Use of clozapine in Brazilian patients with Parkinson's disease

Gomide, Laura; Kümmer, Arthur; Cardoso, Francisco; Teixeira, Antônio Lúcio

doi:10.1590/s0004-282x2008000500001

Cited by 16 publications

(16 citation statements)

References 19 publications

(28 reference statements)

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“…Clozapine improve significantly psychosis without worsening motor signs 82,83 . In fact, clozapina is the only antipsychotic with established efficacy based on randomized placebo-controlled trials [84][85][86] .…”

Section: Pychotic Symptomsmentioning

confidence: 93%

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Neuropsychiatry of Parkinson's disease

Kümmer

Teixeira

2009

Arq. Neuro-Psiquiatr.

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-Parkinson's disease (PD) is traditionally regarded as a movement disorder. In recent years, however, non-motor symptoms have been considered significant factors of disability at all stages of the illness. Behavioral and psychological symptoms or neuropsychiatric syndromes associated with PD are frequent and may represent a challenge in the management of these patients. They include anxiety, depression, psychosis, sleep, sexual and impulse control disorders, apathy and cognitive dysfunction. Their pathogenesis in PD is complex, involving neurodegenerative, drug-related and psychological mechanisms. We will review the current knowledge of this growing field, also focusing on the management of theses syndromes.KEY WORDS: Parkinson's disease, neuropsychiatry, psychology, psychiatric disorders. Neuropsiquiatria da doença de ParkinsonResumo -A doença de Parkinson (DP) é tradicionalmente conhecida como um distúrbio do movimento. Entretanto, os sintomas não-motores têm sido considerados recentemente como fatores relevantes de incapacidade em todos os estágios da doença. Sintomas motores e comportamentais ou síndromes neuropsiquiátricas associadas à DP são frequentes e seu manejo pode se tornar um verdadeiro desafio. São comuns quadros de ansiedade, depressão, psicose, distúrbios do sono, transtornos do controle do impulso, apatia e disfunções cognitivas. A patogênese desses transtornos na DP é complexa, envolvendo mecanismos degenerativos, psicológicos e relacionados ao tratamento. Neste artigo, revisamos o estado do conhecimento desse campo de interesse crescente, também enfocando o manejo dessas síndromes. PALAVRAS-CHAVE: doença de Parkinson, neuropsiquiatria, psicologia, transtornos psiquiátricos.

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Section: Pychotic Symptomsmentioning

confidence: 93%

“…In fact, clozapina is the only antipsychotic with established efficacy based on randomized placebo-controlled trials [84][85][86] . Clozapine may also decrease dyskinesias 87 , but it has low tolerability among elderly with PD 83 . Hence, clozapine must be used judiciously in elderly patients.…”

Section: Pychotic Symptomsmentioning

confidence: 99%

Neuropsychiatry of Parkinson's disease

Kümmer

Teixeira

2009

Arq. Neuro-Psiquiatr.

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“…[36][37][38] In 2004, Pollak et al 36 conducted a multiphase RCT in 60 patients with PO to determine the effectiveness and tolerability of clozapine in drug-induced psychosis. At baseline, the mean age of study participants was -71 years, the dura- …”

Section: Clozapine Studiesmentioning

confidence: 99%

Management of hallucinations and psychosis in Parkinson's disease

Eng

Welty

2010

The American Journal of Geriatric Pharmacotherapy

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Abstract:BACKGROUND: Hallucinations and psychosis are common in patients with Parkinson's disease (PD), with reported prevalences of up to 48% and 80%, respectively. However, few randomized, double-blind, placebo-controlled trials evaluating the treatment options have appeared in the literature. The studies that have been published were complicated by lack of agreement on the diagnosis of psychosis in PD, poor completion rates, mixed populations that included dementia, and other issues. Several reviews, guidelines, and consensus statements have sought to establish standards for treating these symptoms of PD. In 2006, the American Academy of Neurology (AAN) published a practice guideline (based on articles published up to 2004) for management of depression, psychosis, and dementia in patients with PD. Since then, a number of relevant studies have been published. OBJECTIVE: The purpose of this article was to review data that have appeared in the literature since publication of the AAN guideline regarding the management of hallucinations and psychosis in PD. METHODS: A literature search of the PubMed, CINAHL, and PsychInfo databases was conducted for human studies published in English from January 2004 to June 2010. All clinical studies were included except case reports and case series. Studies with <20 participants were also excluded. Search terms included psychosis, hallucinosis, hallucination, delusion, Parkinson, atypical antipsychotic, neuroleptic, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and ziprasidone. RESULTS: Thirteen studies were included in the review: 3 studies of clozapine, 7 studies of quetiapine, 2 head-to-head trials comparing quetiapine and clozapine, and 1 noncomparative trial of clozapine or quetiapine interventions. Most of the studies included participants with a mean age in the early to mid 70s and a mean duration of PD typically >10 years. CONCLUSIONS: Results of the identified studies suggested that patients with PD might benefit from long-term clozapine therapy. Results of the quetiapine studies were conflicting. However, no statistically significant difference in effectiveness was found between quetiapine and clozapine in comparative trials. The significance of the differences in treatment responses between patients with dementia and those without dementia remains unclear, and it was not possible to draw conclusions for or against other atypical antipsychotics because of insufficient evidence. Further studies are needed to address the methodologic issues in the current trials and to assess safety issues in larger cohorts. Eng, Marty L. and Welty, Timothy E. (1999) Management of Hallucinations and Psychosis in Parkinson's Disease. Am J Geriat Pharm. 8(4), 316-330. PMID: 20869621. Publisher's official version:

