Age, Gender, Comorbidities Linked With Antipsychotic Changes in Residents With Parkinson Disease Psychosis

Approximately 80% of patients with Parkinson disease psychosis prescribed antipsychotic therapy in US long-term care facilities continued their antipsychotic unchanged over the next 12 months, according to a study published in the Journal of Applied Gerontology.

“It is important to discuss prior and current criteria or guidelines and provide more context to our findings. The time period for the data evaluated in this study is from 2013 to 2017. During this time, the American Geriatrics Society 2015 Beers Criteria recommended that ‘all antipsychotics (except aripiprazole, quetiapine, and clozapine) were to be avoided with the rationale that dopamine-receptor antagonists had the potential to worsen parkinsonian symptoms,’” wrote corresponding author Nazia Rashid, PharmD, of Acadia Pharmaceuticals Inc., San Diego, California, and coauthors.

In 2019, the authors added, the Beers Criteria were revised to list quetiapine, clozapine, and pimavanserin as exceptions to the recommendation to avoid antipsychotics in older adults with Parkinson disease.

The study assessed treatment changes in 864 long-term care residents with Parkinson disease psychosis. Among participants, 408, or 47.2%, were prescribed antipsychotic therapy. The top 5 antipsychotics prescribed were quetiapine (52%), risperidone (17%), olanzapine (11%), aripiprazole (9%), and haloperidol (6%).

Some 82.1% of residents continued their prescribed antipsychotic therapy over the next 12 months, according to the study. Meanwhile, 3.2% discontinued, 2.7% switched, and 12% augmented their index antipsychotic therapy to include additional antipsychotics.

Factors associated with a higher likelihood of antipsychotic treatment change were younger age, male gender, anemia, anxiolytic use or anxiety, sedative/hypnotic use, bladder disorders, coronary conditions, diabetes, hypertension, and dementia.

“Understanding the factors associated with treatment change may inform ways to improve management of Parkinson disease psychosis in the US long-term care setting,” researchers wrote.

Reference

Rashid N, Shim A, Andes S, Quale S, Abler V. Treatment patterns with antipsychotics in long-term care patients with Parkinson’s disease psychosis. J Appl Gerontol. 2022;41(1):198-206. doi:10.1177/0733464820987032