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Clozapine Appears Better Therapy For Patients With Parkinson's Disease And Psychosis
A DGReview of :"Clozapine in Parkinson's Disease Psychosis: 5-Year Follow-up Review."
Clinical Neuropharmacology
02/17/2003
By Veronica Rose
Clozapine is presently the better option for managing patients with Parkinson's disease and psychosis, according to Israeli neurologists.
Long-term dopaminergic management of Parkinson's disease (PD) produce serious dose-limiting factors such as confusion, visual hallucinations and psychosis, the researchers acknowledge, and the motor symptoms of the disease are exacerbated through the use of classic neuroleptic agents.
Researchers at the Sackler School of Medicine, Zerefin, monitored the long-term effect of clozapine on 32 patients with PD and psychosis (DSM-IV) over varying periods. Their mean age was 73 years, and mean duration of the disease was 12.2 years. Fourteen patients also had dementia.
All were followed over five years with periodic, clinical evaluation, Mini Mental State Examination (MMSE), and Parkinsonian Psychosis Rating Scale (PPRS), administered both before and after the study. Neutropenia was monitored by periodic blood counts.
Nineteen patients, eight with dementia, continued to receive clozapine, at a mean daily dose of 50 mg. Medication was discontinued in 13 patients, however: nine had improved symptoms that did not return after they were weaned from clozapine three encountered drowsiness, and one discontinued medication for personal reasons.
The researchers noted that those discontinuing medication received clozapine for an average period of 8.5 months (range 1 to 24 months).
There was no notable correlation between age, gender, duration and severity of disease according to Yahr scoring, the presence of dementia and response to clozapine. The PPRS scoring did not influence clozapine response and no incidents of neutropenia were seen, concluded the researchers.
Clinical Pharmacology 2003;26:1:8-11.
"Clozapine in Parkinson's Disease Psychosis: 5-Year Follow-up Review."
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