Impact of standard of care for psychosis in Parkinson disease

Neuropsychiatric symptoms are frequently found in patients with advanced Parkinson disease (PD).1 Psychotic symptoms, defined as disturbances of perception and thought, including visual or auditory hallucinations, paranoid delusions and delirium, are particularly problematic for patients and care givers. Hallucinations and delusions were reported in PD patients prior to the advent of dopaminergic medications; however, most psychotic symptoms are thought to be due to complications of drug therapy.2 The standard of care calls for an investigation and elimination of potential underlying causes of psychosis, prior to the initiation of neuroleptic therapy. No study has examined the frequency of finding a systemic illness or other triggering event as part of the evaluation of psychotic symptoms in PD or the success rate in improving psychotic symptoms through treatment of underlying systemic conditions and/or adjusting anti-PD medications. A group of 26 patients with idiopathic PD, initially referred for participation in a study of quetiapine as a treatment for psychotic symptoms in PD patients, were evaluated using a separate investigator-initiated protocol. Despite the small sample size (due to the main quetiapine study being cancelled), we felt that it was important to report our results because no previous studies have formally evaluated the validity of this approach. Inclusion and exclusion criteria and evaluation methods are outlined in supplementary table 1 online. The baseline …