Department of Neurology, Georgetown University Hospital, Washington DC, USA.
Department of Neurology, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA.
CNS Drugs. 2024 May;38(5):333-347. doi: 10.1007/s40263-024-01084-1. Epub 2024 Apr 8.
Parkinson's disease (PD) is associated with the development of psychosis (PDP), including hallucinations and delusions, in more than half of the patient population. Optimal PD management must therefore involve considerations about both motor and non-motor symptoms. Often, clinicians fail to diagnosis psychosis in patients with PD and, when it is recognized, treat it suboptimally, despite the availability of multiple interventions. In this paper, we provide a summary of the current guidelines and clinical evidence for treating PDP with antipsychotics. We also provide recommendations for diagnosis and follow-up. Finally, an updated treatment algorithm for PDP that incorporates the use of pimavanserin, the only US FDA-approved drug for the treatment of PDP, was developed by extrapolating from a limited evidence base to bridge to clinical practice using expert opinion and experience. Because pimavanserin is only approved for the treatment of PDP in the US, in other parts of the world other recommendations and algorithms must be considered.
帕金森病(PD)与精神症状(PDP)的发展相关,超过一半的患者人群会出现幻觉和妄想等症状。因此,PD 的最佳管理必须考虑运动和非运动症状。临床医生经常未能诊断出 PD 患者的精神症状,即使已经认识到这一点,也未能进行最佳治疗,尽管有多种干预措施可用。在本文中,我们总结了目前使用抗精神病药物治疗 PDP 的指南和临床证据。我们还提供了诊断和随访的建议。最后,通过使用专家意见和经验外推,从有限的证据基础开发了一个更新的 PDP 治疗算法,其中纳入了 pimavanserin 的使用,pimavanserin 是唯一获得美国 FDA 批准用于治疗 PDP 的药物。因为 pimavanserin 仅在美国被批准用于治疗 PDP,所以在世界其他地区必须考虑其他建议和算法。