Long‐term outcome of quetiapine use for psychosis among parkinsonian patients

Abstract

To evaluate the long-term efficacy and tolerability of quetiapine for psychosis among parkinsonian patients, a retrospective analysis of all parkinsonian patients taking quetiapine for psychosis in a single movement disorders center was carried out. Demographic data, including type and severity of psychosis, presence of dementia, treatment response, before and after Unified Parkinson's Disease Rating Scale (UPDRS)-motor scores and Hoehn and Yahr (H&Y) scale were obtained. One hundred six parkinsonian patients with a mean age of 76.6 years were on an average levodopa (L-dopa) dose of 415 mg/d. Seventy-eight of 106 (74%) remained on quetiapine for a mean duration of 15 months at an average dose of 60 mg per day. Eighty-seven (82%) patients had partial or complete resolution of their psychosis whereas 19 (18%) patients had no improvement on quetiapine. Motor worsening was noted in 34 (32%) patients but was uncommonly sufficient to warrant quetiapine discontinuation. More quetiapine non-responders were noted to be demented, delusional, and experienced threatening psychosis but only the presence of dementia remained significant on multivariate analysis (OR = 11.6; 95% CI = 1.4-92.9). Also, patients who developed motor worsening while on quetiapine tended to be more demented (P = 0.07).

Dementia in Parkinson's Disease: A Clinical Review

“…The results of these three studies, although limited by the open design and small sample, are aligned with those of previous clinical studies with donepezil, rivastigmine and tacrine, which were reviewed in a recent study and suggested that the cholinesterase inhibitors could be useful in the treatment of patients with dementia in PD (Fernandez et al, 2003). An open label study about the efficacy of donepezil in PDD was demonstrated that the cholinesterase inhibitor donepezil can improve cognitive and psychiatric deficits in DLB and PDD patients and this is reflected in a reduction in carer distress (Thomas et al, 2005).…”

Diagnosis and treatment of impulse control disorders in patients with movement disorders

“…Quetiapine is typically used first because clozapine requires long-term hematological monitoring. This advantage has to be weighed against the observation that motor worsening with quetiapine can happen in 32% of Parkinsonian patients and lead to discontinuation in 9% of those patients [Fernandez et al 2003]. Anecdotally, quetiapine in doses of 100-200 mg triggered punding in two patients with PD and psychosis, which resolved with dose reduction [Miwa et al 2004].…”

Recognition and management of neuropsychiatric complications in Parkinson's disease

“…Atypical antipsychotic agents are less likely to cause extrapyramidal side effects. Among them, quetiapine is the current first-line choice (on the basis of open-labelled studies 30,31 ), at a starting dose of 12.5-25 mg/d at bedtime and a mean maintenance dose of about 75 mg/d. Clozapine is most efficacious, 32 at often low daily doses (12.5-50 mg/d), but it is still considered by clinicians as a second-line choice because of the risk of agranulocytosis and the need for frequent monitoring of blood counts.…”