Parkinson’s disease psychosis (PDP) treatment with antipsychotic drugs increase risk of death

By: Emily Lunardo | Brain Function | Thursday, October 01, 2015 - 03:00 PM

Parkinson’s disease psychosis (PDP) treatment with antipsychotic drugs increase risk of deathParkinson’s disease psychosis (PDP) treatment with antipsychotic drugs increases the risk of death, according to the latest research. Antipsychotic drugs are being prescribed for many off-label purposes, especially to adolescents, which is putting people at risk.

Antipsychotic drugs are used for individuals with psychosis, such as schizophrenia. The medications affect neurotransmitters to allow communication between nerve cells.

One study found that many adolescents are being over prescribed antipsychotics for conditions like attention deficit and hyperactivity disorder (ADHD). The study found that prescribing antipsychotic medications to youths for ADHD increases their risk for irreparable brain damage. Not only does the brain become damaged, but in another study it was revealed that these drugs can contribute to weight gain as well, which we know to be a factor for other health complications.

In individuals with Parkinson’s disease, antipsychotic drugs can be even more harmful by increasing the risk of death.


Details about the study

Details about the studyThe findings, published in JAMDA, found that treating Parkinson’s disease psychosis (PDP) with antipsychotic drugs increases the risk of death. Furthermore, those treated with antipsychotic drugs were more likely to experience cognitive decline, worsened Parkinson’s symptoms, stroke, infections and falls.

Roughly seven to 10 million Americans suffers from Parkinson’s disease, which consists of a slow, progressive loss of motor function and cognitive impairment. Psychosis is commonly seen in Parkinson’s patients, presenting as hallucinations and delusions.

Even though more than half of Parkinson’s patients with psychosis use antipsychotic medications to treat it, there is very little evidence to support that the drugs are effective.

Over 400 patients with PDP were assessed on their use of antipsychotic medications. Study participants were placed in two groups: those who received the antipsychotic medications and those who did not.

Professor Clive Ballard from King’s College London said, “Our findings clearly indicate serious risks associated with antipsychotics and highlight the need for greater caution in treating psychosis in Parkinson’s disease. Antipsychotics are known to be linked to serious harm in people with Alzheimer’s disease, and these findings show that a similar, although not identical, risk is seen in people with Parkinson’s.”

Ballard continued, “Our findings therefore strongly suggest that doctors, patients and family members should consider these risks very carefully when considering potential treatments for psychosis and any other behavioral symptom in people with Parkinson’s disease, such as agitation or aggression. Further research is required to develop new, better treatments for psychosis and other behavioral symptoms.”

High occurrence of psychosis in Parkinson’s patients

High occurrence of psychosis in Parkinson’s patientsAs mentioned, psychosis in Parkinson’s disease can manifest itself through hallucinations or delusions. Hallucinations are commonly visual but non-threatening, and only in rare occurrences can they threaten the individual. Some hallucinations can be auditory, but once again these are quite rare and usually accompany visual hallucinations.

Common themes of delusion are spousal infidelity or paranoia. The paranoia can be a fear of being poisoned, having their belonging’s stolen, or having their medication switched. Paranoia can be more threatening than hallucinations. Paranoia may prompt patients to call authorities to report a burglary or report a plot against them.

Psychosis can occur in up to 40 percent of Parkinson’s patients, making it quite common. In the early stages of Parkinson’s, patients with psychosis still have an understanding of what is going on and maintain their insight. As the disease worsens, so does the psychosis and the person can lose touch with reality altogether.

Long-term medication use is thought to contribute to the onset of psychosis in Parkinson’s patients. Another theory suggests lack of sleep and medication use is what can lead to psychosis, but it is still not completely proven yet.


Risk factors for psychosis development in Parkinson’s disease

There are a list of factors, which may increase a person’s risk for Parkinson’s disease psychosis, such as:

  • History of depression
  • Old age
  • Sleep disorders
  • Cognitive impairment
  • Medications which treat Parkinson’s disease
  • Genetic susceptibility


Treatment and management of psychosis

Depending on the severity of the psychosis, there are many different forms of treatment available. If psychosis is mild and the patient still retains their insight, it is best to simply stick with the treatment for Parkinson’s disease. On the other hand, if delusions become threatening, then more aggressive treatment must be conducted.

Management of psychosis in Parkinson’s patients includes:

  • Ruling out reversible causes such as sleep disorders or infections.
  • Decreasing or stopping use of antiparkinsonian drugs. This is to monitor if a certain medication was the cause of the psychosis. Drugs are typically eliminated in the following order: anticholinergic drugs, amantadine, selegiline or rasagiline, dopamine agonists, catechol O-methyltransferase (COMT) inhibitors and finally levodopa.
  • Simplifying the Parkinson’s medication regime.
  • Adding a new or additional antipsychotic medication.
  • Considering the use of medications to treat dementia or cognitive decline.

The best way to manage psychosis with Parkinson’s disease is to notify your doctor right away, so they can begin monitoring it and start treatment as soon as it worsens.

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