Please note that the PMID number at the end of each abstract
is the PubMed Identification number.
These and over 9 million other abstracts of published medical studies
are available at the PubMed web site:
http://www.ncbi.nlm.nih.gov/PubMed/

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1998
Early dopaminergic drug-induced hallucinations
in parkinsonian patients
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OBJECTIVE: To characterize patients who develop hallucinations early in the
course of dopaminergic therapy for Parkinson's disease (PD) and contrast them
with patients developing hallucinations after chronic drug treatment.

METHODS: Parkinsonian patients who met diagnostic criteria for PD, experienced
hallucinations, had a detailed hallucination interview at the onset time of
their first hallucination, and had a 5-year clinical follow-up or an autopsy
in those 5 years were identified and divided into two groups for comparison:
12 patients who developed early hallucinations within 3 months of starting
levodopa therapy and 58 PD patients who developed hallucinations after 1 year
of dopaminergic therapy.

We contrasted the quality, content, diurnal nature, and emotional elements of
the hallucinations, as well as the 5-year follow-up data on diagnosis, disease
course, community home or nursing home outcome, and mortality.

RESULTS: Both groups experienced a predominance of visual hallucinations,
visions of people and animals, and vivid colors and definition.

Features distinctive to the early onset hallucinating patients included
visions that persisted in daytime as well as nighttime, frightening content
with paranoia, and accompanying nonvisual hallucinations, either auditory,
olfactory, tactile, or combinations thereof.

At the 5-year follow-up, none of the early onset hallucinators had PD as their
sole disorder. Four of the 12 had an underlying psychiatric illness that
included hallucinations or psychosis preceding their parkinsonism by several
years.

In the other eight patients at the 5-year follow-up, their parkinsonism
evolved to include additional signs that were no longer consistent with PD.

The primary diagnoses were diffuse Lewy body disease and Alzheimer's disease
(AD) with extrapyramidal signs.

Patients with early drug-induced hallucinations had significantly greater
placement to nursing homes and greater mortality.

CONCLUSIONS: Early onset drug-related hallucinations are not typical of PD.

Their presence should signal an investigation of two alternative diagnoses,
either a comorbid psychotic illness (often unrevealed by the patient
initially) or an evolving parkinsonism-plus syndrome.

Neurology 1998 Sep;51(3):811-4
Goetz CG, Vogel C, Tanner CM, Stebbins GT
Rush Presbyterian St. Luke's Medical Center, Chicago, IL 60612, USA.
PMID: 9748031, UI: 98418827

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1998
Clozapine use in Parkinson's disease: a retrospective
analysis of a large multicentered clinical experience
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We conducted a multicentered, retrospective review of clozapine's (CZP)
effects on a range of psychiatric, sleep, cognitive, motor, and sensory
disorders in Parkinson's disease (PD).

Therapeutic outcomes and adverse events were compared with varying prescribing
practices at participating sites.

The medical records of 172 consecutive PD patients treated with CZP at four
movement disorder clinics were reviewed.

Low-dose CZP improved psychiatric symptoms of psychosis, anxiety, depression,
hypersexuality, sleep disturbance, and akathisia. Tremor, torticollis, limb
dystonia, and pain showed modest rates of improvement.

Twenty-three percent of patients withdrew as a result of adverse events or
treatment failure. Inpatient CZP initiation did not improve therapeutic
efficacy, or reduce adverse events or the withdrawal rate.

Low-dose CZP in the outpatient setting is generally an effective and well-
tolerated treatment for many of the psychiatric, sleep, motor, and sensory
disturbances common to late-stage PD.

Mov Disord 1998 May;13(3):377-82
Trosch RM, Friedman JH, Lannon MC, Pahwa R,
Smith D, Seeberger LC, O'Brien CF, LeWitt PA, Koller WC
Wayne State University School of Medicine, Detroit, Michigan, USA.
PMID: 9613725, UI: 98273781

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1998
Quetiapine (Seroquel) in the treatment of
psychosis in patients with Parkinson's disease
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Psychoses are a common clinical problem in patients with Parkinson's disease.

Treatment with typical neuroleptics or withdrawal of antiparkinsonian drugs
may improve mental symptoms but will worsen the parkinsonism.

Quetiapine (Seroquel), ICI 204,636, is a novel antipsychotic medication with a
low potential for producing extrapyramidal side effects.

In this open-label clinical study of 2 patients with Parkinson's disease,
treatment with Seroquel successfully controlled psychotic symptoms without
worsening of motor disability.

J Neuropsychiatry Clin Neurosci 1998 Spring;10(2):216-9
Parsa MA, Bastani B
Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio,
USA.
PMID: 9608412, UI: 98271339

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1997
Clozapine in treatment of neuropsychiatric
diseases in the elderly
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The atypical antipsychotic clozapine has been reported to be effective in
otherwise refractory psychoses.

This, and its low potential for inducing extrapyramidal side effects and
tardive dyskinesia, predestines this drug for the treatment of psychotic
disorders in late life.

However, not much is known about the efficacy, safety and pharmacokinetics of
clozapine in the treatment of aged patients.

There are some studies and reports available about clozapine in the treatment
of psychosis in patients suffering from dementia, schizophrenia and
Parkinson's disease, which are reported here.

They give some evidence that even low doses of clozapine are effective in
controlling psychotic symptoms in the elderly.

To avoid side effects, patient-specific factors and changes of
pharmacokinetics in the elderly have to be considered.

However, side effects including sedation, delirium, posturnal hypotension and
the risk of agranulocytosis in particular limits the use of clozapine in
elderly patients.

Fortschr Neurol Psychiatr 1997 Aug;65(8):347-53
Retz W, Rosler M, Sitzmann L, Becker T
Psychiatrische Universitatsklink Wurzburg, Germany
PMID: 9378447, UI: 98017671

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1997
The use of risperidone for psychosis and agitation
in demented patients with Parkinson's disease.
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This pilot study investigated effectiveness and tolerability of risperidone
for the treatment of psychosis and agitation in 9 inpatients with Parkinson's
disease and dementia.

Investigators found risperidone to be effective and safe, without worsening
extrapyramidal symptoms or further impairing cognition.

J Neuropsychiatry Clin Neurosci 1997 Fall;9(4):594-7
Workman RH Jr, Orengo CA, Bakey AA, Molinari VA, Kunik ME
Veterans Affairs Medical Center, Houston, Texas 77030, USA.
[log in to unmask]
PMID: 9447503, UI: 98108764

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1997
Psychosis during chronic levodopa therapy triggered by
the new antidepressive drug mirtazapine.
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We report the case of a patient developing psychosis after the addition of
mirtazapine, a novel antidepressant enhancing serotonergic neurotransmission,
to a chronic levodopa regimen.

There was complete and rapid recovery upon low-dose clozapine treatment.

To our knowledge, this is the first published case of a mirtazapine-levodopa
interaction and the second case report of a psychosis induced by a
serotonergic antidepressant in a patient with Parkinson's disease (PD).

This phenomenon might be due to a postsynaptic serotonin receptor
supersensitization caused by low central serotonin levels in treated PD.

Pharmacopsychiatry 1997 Nov;30(6):263-5
Normann C, Hesslinger B, Frauenknecht S, Berger M, Walden J
Department of Psychiatry and Psychotherapy, University of Freiburg, Germany.
PMID: 9442549, UI: 98104642

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continued in part 2 of 2...