Impact of Current Antipsychotic Medications on Comparative Mortality and Adverse Events in People With Parkinson Disease Psychosis

Ballard, Clive; Isaacson, Stuart; Mills, Roger; Williams, Hilde; Corbett, Anne; Coate, Bruce; Pahwa, Rajesh; Rascol, Olivier; Burn, David J.

doi:10.1016/j.jamda.2015.06.021

Cited by 49 publications

(28 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Despite the lack of an evidence base, atypical and typical antipsychotics continue to be used in clinical practice 144 , but are associated with increased mortality in the context of clinical trials 145 and a retrospective database analysis, which ranked haloperidol as carrying the highest risk, followed by olanzapine, risperidone and quetiapine 144 . Such evidence cautions against the use of antipsychotics in PD, and highlights the need for further studies in this area, as well as the development of new therapeutic approaches for PD psychosis.…”

Section: Treatmentmentioning

confidence: 99%

The psychosis spectrum in Parkinson disease

et al. 2017

Self Cite

View full text Add to dashboard Cite

In 2007, the clinical and research profile of illusions, hallucinations, delusions and related symptoms in Parkinson disease (PD) was raised with the publication of a consensus definition of PD psychosis. Symptoms that were previously deemed benign and clinically insignificant were incorporated into a continuum of severity, leading to the rapid expansion of literature focusing on clinical aspects, mechanisms and treatment. Here, we review this literature and the evolving view of PD psychosis. Key topics include the prospective risk of dementia in individuals with PD psychosis, and the causal and modifying effects of PD medication. We discuss recent developments, including recognition of an increase in the prevalence of psychosis with disease duration, addition of new visual symptoms to the psychosis continuum, and identification of frontal executive, visual perceptual and memory dysfunction at different disease stages. In addition, we highlight novel risk factors — for example, autonomic dysfunction — that have emerged from prospective studies, structural MRI evidence of frontal, parietal, occipital and hippocampal involvement, and approval of pimavanserin for the treatment of PD psychosis. The accumulating evidence raises novel questions and directions for future research to explore the clinical management and biomarker potential of PD psychosis.

show abstract

Section: Treatmentmentioning

confidence: 99%

The psychosis spectrum in Parkinson disease

et al. 2017

Self Cite

View full text Add to dashboard Cite

show abstract

“…Although the reasons are not well defined, antipsychotic medications are also associated with increased mortality in vulnerable populations receiving off-label prescriptions including children [12] and older adults [13][14]. Clinical data indicate that schizophrenic patients are more susceptible to infections [15]; the role of medications, per se, on the increased susceptibility to infections in this population has not been clearly delineated.…”

Section: Introductionmentioning

confidence: 99%

The antipsychotic medication, risperidone, causes global immunosuppression in healthy mice

et al. 2019

View full text Add to dashboard Cite

Atypical antipsychotic medications such as risperidone are widely prescribed for diverse psychiatric indications including schizophrenia, bipolar disorder and depression. These medications have complex pharmacology and are associated with significant endocrine and metabolic side effects. This class of medications also carries FDA black box warnings due to increased risk of death in elderly patients. Clinical reports indicate that patients treated with these medications are more susceptible to infections; however, the underlying mechanisms/pharmacology are unclear. We have previously reported that risperidone and it's active metabolite distributes to the bone marrow in clinically relevant concentrations in preclinical species, leading us to hypothesize that the hematopoietic system may be impacted by these medications. To test this hypothesis, using proteomic and cytokine array technology, we evaluated the expression of genes involved in inflammatory and immune function following short term (5 days) and longer term (4 weeks) treatment in healthy animals. We report that low-dose risperidone treatment results in global immunosuppression in mice, observed following 5 days of dosing and exacerbated with longer term drug treatment (4 weeks). These data are consistent with increased susceptibility to infection in patients administered these medications and have profound implications for the increasing off-label prescribing to vulnerable patient populations including children and the elderly.

show abstract

“…The relatively few nonelderly adults with Parkinson disease may have had higher rates of AP use due to psychosis or dementia‐like symptoms occurring before reaching older adulthood. Antipsychotic use for Parkinson‐related psychosis has been associated with adverse events such as increased mortality, worsening parkinsonism, and cognitive decline . To minimize residual harm, careful observation for adverse effects and appropriate titration procedures must be implemented for SNF residents with Parkinson disease who are prescribed APs.…”

Section: Discussionmentioning

confidence: 99%

“…Antipsychotic use for Parkinson-related psychosis has been associated with adverse events such as increased mortality, worsening parkinsonism, and cognitive decline. 44,45 To minimize residual harm, careful observation 46 This likelihood of institutionalization increases with greater age and if the patient was living alone prior to the injury. 47 In our study population, TBI frequencies were found to be fourfold, 11 should not be considered a limitation.…”

Section: Third Potentially Disconcerting Off-label Conditions Such Asmentioning

confidence: 99%

Age‐dependent determinants of antipsychotic use among newly admitted residents of skilled nursing facilities: A population‐based study

Jester

Hyer

Molinari

et al. 2018

Int J Geriat Psychiatry

View full text Add to dashboard Cite

Correlates of AP use varied by age, with stronger associations between on-label conditions and AP use among younger adults and off-label conditions among older adults. Several less conventional determinants, namely, Parkinson disease, traumatic brain injury, and the use of physical restraints were identified to increase the likelihood of AP use. This study highlights the importance of monitoring for adverse effects for residents of all ages.

show abstract

Impact of Current Antipsychotic Medications on Comparative Mortality and Adverse Events in People With Parkinson Disease Psychosis

Cited by 49 publications

References 23 publications

The psychosis spectrum in Parkinson disease

The psychosis spectrum in Parkinson disease

The antipsychotic medication, risperidone, causes global immunosuppression in healthy mice

Age‐dependent determinants of antipsychotic use among newly admitted residents of skilled nursing facilities: A population‐based study

Contact Info

Product

Resources

About