipsychotic therapy based on the finding that 28% of NH patients died within 2 years compared with 100% in a previous study done prior to availability of this treatment.

Visual hallucinations associated with Parkinson disease.

While reduction in levodopa and anticholinergic medication doses is appropriate in the management of hallucinations, the factors that predispose patients to hallucinations include dementia and advancing age.

Hallucinations in Parkinson's disease: prevalence, phenomenology and risk factors.

Findings indicate that, when minor hallucinations are included, the total prevalence of hallucinations in Parkinson's disease is much higher than previously reported, and a simple side-effect of dopaminergic treatment is not sufficient to explain the occurrence of all visual hallucinations.

Prospective longitudinal assessment of hallucinations in Parkinson’s disease

The consistent association of hallucinations with combined levodopa/agonist therapy suggests that these drugs may play a role in the pathophysiology of hallucinations in PD patients on chronic dopaminergic therapy.

Rationale for current therapies in Parkinson’s disease

The rationale and strategies for current medical therapies in PD are described, with special emphasis on the use of antipsychotic agents, and levodopa remains the most efficacious medication for the management of PD.