Magazine article Clinical Psychiatry News

Quetiapine, the Antipsychotic of Choice for Parkinson's Psychosis

Magazine article Clinical Psychiatry News

Quetiapine, the Antipsychotic of Choice for Parkinson's Psychosis

Article excerpt

PHILADELPHIA -- If psychosis in patients with Parkinson's disease does not respond to a reduction in anti-Parkinson medication, quetiapine should be the first antipsychotic tried, Dr. Stewart Factor said at the annual meeting of the American Academy of Neurology

The first step for treating psychosis in patients with Parkinson's disease is to taper the dosage and reduce the number of anti-Parkinson medications prescribed. Psychosis can be a side effect of these drugs, and the likelihood of psychosis multiplies as more drugs are added to the treatment regimen, said Dr. Factor of the Parkinson's disease and movement disorders center at the Albany (NY) Medical Center.

Medications should be tapered in the order of those with the highest risk-to-benefit ratio: Anticholinergics should be tapered first, followed by selegiline, amantadine, dopamine agonists, and catechol 0-methyltransferase inhibitors. Finally, levodopa should be reduced. None of the medications should be reduced to a level that jeopardizes motor function, he noted.

If psychosis persists, an antipsychotic should be added, starting with quetiapine. Clozapine carries a less than 5% risk for worsening the disease--the lowest among atypicals--and would be the antipsychotic of choice except for its daunting safety profile. …

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