Parkinson’s Disease Psychosis – Patterns of Care and Treatment in the EU-5 from Neurologists’ Perspective

Abstract

Over half of patients with Parkinson’s disease (PD) develop symptoms of psychosis during the course of their disease. Existing guidelines include recommendations for managing symptoms of psychosis in patients with PD. However, the extent to which such recommendations translate to clinical practice in major European nations is unclear. The current study describes trends in the clinical management of patients diagnosed with PD psychosis (PDP) based on survey responses and patient chart reviews from 437 neurologists across France, Germany, Italy, Spain, and the UK (collectively, the EU-5). Surveyed neurologists reported that PDP typically manifests four or more years after the diagnosis of PD, with the most commonly reported initial symptoms being moderately disruptive visual hallucinations, agitation, and illusions/false sense of presence. PD medications adjustment was the most common first-line intervention, applicable to an estimated 59–79% of patients for the initial management of PDP depending on country. Responses from surveyed neurologists suggest PD medications adjustment is a temporary solution for many patients with PDP and that there is considerable variability in subsequent lines of intervention. The current report provides a resource for understanding the patterns of care and treatment for PDP across these major European nations.

Parkinson’s Disease Psychosis – Prevalence Patterns Across the EU-5

“…Data on PDP treatment patterns among neurologists in the EU-5 are also limited and are presented in a separate report. 33 In the current study, the estimated prevalence rates for PDP among patients with PD in the EU-5 nations are in line with those reported in previous studies.…”

“…A report of survey data related to treatment patterns for patients with PDP in the EU-5 is presented in a separate report. 33 …”

Comparison of Pimavanserin Versus Quetiapine for Hospitalization and Mortality Risk Among Medicare Beneficiaries with Parkinson's Disease Psychosis

“…When pharmacotherapy for PD psychosis is indicated, the most recent Movement Disorders Society Evidence‐Based Medicine review identified clozapine and pimavanserin as efficacious and “clinically useful.” Quetiapine was deemed “possibly useful” due to insufficient clinical trial evidence 3 . Because pimavanserin is newly available in the United States and clozapine requires specialized monitoring, quetiapine remains a frequently used first‐line agent for the treatment of PD psychosis 4–6 …”

“…3 Because pimavanserin is newly available in the United States and clozapine requires specialized monitoring, quetiapine remains a frequently used first-line agent for the treatment of PD psychosis. [4][5][6] Approved by the US Food and Drug Administration (FDA) in 2016, pimavanserin is the only medication specifically indicated for the treatment of PD psychosis in the United States. Pimavanserin is distinct from other antipsychotics because its mechanism of action is via serotonin (5-HT) 2A receptor activity and avoids effects on dopamine receptors, which can worsen parkinsonism.…”