{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:04:16Z","timestamp":1790996656216,"version":"4.1.0"},"reference-count":46,"publisher":"American Association of Psychiatric Pharmacists (AAPP)","issue":"6","license":[{"start":{"date-parts":[[2019,10,8]],"date-time":"2019-10-08T00:00:00Z","timestamp":1570492800000},"content-version":"vor","delay-in-days":706,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Persistent psychotic symptoms will develop in up to 60% of patients with Parkinson disease (PD). The initial approach to the management of PD psychosis (PDP) begins with addressing concurrent systemic conditions associated with psychotic behavior, such as delirium, medical conditions (eg, infections), psychiatric disorders (eg, major depression with psychotic symptoms, mania, schizophrenia), and substance misuse or withdrawal. A review of current medications is recommended, and medications that may trigger psychotic symptoms should be eliminated. If possible, antiparkinson medications should be reduced to the minimum therapeutic dose or discontinued in a sequential manner. Generally, dose reduction or discontinuation of anticholinergics is attempted first, followed by that of monoamine oxidase B inhibitors, amantadine, dopamine agonists, catechol-O-methyltransferase inhibitors, and lastly carbidopa\/levodopa. The aim of antiparkinson medication dose reduction is to achieve a balance between improving drug-related psychotic symptoms and not significantly worsening the motor symptoms of PD. If additional measures are needed for chronic PDP treatment, the use of second-generation antipsychotics, such as clozapine, pimavanserin, or quetiapine, must be considered. The first-generation antipsychotics (eg, fluphenazine, haloperidol) are not recommended. In the patient with comorbid dementia, the addition of a cholinesterase inhibitor might also be beneficial for PDP. The choice of agent is based on patient-specific parameters, potential benefit, and side effects.<\/jats:p>","DOI":"10.9740\/mhc.2017.11.262","type":"journal-article","created":{"date-parts":[[2017,11,1]],"date-time":"2017-11-01T10:56:17Z","timestamp":1509533777000},"page":"262-270","source":"Crossref","is-referenced-by-count":46,"title":["Treatment of psychotic symptoms in patients with Parkinson disease"],"prefix":"10.9740","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9671-9137","authenticated-orcid":false,"given":"Jack J.","family":"Chen","sequence":"first","affiliation":[{"name":"(Corresponding author) Professor and Chair, Department of Pharmacy Practice, College of Pharmacy, Marshall B. Ketchum University, Fullerton, California; Professor, Department of Neurology, Loma Linda University, Loma Linda, California, jchen@ketchum.edu"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4719","reference":[{"issue":"12","key":"2020060307342172500_i2168-9709-7-6-262-b01","doi-asserted-by":"publisher","first-page":"1591","DOI":"10.1002\/mds.26424","article-title":"MDS clinical diagnostic criteria for Parkinson's disease","volume":"30","author":"Postuma","year":"2015","journal-title":"Mov Disord"},{"issue":"10 Suppl","key":"2020060307342172500_i2168-9709-7-6-262-b02","first-page":"s199","article-title":"Parkinson's disease psychosis: symptoms, management, and economic burden","volume":"21","author":"Hermanowicz","year":"2015","journal-title":"Am J Manag Care"},{"issue":"5","key":"2020060307342172500_i2168-9709-7-6-262-b03","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1002\/gps.389","article-title":"A comparative study of psychiatric symptoms in dementia with Lewy bodies and Parkinson's disease with and without dementia","volume":"16","author":"Aarsland","year":"2001","journal-title":"Int J Geriatr Psychiatry"},{"issue":"6","key":"2020060307342172500_i2168-9709-7-6-262-b04","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/j.parkreldis.2015.03.024","article-title":"Neuropsychiatric symptoms and caregiver's burden in Parkinson's disease","volume":"21","author":"Martinez-Martin","year":"2015","journal-title":"Park Relat Disord"},{"issue":"8","key":"2020060307342172500_i2168-9709-7-6-262-b05","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1111\/j.1532-5415.2000.tb06891.x","article-title":"Predictors