| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Departments of Neurological Sciences (Dr. Goetz and L.M. Blasucci) and Preventive Medicine (Dr. Leurgans), Rush Medical College, Rush University, Rush-Presbyterian-St. Luke’s Medical Center, Chicago, IL; and San Marco Neurology (Dr. Pappert), San Marcos, TX.
Address correspondence and reprint requests to Dr. Goetz, 1725 W. Harrison Street, Chicago, IL 60612.
OBJECTIVE: To compare olanzapine and clozapine for safety and efficacy measures of psychosis and motor function in patients with PD and chronic hallucinations.
BACKGROUND: Hallucinations occur in approximately one third of patients with PD treated chronically with dopaminergic drugs. Although clozapine is known to be an effective antipsychotic agent that does not significantly exacerbate parkinsonism, its use requires frequent blood count assessment. Olanzapine is another novel antipsychotic that is not associated with blood dyscrasia, and if equally effective could become the preferred drug for treating hallucinations in subjects with PD.
METHODS: A randomized, double-blind, parallel comparison of olanzapine and clozapine in patients with PD with chronic hallucinations was conducted. The primary outcome measure was the Scale for the Assessment of Positive Symptoms (SAPS) for psychotic symptoms. The Unified Parkinson’s Disease Rating Scale (UPDRS) motor subscale was used as a secondary outcome measure and as a safety monitoring tool.
RESULTS: After 15 patients had completed the study, safety stopping rules were invoked because of exacerbated parkinsonism in olanzapine-treated subjects. UPDRS motor impairment scores from baseline to study end significantly increased with olanzapine treatment, and change scores between the olanzapine and clozapine groups significantly differed. The primary clinical domains responsible for the motor decline were gait and bradykinesia. Even with a smaller patient number than originally anticipated, clozapine significantly improved hallucinations and overall behavioral assessment, whereas olanzapine had no effect.
CONCLUSIONS: At the doses studied, olanzapine aggravates parkinsonism in comparison with clozapine and should not be regularly used in the management of hallucinations in patients with PD.
This article has been cited by other articles:
|
|
 |
|
  B. TOUSI Movement disorder emergencies in the elderly: Recognizing and treating an often-iatrogenic problem Cleveland Clinic Journal of Medicine, June 1, 2008; 75(6): 449 - 457. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 U. Lertxundi, J. Peral, O. Mora, S. Domingo-Echaburu, M. J. Martinez-Bengoechea, and J. C. Garcia-Monco Antidopaminergic therapy for managing comorbidities in patients with Parkinson's disease Am. J. Health Syst. Pharm., March 1, 2008; 65(5): 414 - 419. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Weintraub and H. I. Hurtig Presentation and Management of Psychosis in Parkinson's Disease and Dementia With Lewy Bodies Am J Psychiatry, October 1, 2007; 164(10): 1491 - 1498. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Samuel, I. Maidment, M. Boustani, and C. Fox Clinical management of Parkinson's disease dementia: pitfalls and progress Advan. Psychiatr. Treat., March 1, 2006; 12(2): 121 - 129. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. H. Adler and M. J. Thorpy Sleep issues in Parkinson's disease Neurology, June 28, 2005; 64(12_suppl_3): S12 - S20. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Turjanski and G. G. Lloyd Psychiatric side-effects of medications: recent developments Advan. Psychiatr. Treat., January 1, 2005; 11(1): 58 - 70. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. P. Wint, M. S. Okun, and H. H. Fernandez Psychosis in Parkinson's Disease J Geriatr Psychiatry Neurol, September 1, 2004; 17(3): 127 - 136. [Abstract] [PDF]
|
|
|
|
 |
|
 P Pollak, F Tison, O Rascol, A Destee, J J Pere, J M Senard, F Durif, and I Bourdeix Clozapine in drug induced psychosis in Parkinson's disease: a randomised, placebo controlled study with open follow up J. Neurol. Neurosurg. Psychiatry, May 1, 2004; 75(5): 689 - 695. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R Katzenschlager, A J Manson, A Evans, H Watt, and A J Lees Low dose quetiapine for drug induced dyskinesias in Parkinson's disease: a double blind cross over study J. Neurol. Neurosurg. Psychiatry, February 1, 2004; 75(2): 295 - 297. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. S. Ismail and I. H. Richard A Reality Test: How Well Do We Understand Psychosis in Parkinson's Disease? J Neuropsychiatry Clin Neurosci, February 1, 2004; 16(1): 8 - 18. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Mintzer and S. D. Targum Psychosis in Elderly Patients: Classification and Pharmacotherapy J Geriatr Psychiatry Neurol, December 1, 2003; 16(4): 199 - 206. [Abstract] [PDF]
|
|
|
|
|
|
D. L. Murman, S. B. Kuo, M. C. Powell, and C. C. Colenda The impact of parkinsonism on costs of care in patients with AD and dementia with Lewy bodies Neurology, October 14, 2003; 61(7): 944 - 949. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. Factor, P. J. Feustel, J. H. Friedman, C. L. Comella, C. G. Goetz, R. Kurlan, M. Parsa, R. Pfeiffer, and the Parkinson Study Group Longitudinal outcome of Parkinson's disease patients with psychosis Neurology, June 10, 2003; 60(11): 1756 - 1761. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. P. Bouman and G. Pinner Use of atypical antipsychotic drugs in old age psychiatry Advan. Psychiatr. Treat., January 1, 2002; 8(1): 49 - 58. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Marsh, C. Lyketsos, and S. G. Reich Olanzapine for the Treatment of Psychosis in Patients With Parkinson's Disease and Dementia Psychosomatics, December 1, 2001; 42(6): 477 - 481. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. S. Sa, A. E. Lang, S. Leucht, and C. Goetz Olanzapine and clozapine: Comparative effects on motor function in hallucinating PD patients Neurology, August 28, 2001; 57(4): 747 - 747. [Full Text] [PDF]
|
|
|
|
|
|
D. S. Sa and A. E. Lang Olanzapine for psychosis in Parkinson's disease Neurology, June 26, 2001; 56(12): 1781 - 1781. [Full Text] [PDF]
|
|
|
|
|
|
C. W. Olanow, R. L. Watts, and W. C. Koller An algorithm (decision tree) for the management of Parkinson's disease (2001):: Treatment Neurology, June 12, 2001; 56(suppl_5): S1 - S88. [Full Text] [PDF]
|
|
|
|
 |
|
 Olanzapine Ineffective for Side Effects of Parkinson's Disease Treatment Journal Watch Psychiatry, November 14, 2000; 2000(1114): 6 - 6. [Full Text]
|
|
|
|
|
|
I. H. Richard and J. Nutt Worsening of motor function in Parkinson's disease: A ""typical"" response to ""atypical"" antipsychotic medications Neurology, September 26, 2000; 55(6): 748 - 749. [Full Text] [PDF]
|
|
Read all Correspondence
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
