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Judith and all, Thanks to you and Janet and others for posting the NEJM info. But I take issue with the headline in the Reuters report: "Drug Can Prevent Psychosis In Parkinson's Disease By Gene Emery" The use as described in the NEJM is for treatment of psychosis not prevention. It would be unreasonably dangerous (and expensive) to use Clozaril prophalacticly for psychosis due to the risk of aplastic anemia. In addition for treatment- as others have said there are probably drugs nearly as good and less dangerous than Clozaril at this point and- except in an emergency situation- if I were treating a PWP with early psychotic symptoms I might well try olanzepine or one of the other new neuroleptic drugs. I point out the error of reporting in the interest also of demonstrating that one should take press reports - especially headlines- with a grain of salt. Remember NBC's lead in of a story several months ago which implied that doctors were doing sham surgery without the patients knowledge- which was not substantiated by their own report. Charlie judith richards wrote: > March 10, 1999 > > Drug Can Prevent Psychosis In Parkinson's Disease > By Gene Emery > > BOSTON (Reuters) - The sometimes psychotic side-effects produced by > drugs used to treat Parkinson's disease can be prevented with small > doses of the drug clozapine, researchers report in Thursday's New > England Journal of Medicine. > > Between 5 percent and 8 percent of the 50,000 Americans stricken each > year by Parkinson's disease develop some type of psychosis as a result > of treatment, usually with the drug L-dopa. Older drugs designed to > treat psychosis also often make the muscle tremors, stiffness and > weakness of Parkinson's disease even worse. > > Dr. Joseph H. Friedman, chief of neurology at Memorial Hospital of Rhode > Island and the study's lead author, told Reuters the findings should be > ``very helpful'' to those patients who suffer from psychotic episodes. > > ``There's no question that this is a big plus,'' he said. > > Those stricken by psychosis may become convinced that their spouses are > cheating, or someone is stealing their money. Or they may start having > visual hallucinations, such as witnessing people selling body parts or > seeing a cemetery in a hospital, Friedman said. > > His group found that small doses of clozapine, an antipsychotic drug, > can prevent the hallucinations and paranoia. > > The researchers found in a study of 60 volunteers at six U.S. medical > centers that clozapine, sold under the brand name Clozaril by Sandoz > Pharmaceuticals, significantly reduced the psychosis without making the > Parkinson's symptoms worse. > > ``The (Friedman) report describes an important advance in our ability to > treat one of the most disabling conditions encountered in patients with > Parkinson's disease,'' said Dr. Jeffrey Cummings of the UCLA School of > Medicine in an accompanying editorial. > > ``The addition of clozapine may allow some patients to continue living > at home for longer periods and will facilitate the care of many of those > living in nursing homes,'' Cummings said. > > But clozapine must be given with care. In about 1 percent of those who > take it for schizophrenia, it causes a dangerous depletion in white > blood cells, known as agranulocytosis, setting the stage for a > potentially fatal infection. > > Even though the Parkinson's sufferers were treated in the study with a > dose 20 times less than that prescribed for schizophrenics, Friedman > said the risk of agranulocytosis ''isn't related to the dose of > clozapine. It's related only to exposure to the drug.'' > > As a result patients must have their blood tested regularly to watch for > the condition. > > But ``if you do the monitoring,'' said Friedman, ``the risks are > incredibly tiny.'' > > Parkinson's disease is a degenerative brain disorder. About one person > in 200 is affected by the disease. Men are more likely to be affected > than women, and the elderly are particularly at risk. There is no cure > for the disease. > -- > Judith Richards, London, Ontario, Canada > <[log in to unmask]> > ^^^ > \ / > \ | / Today’s Research > \\ | // ...Tomorrow’s Cure > \ | / > \|/ > ``````` -- ****************************************************************************************** Charles T. Meyer, M.D. Middleton (Madison), Wisconsin [log in to unmask] ******************************************************************************************