of nursing home placement in Parkinson's disease: a population-based, prospective study","volume":"48","author":"Aarsland","year":"2015","journal-title":"J Am Geriatr Soc"},{"issue":"14","key":"2020060307342172500_i2168-9709-7-6-262-b06","doi-asserted-by":"publisher","first-page":"1270","DOI":"10.1212\/WNL.0b013e3181f61311","article-title":"What predicts mortality in Parkinson disease?: a prospective population-based long-term study","volume":"75","author":"Forsaa","year":"2010","journal-title":"Neurology"},{"issue":"2","key":"2020060307342172500_i2168-9709-7-6-262-b07","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1097\/JGP.0b013e31821f1b41","article-title":"Prevalence of psychotic symptoms in a community-based Parkinson disease sample","volume":"20","author":"Mack","year":"2012","journal-title":"Am J Geriatr Psychiatry"},{"issue":"11","key":"2020060307342172500_i2168-9709-7-6-262-b08","doi-asserted-by":"crossref","first-page":"2227","DOI":"10.1212\/WNL.43.11.2227","article-title":"Risk factors for nursing home placement in advanced Parkinson's disease","volume":"43","author":"Goetz","year":"1993","journal-title":"Neurology"},{"issue":"8","key":"2020060307342172500_i2168-9709-7-6-262-b09","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1002\/mds.21382","article-title":"Diagnostic criteria for psychosis in Parkinson's disease: report of an NINDS, NIMH work group","volume":"22","author":"Ravina","year":"2007","journal-title":"Mov Disord"},{"issue":"4","key":"2020060307342172500_i2168-9709-7-6-262-b10","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1136\/jnnp.64.4.533","article-title":"Auditory hallucinations in Parkinson's disease","volume":"64","author":"Inzelberg","year":"1998","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"5","key":"2020060307342172500_i2168-9709-7-6-262-b11","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1001\/archneur.63.5.713","article-title":"The malignant course of \u201cbenign hallucinations\u201d in Parkinson disease","volume":"63","author":"Goetz","year":"2006","journal-title":"Arch Neurol"},{"issue":"11","key":"2020060307342172500_i2168-9709-7-6-262-b12","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1007\/s40265-016-0600-5","article-title":"Psychosis in Parkinson's disease: epidemiology, pathophysiology, and management","volume":"76","author":"Chang","year":"2016","journal-title":"Drugs"},{"issue":"13","key":"2020060307342172500_i2168-9709-7-6-262-b13","doi-asserted-by":"publisher","first-page":"2009","DOI":"10.1517\/14656566.2011.587122","article-title":"An update expert opinion on management and research strategies in Parkinson's disease psychosis","volume":"12","author":"Goldman","year":"2011","journal-title":"Expert Opin Pharmacother"},{"issue":"10","key":"2020060307342172500_i2168-9709-7-6-262-b14","doi-asserted-by":"publisher","first-page":"1399","DOI":"10.1002\/mds.23083","article-title":"Increased 5-HT2A receptors in the temporal cortex of parkinsonian patients with visual hallucinations","volume":"25","author":"Huot","year":"2010","journal-title":"Mov Disord"},{"issue":"1-2","key":"2020060307342172500_i2168-9709-7-6-262-b15","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.jns.2009.08.014","article-title":"Epidemiology of psychosis in Parkinson's disease","volume":"289","author":"F\u00e9nelon","year":"2010","journal-title":"J Neurol Sci"},{"issue":"6","key":"2020060307342172500_i2168-9709-7-6-262-b16","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1176\/ajp.135.6.669","article-title":"Levodopa-induced psychosis: a kindling phenomenon","volume":"135","author":"Moskovitz","year":"1978","journal-title":"Am J Psychiatry"},{"issue":"4","key":"2020060307342172500_i2168-9709-7-6-262-b17","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1001\/archneurol.2010.35","article-title":"Serotonin 2A receptors and visual hallucinations in Parkinson disease","volume":"67","author":"Ballanger","year":"2010","journal-title":"Arch Neurol"},{"issue":"12","key":"2020060307342172500_i2168-9709-7-6-262-b18","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.1136\/jnnp.2008.153163","article-title":"Impact of standard of care for psychosis in Parkinson