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Published in: Drugs 11/2016

01-07-2016 | Review Article

Psychosis in Parkinson’s Disease: Epidemiology, Pathophysiology, and Management

Authors: Anna Chang, Susan H. Fox

Published in: Drugs | Issue 11/2016

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Abstract

Psychotic symptoms are common in Parkinson’s disease (PD) and are associated with poorer quality of life and increased caregiver burden. PD psychosis is correlated with several factors, such as more advanced disease, cognitive impairment, depression, and sleep disorders. The underlying causes of psychosis in PD thus involve a complex interplay between exogenous (e.g., drugs, intercurrent illnesses) and endogenous (e.g., PD disease pathology) factors. Current theories of the pathophysiology of PD psychosis have come from several neuropathological and neuroimaging studies that implicate pathways involving visual processing and executive function, including temporo-limbic structures and neocortical gray matter with altered neurotransmitter functioning (e.g., dopamine, serotonin, and acetylcholine). Treatment of PD psychosis requires a step-wise process, including initial careful investigation of treatable triggering conditions and a comprehensive evaluation with adjustment of PD medications and/or initiation of specific antipsychotic therapies. Clozapine remains the only recommended drug for the treatment of PD psychosis; however, because of regular blood monitoring, quetiapine is usually first-line therapy, although less efficacious. Emerging studies have focused on agents involving other neurotransmitters, including the serotonin 5-HT2A receptor inverse agonist pimavanserin, cholinesterase inhibitors, and antidepressants and anxiolytics.
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Metadata
Title
Psychosis in Parkinson’s Disease: Epidemiology, Pathophysiology, and Management
Authors
Anna Chang
Susan H. Fox
Publication date
01-07-2016
Publisher
Springer International Publishing
Published in
Drugs / Issue 11/2016
Print ISSN: 0012-6667
Electronic ISSN: 1179-1950
DOI
https://doi.org/10.1007/s40265-016-0600-5

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