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Daniel Weintraub, MD; Peijun Chen, MD, PhD, MPH; Rosalinda V. Ignacio, MS; Eugenia Mamikonyan, MS; Helen C. Kales, MD

Arch Neurol. 2011;68(7):899-904. doi:10.1001/archneurol.2011.139

Background  Antipsychotic (AP) use is common in Parkinson disease (PD), but APs can worsen parkinsonism, evidence for efficacy is limited, and use in patients with dementia increases mortality.

Objective  To examine the frequency and characteristics, including changes over time, of AP use in a large cohort of patients with PD.

Design  Using Veterans Affairs data from fiscal year (FY) 2008, rates and predictors of AP prescribing were determined for patients with PD and psychosis stratified by dementia status (N = 2597) and a comparison group of patients with dementia and psychosis without PD (N = 6907). Fiscal year 2008 and FY2002 data were compared to examine changes in AP prescribing over time.

Setting  Department of Veterans Affairs outpatient facilities.

Participants  Outpatients with PD and psychosis and outpatients without PD with dementia and psychosis, all receiving care at Veterans Affairs facilities in FY2002 and FY2008.

Main Outcome Measure  Antipsychotic prescribing, including overall, class, and specific medications.

Results  In FY2008, 50% of patients with PD having a diagnosis of psychosis were prescribed an AP. Among treated patients, the atypical AP quetiapine was most frequently prescribed (66%), but approximately 30% received high-potency APs. Clozapine was rarely prescribed (<2%). In multivariate models, diagnoses of PD and dementia were associated with AP use. Comparing FY2008 with FY2002, AP use in PD was unchanged, with decreases in risperidone and olanzapine use offset by an increase in quetiapine prescribing and the introduction of aripiprazole.

Conclusions  Half of the patients with PD and psychosis receive APs, not uncommonly high-potency agents associated with worsening parkinsonism, and frequency of use has been unchanged since the "black box" warning for AP use in patients with dementia was issued. Recent trends are a shift to quetiapine use and the common use of aripiprazole. As psychosis and dementia are frequently comorbid in PD, safety risks associated with AP use in this population need to be assessed.

Author Affiliations: Departments of Psychiatry (Dr Weintraub and Ms Mamikonyan) and Neurology (Dr Weintraub), University of Pennsylvania, Philadelphia; Mental Illness and Parkinson's Disease Research, Education and Clinical Centers, Philadelphia Veterans Affairs Medical Center, Philadelphia (Dr Weintraub); Cleveland Veterans Affairs Medical Center, Psychiatric Service, Cleveland, Ohio (Dr Chen); Department of Psychiatry, Case Western Reserve University, Cleveland (Dr Chen); National Veterans Affairs Serious Mental Illness Treatment Research and Evaluation Center, VA Ann Arbor Healthcare System (Ms Ignacio and Dr Kales) and Mental Health Services Outcomes and Translation Section (Ms Ignacio and Dr Kales) and Department of Psychiatry, Geriatric Psychiatry Section (Dr Kales), University of Michigan, Ann Arbor.

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