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“…Dentary problems may occur because the lack of orofacial muscle control, reduced saliva and compromised manual control, having also relating to cognitive deficit . The clozapine, neuroleptic and antipsychotic drug and with inhibitory action on the dopaminergic receptors showed positive effects in the control of the symptoms ones, without, however, to interfer in the motor deficiency board 16,18 . The amantadine, like classically described, exertes pre-and postsynaptic dopaminergic action, mild antiparkinsonian activity and come being used like antidyskinetic agent 19 .…”

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confidence: 99%

“…Such effects can be motors or non-motors 17 and some of this ones achieved the point of to limit the use of the substance. The clozapine, for example, may to cause a myriad of effects that limit the use, like excessive sedation, drooling, dry mouth, vomit, weakness or muscle spasm, dyspnea, tremor, neutropenia, thrombocytopenia, urinary incontinency, epigastric pain and diarrhoea, sickness and grave intestinal constipation, diplopia, hallucination and agitation 16,18 . Among cholinergic adverse effects, include deficits of memory, hallucinations, sedation and ailment.…”

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confidence: 99%

Interferência do tratamento medicamentoso imediato e tardio na doença de Parkinson no gerenciamento da disfagia

et al. 2014

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A Doença de Parkinson apresenta grande incidência na população idosa, gerando comprometimento motor progressivo, que afeta várias funções, dentre as quais se destaca a deglutição. Esse trabalho teve como objetivo relacionar a disfagia na Doença de Parkinson aos efeitos imediatos e/ou tardios do tratamento medicamentoso, que de forma direta ou indireta interferirá no gerenciamento fonoaudiológico. Fizemos uma revisão de literatura nas bases de dados eletrônicas Lilacs, Scielo, Medline e Pubmed no período de 2001 a 2011, utilizando os termos livres “Doença de Parkinson”; (Parkinson Disease), “deglutição”; (deglutition), “disfagia”; (dysphagia), “preparações farmacêuticas”; (pharmaceutical preparations), “levodopa”;, “videofluoroscopia”; (videofluoroscopy), além de um documento governamental (OPAS, 2002), artigos relevantes e exemplares da literatura americana e brasileira sobre o tema. A literatura aponta a Levodopa como o principal tratamento farmacológico da doença de Parkinson. Contudo, a melhora dos sintomas motores deve ser ponderada em função da ocorrência de efeitos colaterais importantes, sejam imediatos ou tardios. Até o momento não há respostas consistentes a favor da melhora da disfagia como resultado do tratamento farmacológico, cujos efeitos podem interferir direta ou indiretamente sobre as manifestações disfágicas e de várias formas. Assim, torna-se fundamental o registro das medicações como parte da anamnese, considerando que tais dados possam auxiliar na orientação/reorientação da conduta fonoaudiológica, especialmente em contexto interdisciplinar. A despeito da possibilidade do doente de Parkinson responder de forma inconsistente à terapia farmacológica, vale ressaltar que o profissional deve estar atento à presença de efeitos colaterais como fatores modificadores do quadro de disfagia orofaríngea na Doença de Parkinson idiopática.

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Use of clozapine in Brazilian patients with Parkinson's disease

Cited by 16 publications

References 19 publications

Neuropsychiatry of Parkinson's disease

Neuropsychiatry of Parkinson's disease

Management of hallucinations and psychosis in Parkinson's disease

Interferência do tratamento medicamentoso imediato e tardio na doença de Parkinson no gerenciamento da disfagia

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