Pharmacological Management of Psychosis in Elderly Patients with Parkinsonism - 12/08/11

Doi : 10.1016/j.amjmed.2009.01.025

Mehrul Hasnain, MD ^a,^⁎ , W. Victor R. Vieweg, MD ^b,^d,^f,^h, Mark S. Baron, MD ^c,^g, Mary Beatty-Brooks, MA ^e, Antony Fernandez, MD ^b,^f, Anand K. Pandurangi, MD ^f
^a Department of Psychiatry, Western Regional Integrated Health Authority, Sir Thomas Roddick Hospital, Stephenville, Newfoundland, Canada
^b Department of Psychiatry, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va
^c Department of Neurology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va
^d Department of Medicine Services, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va
^e Department of Medical Media, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va
^f Department of Psychiatry, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond
^g Department of Neurology, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond
^h Department of Internal Medicine, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond

Requests for reprints should be addressed to Mehrul Hasnain, MD, Sir Thomas Roddick Hospital, 142 Minnesota Drive, Stephenville, Newfoundland A2N 2V6, Canada

Abstract

Parkinsonism is a characteristic feature of Parkinson's disease and dementia with Lewy bodies and is commonly seen in Alzheimer's disease. Psychosis commonly appears during the course of these illnesses. Treatment of parkinsonism with antiparkinsonian medications constitutes an additional risk factor for the appearance or worsening of psychosis. Conversely, treatment of psychosis with antipsychotic drugs in patients with parkinsonism might worsen the underlying movement disorder, especially in the elderly. In this article, we review parkinsonian conditions in the elderly and offer guidelines to assess and manage comorbid psychosis. We focus on the pharmacologic management of psychosis with atypical antipsychotic medications and briefly review the role of acetylcholinesterase inhibitors.

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Keywords : Antipsychotic drugs, Basal ganglia, Dementia, Lewy bodies, Parkinson's disease, Psychosis

Esquema

Common Parkinsonian Conditions in the Elderly: An Overview

Parkinson's Disease

Dementia with Lewy Bodies

Alzheimer's Disease with Extrapyramidal Signs

Pathophysiology of Parkinsonism and Psychosis

Parkinsonism and the Basal Ganglia

Psychosis

Link between Parkinsonism and Psychosis

Clinical Management of Comorbid Parkinsonism and Psychosis

Baseline Assessment and Monitoring of Parkinsonism and Psychosis

Ruling Out Secondary Parkinsonism

Diagnostic Clarity of Parkinsonian Features

Ruling Out Other Causes for Psychosis

Recognizing that Antiparkinsonian Medications Might Induce Psychosis

Potential for Antipsychotic Medications to Cause Parkinsonism

Pharmacologic Treatment of Psychosis in Patients With Concurrent Parkinsonism

Atypical Antipsychotic Medications

Use of Atypical Antipsychotic Drugs for Treatment of Psychosis and Behavioral Problems in Dementia

Other Adverse Effects of Atypical Antipsychotic Drugs

Cholinesterase Inhibitors

Conclusions

	Funding: None.
	Conflict of Interest: Dr Pandurangi is on the speaker's bureau of Astra-Zeneca, Bristol Myers Squibb, Janssen, and Pfizer Pharmaceuticals. The other authors do not have any potential conflict of interest to disclose.
	Authorship: All authors had access to the data and played a role in writing this manuscript.