Psychotic disorders are not uncommon in late life. These disorders often have
varied etiologies, different clinical presentations, and are associated with
significant morbidity and mortality among the older adult population. Psychotic
disorders in late life develop due to the complex interaction between various
biological, psychological, social, and environmental factors. Given the
significant morbidity and mortality associated with psychotic disorders in late
life, a comprehensive work-up should be conducted when they are encountered. The
assessment should not only identify the potential etiologies for the psychotic
disorders, but also recognize factors that predicts possible outcomes for these
disorders. Treatment approaches for psychotic disorders in late life should
include a combination of nonpharmacological management strategies with the
judicious use of psychotropic medications. When antipsychotic medications are
necessary, they should be used cautiously with the goal of optimizing outcomes
with regular monitoring of their efficacy and adverse effects.
The aim of this editorial is to evaluate the evidence for using pimavanserin for the treatment of Parkinson's disease psychosis (PDP) from randomized controlled trials (RCTs). We only identified two published trials that evaluated the use of pimavanserin among individuals with PDP. Both studies found that pimavanserin improved psychotic symptoms among individuals with PDP when compared to placebo. Pimavanserin was fairly well tolerated in both studies and did not appear to cause significant sedation or worsen motor symptoms among individuals with PDP. However, given the limited data, additional confirmatory studies are required before pimavanserin can be considered as a first line agent for the treatment of psychotic symptoms among individuals with PD.
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