Antipsychotic Use in Parkinson`s Disease

The prevailing psychotic symptoms in Parkinson’s Disease (PD) are hallucinations and delusions. Hallucinations are sensory phenomena that are not induced by physical stimuli, and occur in each sensory modality. Visual hallucinations are the most common psychotic symptoms in PD followed by auditory hallucinations. Before treating psychotic symptoms in PD, it is important to rule out an underlying medical illness as the cause of the symptoms, like urinary and pulmonary infections, metabolic and endocrine imbalances, cerebral hypoperfusion states and psychosocial stressors. Antipsychotics medications lower brain dopaminergic transmission and can cause or worsen parkinsonism by diminishing dopaminergic transmission in the nigrostriatal pathways. Prior to the introduction of clozapine there was no effective treatment, and by the time being, is the only antipsychotic that has level I evidence to support its use in PD patients. Several open label studies on quetiapine for the treatment of psychosis in PD have been reported. Some of them showed quetiapine to be effective without worsening motor function while in others it was reported as ineffective although well tolerated.

Keywords: Adverse Drug Reactions, Aripiprazole, Cholinesterase Inhibitors, Clozapine, Delusions, Drug Holidays, Elderly, Electroconvulsive Therapy, First Generation Antipsychotics, Hallucinations, Melperone, Olanzapine, Parkinson’s Disease, Pimavanserine, Psychosis, Quetiapine, Risperidone, Second Generation Antipsychotics, Strategies, Ziprasidone.