Pharmacological Management of Psychosis in Elderly Patients with Parkinsonism
Abstract
Parkinsonism is a characteristic feature of Parkinson's disease and dementia with Lewy bodies and is commonly seen in Alzheimer's disease. Psychosis commonly appears during the course of these illnesses. Treatment of parkinsonism with antiparkinsonian medications constitutes an additional risk factor for the appearance or worsening of psychosis. Conversely, treatment of psychosis with antipsychotic drugs in patients with parkinsonism might worsen the underlying movement disorder, especially in the elderly. In this article, we review parkinsonian conditions in the elderly and offer guidelines to assess and manage comorbid psychosis. We focus on the pharmacologic management of psychosis with atypical antipsychotic medications and briefly review the role of acetylcholinesterase inhibitors.
aDepartment of Psychiatry, Western Regional Integrated Health Authority, Sir Thomas Roddick Hospital, Stephenville, Newfoundland, Canada
bDepartment of Psychiatry, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va
cDepartment of Neurology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va
dDepartment of Medicine Services, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va
eDepartment of Medical Media, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va
fDepartment of Psychiatry, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond
gDepartment of Neurology, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond
hDepartment of Internal Medicine, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond
Requests for reprints should be addressed to Mehrul Hasnain, MD, Sir Thomas Roddick Hospital, 142 Minnesota Drive, Stephenville, Newfoundland A2N 2V6, Canada
Funding: None.
Conflict of Interest: Dr Pandurangi is on the speaker's bureau of Astra-Zeneca, Bristol Myers Squibb, Janssen, and Pfizer Pharmaceuticals. The other authors do not have any potential conflict of interest to disclose.
Authorship: All authors had access to the data and played a role in writing this manuscript.
ABSTRACT
