Clozapine treatment of drug-induced psychotic symptoms in late stages of Parkinson's disease

1988 ◽  
Vol 78 (4) ◽  
pp. 349-350 ◽  
Author(s):  
K. Østergaard ◽  
E. Dupont
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Psychotic Symptoms ◽  
Drug Induced ◽  
Clozapine Treatment ◽  
Late Stages

Psychiatric complications of drug treatment of Parkinson's disease

2001 ◽  
Vol 13 (1) ◽  
pp. 29-36
Author(s):  
L. Lemey ◽  
J. Godderis ◽  
H. van den Ameele
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Drug Treatment ◽  
Psychotic Symptoms ◽  
Drug Induced ◽  
Severe Problem ◽  
Psychiatric Conditions ◽  
Psychiatric Complications ◽  
Home Placement ◽  
Abnormal Sleep

SUMMARYDrug-induced psychiatric conditions are a common and severe problem in the treatment of patients with Parkinson's disease. Psychotic symptoms are the most frequent reason for nursing home placement of patients with Parkinson's disease. The psychotic symptoms seem to present themselves in a continuum where alterations in dreaming patterns often precede visual hallucinations, which often progress into delusional syndromes and, finally, into confusional organic syndromes. When evaluating a patient on dopaminergic treatment, it is important to inquire systematically about abnormal sleep related phenomena, for these are important clues in the early detection of psychotic symptoms. The pathogenesis of the psychotic symptoms is not yet fully understood but complex adaptations of various neurotransmitter systems seem to be involved. In the treatment of these drug-induced psychotic symptoms, the atypical antipsychotic drug clozapine plays an important role. Drug-induced mania, hypersexuality and anxiety, although less frequent than the psychotic symptoms, also occur as a complication of dopaminergic treatment. Depressive symptoms, although common in Parkinson's disease, are less likely to occur as a side effect of the drug treatment.

‘Adults with Parkinson's disease and hallucinations or delusions can have treatment with clozapine if they need to’

2021 ◽  
pp. 1-3
Author(s):  
Eileen Joyce
Keyword(s):  
Mental Health ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Clinical Practice ◽  
National Health Service ◽  
Quality Standards ◽  
Antipsychotic Treatment ◽  
Current Clinical Practice ◽  
Clozapine Treatment ◽  
Care Systems

SUMMARY Clozapine is the only antipsychotic licensed for treatment of Parkinson's disease psychosis (PDP) but is infrequently used in the National Health Service because of obstacles to the integration of hospital-based neurological/geriatric services with clozapine clinics run by community mental health teams. This commentary points out the mismatch between NICE quality standards on antipsychotic treatment for PDP and current clinical practice. It suggests that forthcoming integrated care systems should be able to overcome these obstacles, enabling innovative models for providing clozapine treatment for PDP such as those described by Taylor et al, so that clozapine treatment becomes a right for patients and their families.

scholarly journals Differentiating drug-induced parkinsonism from Parkinson's disease: An update on non-motor symptoms and investigations

2014 ◽  
Vol 20 (8) ◽  
pp. 808-814 ◽  
Author(s):  
Francesco Brigo ◽  
Roberto Erro ◽  
Antonio Marangi ◽  
Kailash Bhatia ◽  
Michele Tinazzi
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Motor Symptoms ◽  
Drug Induced ◽  
Non Motor Symptoms

An Exploratory Retrospective Evaluation of Ropinirole-Associated Psychotic Symptoms in an Outpatient Population Treated for Restless Legs Syndrome or Parkinson's Disease

2009 ◽  
Vol 43 (9) ◽  
pp. 1426-1432 ◽  
Author(s):  
Steven C Stoner ◽  
Megan M Dahmen ◽  
Mignon Makos ◽  
Jessica W Lea ◽  
Lora J Carver ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Dopamine Receptors ◽  
Restless Legs Syndrome ◽  
Dopamine Agonists ◽  
Dual Therapy ◽  
Psychotic Symptoms ◽  
Antipsychotic Treatment ◽  
Restless Legs ◽  
Psychotic Features

