Published recently in US Neurology, the peer-reviewed journal from touchNEUROLOGY, Rajesh Pahwa and Kelly E Lyons discuss neuropsychiatric symptoms, such as psychosis, in Parkinson's disease (PD). Most symptoms appear to be due to disease pathology with exacerbation caused by dopaminergic treatment. More than 50% of patients with PD develop psychosis at some point throughout their disease course. Clinicians need to routinely assess patients with PD for psychotic symptoms, particularly hallucinations. Treatment of psychotic symptoms in PD is an unmet need as there are currently no US Food and Drug Administration (FDA) approved medications specifically for PD psychosis (PDP). Current treatments for PDP have been adapted from dopamine antagonists used to treat psychosis in other conditions, such as schizophrenia. Typical antipsychotics, as well as some atypical antipsychotics, worsen PD motor symptoms due to blockade of dopamine D2 receptors. Quetiapine and clozapine have been studied in PDP and are the most commonly used treatments for PDP. Clozapine has been shown to be effective; however, regular bloodwork is required, while data for quetiapine are inconsistent. Pimavanserin, a highly selective serotonin (5HT2A subtype) receptor inverse agonist, is not associated with motor worsening in PDP patients due to the absence of dopamine blockade. In a double-blind, placebo-controlled study, pimavanserin showed significant improvement in moderate to severe psychosis compared to placebo, with good tolerability and without worsening of PD motor symptoms. These data suggest that pimavanserin is a safe and efficacious treatment for PDP psychosis and could be a potential new treatment option for PDP.
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Disclosure: Rajesh Pahwa has served as a consultant, speaker or advisor for AbbVie, Acadia, Acorda, Adamas, Cynapsus, Impax, Lundbeck, Medtronic, Neurocrine, Pfizer, Sage, St Jude Medical, Teva, UCB, and US WorldMeds. He has received research funds awarded to the University of Kansas Medical Center from AbbVie, Acorda, Adamas, Avid, Biotie, Boston Scientific, Cala Health, Civitas, Cynapsus, Kyowa, National Parkinson Foundation, NIH/NINDS, Parkinson Study Group, and US World Meds. Kelly E Lyons has served as a consultant for Adamas, Medtronic, St Jude Medical and US WorldMeds. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published.
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US Neurology, a peer-reviewed, open access, bi-annual journal specialising in the publication of balanced and comprehensive review articles written by leading authorities to address the most important and salient developments in the field of neurology. The aim of these reviews is to break down the high science from 'data-rich' primary papers and provide practical advice and opinion on how this information can help physicians in the day to day clinical setting. Practice guidelines, symposium write-ups, case reports, and original research articles are also featured to promote discussion and learning amongst physicians, clinicians, researchers and related healthcare professionals.