Olanzapine in the treatment of dopamimetic-induced psychosis in patients with Parkinson’s disease

Breier, Alan; Sutton, Virginia K.; Feldman, Peter D.; Kadam, D.; Ferchland, Iris; Wright, Pádraig; Friedman, Joseph H.

doi:10.1016/s0006-3223(02)01392-6

Cited by 181 publications

(120 citation statements)

References 32 publications

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“…This appears secondary to a high number of side effects, many of which were worsening motor symptoms, a finding that is consistent with prior studies. 18,19,25,26 Despite not reaching statistical significance, donepezil again seemed to be slightly better than rivastigmine according to these metrics. Quetiapine users also had a large majority (albeit less than clozapine) with an apparent efficacious response, a finding which is also consistent with prior PD studies and would support the aggressive use of this neuroleptic.…”

mentioning

confidence: 86%

“…17 A third atypical neuroleptic, olanzapine, has lower efficacy, and its utility has been limited by worsening PD motor function. [18][19][20] Many studies, including some related to CATIE (Clinical Antipsychotic Trials in Intervention Effectiveness), raise concerns that any atypical neuroleptic benefits are offset by side effects and intolerability. 21 In these studies, olanzapine and quetiapine were associated with a higher degree of cardiovascular morbidity 22 and weight gain, 23 while the class as a whole was shown to increase the odds of death by 1.3-1.9 times that in the nontreatment group.…”

Section: Introductionmentioning

confidence: 99%

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Tolerability of atypical neuroleptics and acetylcholinesterase inhibitors when treating neuropsychiatric symptoms in Parkinson's disease

Tolleson¹,

Fang²,

Lu³

et al. 2012

JPRLS

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Background: Treating neuropsychiatric problems in Parkinson's disease (PD) remains challenging. Only rivastigmine has US Food and Drug Administration approval for the treatment of PD dementia. Some studies have shown that atypical neuroleptics adequately improve hallucinations while others suggest that side effects and increased mortality negate benefit. We utilized a chart review to assess the tolerability and efficacy of commonly used agents for neuropsychiatric symptoms in PD. Methods: We reviewed patients with a PD diagnosis in our clinic database who were being treated with antidementia agents (donepezil, galantamine, rivastigmine, memantine) or atypical neuroleptics (quetiapine, olanzapine, clozapine) by two PD specialists over 13 years. We determined tolerability by therapy retention in comparison with the accepted gold standard, ie, rivastigmine for dementia and clozapine for hallucinations. Clinician documentation of patient/ caregiver or personally perceived clinical improvement was recorded to define therapeutic response. Secondary outcome measures were death, treatment-limiting side effects, and weight change. Results: A total of 171 PD patients met criteria for study inclusion. All medications were similarly retained in comparison with the standard, with the exception of donepezil which was significantly better (P , 0.02) than rivastigmine. Using the documentation metric, no medication was statistically superior to its standard. Olanzapine approached significance because it was inferior to the clozapine standard (P , 0.08). Secondary outcome measures were similar among medications. Conclusion: We conclude that, as a group, acetylcholinesterase inhibitors, atypical neuroleptics, and memantine are well tolerated in treating either cognitive difficulties or hallucinations in PD. They appear to offer variable levels of clinical benefit, as well per documented therapeutic responses. Side effects, death, and weight change were not significantly different among medications.

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confidence: 86%

Section: Introductionmentioning

confidence: 99%

Tolerability of atypical neuroleptics and acetylcholinesterase inhibitors when treating neuropsychiatric symptoms in Parkinson's disease

Tolleson¹,

Fang²,

Lu³

et al. 2012

JPRLS

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“…After a single open label study demonstrating a good effect of olanzapine in PDP [74], rivaling that reported in the open label reports for clozapine, four double blind controlled trials were launched [75][76][77]. Unfortunately, olanzapine produced similar results in all studies: the drug was ineffective for the psychosis and worsened Parkinson motor features.…”

Section: Managementmentioning

confidence: 99%

Parkinson Disease Psychosis: Update

Friedman

2013

Behavioural Neurology

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Abstract. Psychotic symptoms are common in drug treated patients with Parkinson's disease (PD). Visual hallucinations occur in about 30% and delusions, typically paranoid in nature, occur in about 5%. These problems, particularly the delusions, cause great distress for patient and caregivers, and are among the most important precipitants for nursing home placement. Psychotic symptoms carry a poor prognosis. They often herald dementia, and are associated with increased mortality. These symptoms often abate with medication reductions, but this may not be tolerated due to worsened motor function. Only clozapine has level A evidence to support its use in PD patients with psychosis (PDP), whether demented or not. While quetiapine has been recommended by the American Academy of Neurology for "consideration," double blind placebo controlled trials have demonstrated safety but not efficacy. Other antipsychotic drugs have been reported to worsen motor function and data on the effectiveness of cholinesterase inhibitors is limited. PDP remains a serious problem with limited treatment options.

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“…[25][26][27] Three double-blind, placebocontrolled studies showed no benefit of olanzapine compared to placebo for PDP and significant worsening of PD motor symptoms was observed. [28][29][30] Risperidone has also been studied as a treatment for PDP. Several small open-label studies demonstrated improvement in PDP with risperidone, but results were inconsistent regarding the worsening of motor symptoms.…”

Section: Antipsychotic Treatments To Avoidmentioning

confidence: 99%

A New Perspective in the Treatment of Parkinson’s Disease Psychosis

Pahwa¹,

Lyons²

2016

US Neurology

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N europsychiatric symptoms, such as psychosis, are well described in Parkinson's disease (PD); most 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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Olanzapine in the treatment of dopamimetic-induced psychosis in patients with Parkinson’s disease

Cited by 181 publications

References 32 publications

Tolerability of atypical neuroleptics and acetylcholinesterase inhibitors when treating neuropsychiatric symptoms in Parkinson's disease

Tolerability of atypical neuroleptics and acetylcholinesterase inhibitors when treating neuropsychiatric symptoms in Parkinson's disease

Parkinson Disease Psychosis: Update

A New Perspective in the Treatment of Parkinson’s Disease Psychosis

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Olanzapine in the treatment of dopamimetic-induced psychosis in patients with Parkinson’s disease

Cited by 181 publications

References 32 publications

Tolerability of atypical neuroleptics and acetylcholinesterase inhibitors when treating neuropsychiatric symptoms in Parkinson&#39;s disease

Tolerability of atypical neuroleptics and acetylcholinesterase inhibitors when treating neuropsychiatric symptoms in Parkinson&#39;s disease

Parkinson Disease Psychosis: Update

A New Perspective in the Treatment of Parkinson’s Disease Psychosis

Contact Info

Product

Resources

About

Tolerability of atypical neuroleptics and acetylcholinesterase inhibitors when treating neuropsychiatric symptoms in Parkinson's disease

Tolerability of atypical neuroleptics and acetylcholinesterase inhibitors when treating neuropsychiatric symptoms in Parkinson's disease