In the past, antipsychotics were recommended as a potential treatment for patients with Parkinson’s disease (PD). This is because, in later stages of PD, patients may experience Parkinson’s psychosis, which includes delusions or hallucinations. Thus, antipsychotics were prescribed to reduce these symptoms. However, Parkinson’s News Today reports that antipsychotic use in patients with PD has fallen after the FDA warned against this treatment. According to a study published in Risk Management and Healthcare Policy, which explores the trends of antipsychotic prescriptions, these drugs are being used at a significantly lower rate now than they were between 2000-2008.

Antipsychotic Use

According to GoodTherapy, antipsychotic medicines:

sometimes referred to as neuroleptics or major tranquilizers, are prescribed to treat schizophrenia and to reduce the symptoms associated with psychotic conditions such as bipolar, psychotic depression, senile psychoses, various organic psychoses, and drug-induced psychoses. Antipsychotic medications have both a short-term sedative effect and the long-term effect of reducing the chances of psychotic episodes.

Examples of antipsychotics include Haldol, Thorazine, Moban, and Prolixin.

As explained, antipsychotics were sometimes prescribed (at a higher rate) to treat PD-related psychosis in patients. However, antipsychotics may also exacerbate and worsen other Parkinson’s symptoms, such as dyskinesia, a characteristic of PD. In 2005, the FDA warned against prescribing antipsychotic treatment to patients with dementia. Just three years later, clinical trial data showed that elderly patients taking antipsychotics had higher mortality rates than those who did not. Thus, the FDA once again warned against this form of treatment using black-box warnings.

Research Study

Dr. Khalid Orayj, PhD, wanted to understand the relationship between newly diagnosed PD and antipsychotic administration. To do so, he sourced data from a Welsh database. Altogether, the data included 9,142 patients with PD (a slight majority of which were male) diagnosed over a 16-year period. To be included, patients had to have received prescription drugs within one year of their diagnosis. His research discovered that:

• Overall, 21.8% of patients with newly diagnosed PD developed psychosis or psychotic symptoms. 55% of these patients received antipsychotic medications, most often Seroquel.
• Older patients (aged 61-80) were significantly more likely to be prescribed antipsychotic treatment than younger patients (40-60).
• Patients with a history of dementia, heart attacks, or stomach ulcers were more likely to receive and take antipsychotics.
• Between 2000-2008, patients were much more likely to receive antipsychotic prescriptions than they were in later years. Thus, the FDA’s warnings seemed to be efficacious.

Parkinson’s Disease (PD)

Dopaminergic (dopamine-producing) neuron death causes Parkinson’s disease (PD), a progressive central nervous system (CNS) disorder. Normally, dopamine plays a role in communication between the brain and muscles. As dopaminergic neurons die, this inhibits movement and can cause a variety of other symptoms. Typically, PD manifests in five stages. In the early stages, patients experience light tremors and muscle rigidity. By the mid-stage, patients often experience slowed movement and changes in balance and coordination. Finally, in stages four and five, patients are often unable to live independently and may experience non-motor symptoms, such as hallucinations. When symptoms of PD appear, they include:

• Slowed movement
• Muscle rigidity
• Tremors or shaking in one or both hands
• Slurred, fast, soft, or stuttering speech
  • Note: Additional changes in speech may also occur.
• Difficulty writing, blinking, or smiling
• Poor posture or balance
• Hallucinations or dementia
• Loss of ability to smell
• Constipation
• Blank facial expression
• Frequent falling