Patterns and Trends in Antipsychotic Prescribing for Parkinson Disease Psychosis

Weintraub, Daniel; Chen, Peijun; Ignacio, Rosalinda V.; Mamikonyan, Eugenia; Kales, Helen C.

doi:10.1001/archneurol.2011.139

Cited by 100 publications

(79 citation statements)

References 39 publications

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“…The use of antipsychotic drugs to treat psychosis in Parkinson's disease patients is dif fi cult to achieve without worsening the bradykinesia of the neurological disorder. Clozapine, and low doses of quetiapine have been tolerated and effective in this circumstance, but most other older and many modern antipsychotic agents tend to worsen bradykinesia in Parkinson's disease, surprisingly, including the dopamine partial-agonist aripriprazole [ 27,80,226 ] . ECT also may be effective and tolerated in psychosis associated with Parkinson's disease [ 214 ] .…”

Section: Adverse Neurological Effectsmentioning

confidence: 99%

Antipsychotic Agents

Baldessarini

2012

Chemotherapy in Psychiatry

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Section: Adverse Neurological Effectsmentioning

confidence: 99%

Antipsychotic Agents

Baldessarini

2012

Chemotherapy in Psychiatry

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“…Aripiprazole, which we did not include in this study, is clinically used for psychosis in PD because its pharmacological function is distinct from other APs. 41) One single arm, open-label study previously evaluated the utility of aripiprazole. 42) The study reported that aripiprazole significantly improved psychosis based on the BPRS, but caused deterioration of motor function leading to the study's discontinuation.…”

Section: Discussionmentioning

confidence: 99%

Comparative Utility of Atypical Antipsychotics for the Treatment of Psychosis in Parkinson’s Disease: A Systematic Review and Bayesian Network Meta-analysis

Iketani

Kawasaki

Yamada

2017

Biological & Pharmaceutical Bulletin

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We performed a systematic review and Bayesian network meta-analysis to determine atypical antipsychotics that are effective and safe for the treatment of psychosis in Parkinson's disease (PD). We conducted a comprehensive literature search using PubMed/MEDLINE, Cochrane Library, and Japana Centra Revuo Medicina (Ichu-shi Web). We used randomized controlled trials evaluating the utility of atypical antipsychotics for the treatment of psychosis in PD using the Brief Psychiatric Rating Scale (BPRS) and the Unified PD rating Scale parts III (UPDRS-III) as the endpoints. Posterior distributions of mean differences between each treatment and placebo were estimated using Bayesian network meta-analysis. The distributions describing each treatment effect were expressed as means (95% credible intervals). Ten trials involving any two treatment arms using clozapine (64 subjects in four trials), olanzapine (99 subjects in three trials), quetiapine (79 subjects in five trials), risperidone (five subjects in one trial), or placebo (156 subjects in seven trials) were finally included in the present study. Pooled estimates of each posterior distribution based on the BPRS were as follows: clozapine, 2.0 ( 6.7 to 2.7); olanzapine, 0.5 ( 2.3 to 3.4); quetiapine, 0.3 ( 3.9 to 4.5); and risperidone, 4.7 ( 57.4 to 53.3). Based on the UPDRS-III, the pooled estimates were clozapine, 0.7 ( 3.8 to 4.3); olanzapine, 2.8 (0.8 to 5.1); quetiapine, 3.3 ( 0.7 to 5.8); and risperidone, 4.5 ( 57.7 to 63.4). Although clozapine had an effective and relatively safe profile, all atypical antipsychotics included in the present study may be unsafe, as they may worsen motor function when compared to placebo.

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“…Respecto a la demencia asociada a la enfermedad de Parkinson, se ha demostrado que el uso de antipsicóticos es común, pero se debe tener en cuenta que la risperidona y la olanzapina tienen una eficacia limitada y pueden empeorar el parkinsonismo, así como algunos de los clásicos que empeoran estos síntomas, por lo cual la American Academy of Neurology ha recomendado manejarlos con fármacos como la clozapina (30,31).…”