Background: Traditional treatment approaches for the management of restless legs syndrome (RLS) and Parkinson's disease (PD) include the use of medications that either directly or indirectly increase dopamine levels. In turn, a potential adverse event that could be expected is the development or exacerbation of psychiatric-related symptoms. Objective: To evaluate and describe the incidence of psychosis and associated behavioral features in patients taking ropinirole for RLS or PD. Methods: Patients were identified from a computerized database search of outpatients being treated with ropinirole for 1 of 2 medical conditions: PD or RLS. Data were collected in a retrospective manner from 95 patients who were tracked over the course of their therapy to determine whether psychosis or associated behavioral symptoms developed as a result and whether an intervention was needed to adjust ropinirole dosing or if additional medications had to be added to control features associated with psychosis. Results: A total of 284 patients being treated for RLS or PD were identified; of this group, 95 patients were identified as being treated for PD or RLS with ropinirole. Of the 95 patients being treated with ropinirole, 13 developed psychotic features that required therapeutic intervention with either the use of an antipsychotic or dose adjustment of ropinirole. PD patients included in this study were numerically more likely to develop psychotic features compared with RLS patients; however, the difference was not statistically significant (p = 0.122). The results do suggest that this risk is increased when ropinirole is used as part of a dual therapy approach with dopamine agonists in the treatment of either PD or RLS (p = 0.003). Discussion: Dopamine agonists have long been used as preferred treatment in the management of PD and RLS. When treating either PD or RLS in the psychiatric population, the concern arises that increased activity at dopamine receptors may induce or exacerbate psychiatric features. A potential clinical concern with the use of ropinirole is the potential for patients to develop psychiatric features, although there are few data available to demonstrate whether stimulation of targeted individual dopamine receptors is linked to the development or exacerbation of psychotic features. It is also undetermined whether concurrent antipsychotic treatment provides any protective benefit against psychosis, especially in patients already being treated for psychotic symptoms. Conclusions: Our findings suggest that ropinirole may play a role in inducing or exacerbating psychosis and its associated features, although a number of confounding variables prevent the determination of a clear association and suggest that further investigation is warranted in controlled clinical trials.

Apomorphine therapy: alternative initiation for patients with complex Parkinson's disease presentation

2019 ◽  
Vol 15 (6) ◽  
pp. 264-271 ◽  
Author(s):  
Jane Mills
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Infusion Pump ◽  
Challenge Test ◽  
Patient Specific ◽  
Drug Induced ◽  
Subcutaneous Infusion ◽  
Alternative Approach ◽  
User Friendly ◽  
Dose Injection

The apomorphine challenge test can be a distressing experience for some patients and, if they are not experienced, a discouraging option for some healthcare professionals (HCPs). The test is repeated exposure to bolus-dose injection of the medication to assess response and patient-specific dose before embarking on apomorphine therapy. Recent changes in prescribing of the anti-emetic domperidone (limited use because of QT prolongation), a drug which is a prerequisite for most patients embarking on therapy, has also added a possible complication. While recognising the value of the apomorphine challenge test, the author suggests an alternative approach of establishing apomorphine by subcutaneous infusion pump (SCAI) without the challenge test. This approach makes it more ‘user friendly’ for people with complex Parkinson's disease (PwPd) and their HCPs, and can eliminate the need for preloading with domperidone or other anti-emetic (if one is available in the country of practice). It is a viable option in acute situations, such as nil by mouth, surgery and oral dopamine agonist withdrawal, because of the associated harmful impulsive behaviour. Starting immediately with SCAI without the challenge test has proven both helpful and beneficial in clinical practice, especially in PwPd who have potential to abuse the intermittent injection, have complicated regimens and are vulnerable to drug-induced adverse effects. Some patients only need nocturnal infusions; injections during the night are difficult to administer and miss the objective of better sleep. Facilitating the process of initiation with the SCAI could improve uptake of this underused treatment through easier use and positive experience, and overcome the need for short- and longer-term domperidone use.

scholarly journals Understanding Parkinson’s disease and deep brain stimulation: Role of monkey models

2019 ◽  
Vol 116 (52) ◽  
pp. 26259-26265 ◽  
Author(s):  
Jerrold L. Vitek ◽  
Luke A. Johnson
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Basal Ganglia ◽  
Medical Therapy ◽  
Brain Stimulation ◽  
Functional Organization ◽  
Surgical Approaches ◽  
Drug Induced ◽  
Deep Brain

Parkinson’s disease (PD) is a progressive neurodegenerative movement disorder affecting over 10 million people worldwide. In the 1930s and 1940s there was little understanding regarding what caused PD or how to treat it. In a desperate attempt to improve patients’ lives different regions of the neuraxis were ablated. Morbidity and mortality were common, but some patients’ motor signs improved with lesions involving the basal ganglia or thalamus. With the discovery ofl-dopa the advent of medical therapy began and surgical approaches became less frequent. It soon became apparent, however, that medical therapy was associated with side effects in the form of drug-induced dyskinesia and motor fluctuations and surgical therapies reemerged. Fortunately, during this time studies in monkeys had begun to lay the groundwork to understand the functional organization of the basal ganglia, and with the discovery of the neurotoxin MPTP a monkey model of PD had been developed. Using this model scientists were characterizing the physiological changes that occurred in the basal ganglia in PD and models of basal ganglia function and dysfunction were proposed. This work provided the rationale for the return of pallidotomy, and subsequently deep brain stimulation procedures. In this paper we describe the evolution of these monkey studies, how they provided a greater understanding of the pathophysiology underlying the development of PD and provided the rationale for surgical procedures, the search to understand mechanisms of DBS, and how these studies have been instrumental in understanding PD and advancing the development of surgical therapies for its treatment.

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