![Sample our Behavioral Sciences journals, sign in here to start your access, latest two full volumes FREE to you for 14 days]({"type":"image" , "src" : "/sda/110801/TOC-Subject-Sample-2021-Behavioral-Sciences.jpg"})
Abstract
Purpose
To assess the present evidence regarding the efficiency, safety, and potential risks of pharmacotherapy used for Parkinson’s disease psychosis (PDPsy) treatment.
Patients and methods
We searched the following databases: PubMed, the Cochrane Library, ISI Web of Science, and Embase using the following terms: atypical antipsychotics, pimavanserin, olanzapine, quetiapine, clozapine, Parkinson’s disease and psychosis. We systematically reviewed all randomized placebo-controlled trials comparing an atypical antipsychotic with a placebo.
Results
A total of 13 randomized placebo-controlled trials for a total 1142 cases were identified involving pimavanserin (n=4), clozapine (n=2), olanzapine (n=3), and quetiapine (n=4). For each atypical antipsychotic, a descriptive synthesis and meta-analyses was presented. Pimavanserin was associated with a significant improvement in psychotic symptoms compared to a placebo without worsening motor function. Clozapine was efficacious in alleviating psychotic symptoms and did not exacerbate motor function either. Quetiapine and Olanzapine did not demonstrate significant differences in reducing psychotic symptoms but may aggravate motor function.
Conclusions
There is strong evidence that pimavanserin is effective for the treatment of PDPsy. Clozapine is also recommended but should be used with caution due to its side effects. In the future, more well-designed randomized controlled trials (RCTs) are needed to confirm and update the findings reported in this meta-analysis.
Acknowledgments
The authors thank Zhuoyuan Zhong and Xinxiang Fan for their advice and suggestions. This study was supported by the Guangdong Province Natural Science Foundation (2016A030313319 and 2017A030313490); The Science and Technology Planning Project of Guangdong Province (2016B010125001) and Guangzhou City (201510010030); Grant [2013]163 from the Key Laboratory of Malignant Tumor Molecular Mechanism and Translational Medicine of Guangzhou Bureau of Science and Information Technology; and Grant KLB09001 from the Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes.
Abbreviation list
AAN, The American Academy of Neurology; FDA, Food and Drug Administration; PDPsy, Parkinson’s disease psychosis; RCTs, Randomized controlled trials; PD, Parkinson’s disease; WMD, Weighted mean difference; CI, Confidence interval; SD, Standard deviation; Pim, Pimavanserin; Pla, Placebo; Clo, clozapine; Ola, Olanzapine; Que, Quetiapine; CGI, clinical global impression scale; PANSS, positive and negative syndrome scale; UPDRS, Unified Parkinson’s Disease Rating Scale; UPDRSM, Unified Parkinson’s Disease Rating Scale Motor; MMSE, mini mental test examination; BPRS, Brief Psychiatric Rating Scale; SAPS-H+D, the Assessment of Positive Symptoms - Hallucinations and Delusions scales; UPDRS Part II, the Unified Parkinson’s Disease Rating Scale Activities of Daily Living; UPDRS Part III, the Unified Parkinson’s Disease Rating Scale Motor Examination.
Disclosure
The authors report no conflicts of interest in this work.