Section: Discussionunclassified

“…La elevada prescripción de antiparkinsonianos y el riesgo de antagonismo con los antipsicóticos, deben conllevar evaluaciones especiales de estos pacientes para evitar la pérdida de eficacia del tratamiento de cualquiera de las dos condiciones y el incremento de efectos indeseables (30,31). Las otras enfermedades asociadas se presentaron en menor proporción, pero son evidencia de que la esquizofrenia se puede asociar con otras condiciones que afectan la calidad de vida de los pacientes.…”

Section: Discussionunclassified

Patrones de prescripción de antipsicóticos en pacientes afiliados al Sistema de Seguridad Social en Salud de Colombia

Machado‐Alba

Morales-Plaza

2013

biomedica

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Introducción. La esquizofrenia altera la percepción del individuo, el pensamiento, el afecto y el comportamiento. El tratamiento farmacológico puede mejorar estas manifestaciones. Objetivo. Determinar los patrones de prescripción de medicamentos antipsicóticos en un grupo de pacientes afilados al Sistema General de Seguridad Social en Salud de Colombia. Materiales y métodos. Se llevó a cabo un estudio descriptivo sobre base de datos de 6,2 millones de personas. Se seleccionaron los pacientes medicados con antipsicóticos, de ambos sexos, todas las edades, con tratamiento continuo de marzo a junio de 2012, y residentes de 57 ciudades colombianas. Se diseñó una base de datos sobre consumo de medicamentos, obtenidos por la empresa que dispensa dichos fármacos. Resultados. Se estudiaron 3.075 pacientes con edad promedio de 55,8±21,5 años; 50,3 % eran mujeres; 81,9 % recibían monoterapia y, 18,1 %, dos o más antipsicóticos. El orden de prescripción fue: atípicos, 77,1 %, y clásicos, 31,9 %. Los medicamentos más utilizados fueron: quetiapina (30,3 %), clozapina (23,7 %), levomepropamiza (18,4 %) y risperidona (14,9 %). Las combinaciones más frecuentes fueron: haloperidol más levomepromazina (n=67; 12,1 % de las asociaciones), clozapina más pipotiazina (n=54; 9,7 %) clozapina más risperidona (n=45; 8,1 %), quetiapina más levomepromazina (n=40; 7,2 %). Los medicamentos prescritos concomitantemente más frecuentes fueron: antidepresivos (n=998; 32,5 %); ansiolíticos (n=799; 26,0 %); hipolipemiantes (n=672; 21,9 %); antiparkinsonianos (341; 11,1 %) y antidiabéticos (n=327; 10,6 %). Conclusiones. Predominan los hábitos de prescripción de medicamentos de alto valor terapéutico, principalmente en la monoterapia antipsicótica. En la mayoría, se emplean en dosis superiores a las recomendadas. Se plantea la necesidad de diseñar estrategias educativas para corregir algunos hábitos de prescripción e investigaciones que evalúen la efectividad del tratamiento.Palabras clave: esquizofrenia, prescripciones de medicamentos, antipsicóticos, clozapina, haloperidol, farmacoepidemiología, Colombia. doi: http://dx.doi.org/10.7705/biomedica.v33i3.1529 Antipsychotic prescription patterns in patients affiliated to the Social Security Health System in ColombiaIntroduction: Schizophrenia alters individual perception, thought, affection and behavior. Drug therapy can improve these manifestations. Objective: To determine prescription patterns of antipsychotic drugs in a group of patients affiliated to the Social Security Health System in Colombia. Materials and methods:This was a descriptive study with a 6.2 million people database. We selected 3,075 patients medicated with antipsychotics, of both sexes, and all ages, with continuous treatment from March to June, 2012, and residing in 57 Colombian cities. We designed a database on drug consumption, obtained by the company that distributes the drugs to the patients. Results: A total of 3,075 patients were studied, with an age mean of 55.8 ± 21.5 years; 50.3% of the participants were women. Of all pa...

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Patterns and Trends in Antipsychotic Prescribing for Parkinson Disease Psychosis

Cited by 100 publications

References 39 publications

Antipsychotic Agents

Antipsychotic Agents

Comparative Utility of Atypical Antipsychotics for the Treatment of Psychosis in Parkinson’s Disease: A Systematic Review and Bayesian Network Meta-analysis

Patrones de prescripción de antipsicóticos en pacientes afiliados al Sistema de Seguridad Social en Salud de Colombia

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