disease","volume":"79","author":"Thomsen","year":"2008","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"2","key":"2020060307342172500_i2168-9709-7-6-262-b19","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1111\/ggi.12126","article-title":"Non-pharmacological treatment reducing not only behavioral symptoms, but also psychotic symptoms of older adults with dementia: a prospective cohort study in Taiwan","volume":"14","author":"Chen","year":"2014","journal-title":"Geriatr Gerontol Int"},{"issue":"39","key":"2020060307342172500_i2168-9709-7-6-262-b20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/hta18390","article-title":"A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia","volume":"18","author":"Livingston","year":"2014","journal-title":"Health Technol Assess"},{"key":"2020060307342172500_i2168-9709-7-6-262-b21","doi-asserted-by":"publisher","first-page":"218980","DOI":"10.1155\/2015\/218980","article-title":"Nonpharmacological interventions to reduce behavioral and psychological symptoms of dementia: a systematic review","volume":"2015","author":"de Oliveira","year":"2015","journal-title":"Biomed Res Int"},{"issue":"9","key":"2020060307342172500_i2168-9709-7-6-262-b22","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1097\/JGP.0b013e3181b0f8c0","article-title":"Brief psychosocial therapy for the treatment of agitation in Alzheimer disease (the CALM-AD trial)","volume":"17","author":"Ballard","year":"2009","journal-title":"Am J Geriatr Psychiatry"},{"issue":"1","key":"2020060307342172500_i2168-9709-7-6-262-b23","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1111\/j.1468-1331.2012.03866.x","article-title":"Summary of the recommendations of the EFNS\/MDS-ES review on therapeutic management of Parkinson's disease","volume":"20","author":"Ferreira","year":"2013","journal-title":"Eur J Neurol"},{"issue":"5","key":"2020060307342172500_i2168-9709-7-6-262-b24","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1001\/jamaneurol.2016.0031","article-title":"Association of antipsychotic use with mortality risk in patients with Parkinson disease","volume":"73","author":"Weintraub","year":"2016","journal-title":"JAMA Neurol"},{"key":"2020060307342172500_i2168-9709-7-6-262-b25","article-title":"Nuplazid (pimavanserin) [Internet]","year":"2016"},{"issue":"10","key":"2020060307342172500_i2168-9709-7-6-262-b26","doi-asserted-by":"publisher","first-page":"2008","DOI":"10.1007\/s11064-014-1293-3","article-title":"On the discovery and development of pimavanserin: a novel drug candidate for Parkinson's psychosis","volume":"39","author":"Hacksell","year":"2014","journal-title":"Neurochem Res"},{"issue":"2","key":"2020060307342172500_i2168-9709-7-6-262-b27","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.pharmthera.2008.10.010","article-title":"Current status of inverse agonism at serotonin2A (5-HT2A) and 5-HT2C receptors","volume":"121","author":"Aloyo","year":"2009","journal-title":"Pharmacol Ther"},{"issue":"4","key":"2020060307342172500_i2168-9709-7-6-262-b28","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1017\/S1092852916000407","article-title":"Mechanism of action of pimavanserin in Parkinson's disease psychosis: targeting serotonin 5HT2A and 5HT2C receptors","volume":"21","author":"Stahl","year":"2016","journal-title":"CNS Spectr"},{"issue":"9916","key":"2020060307342172500_i2168-9709-7-6-262-b29","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1016\/S0140-6736(13)62106-6","article-title":"Pimavanserin for patients with Parkinson's disease psychosis: a randomised, placebo-controlled phase 3 trial","volume":"383","author":"Cummings","year":"2014","journal-title":"Lancet"},{"issue":"3","key":"2020060307342172500_i2168-9709-7-6-262-b30","doi-asserted-by":"publisher","first-page":"733","DOI":"10.3233\/JAD-150818","article-title":"Serotonin 2A receptor inverse agonist as a treatment for Parkinson's disease psychosis: a systematic review and meta-analysis of serotonin 2A receptor negative modulators","volume":"50","author":"Yasue","year":"2016","journal-title":"J Alzheimers Dis"},{"key":"2020060307342172500_i2168-9709-7-6-262-b31","unstructured":"Nuplazid [package insert]. San Diego: ACADIA Pharmaceuticals; 2016."},{"key":"2020060307342172500_i2168-9709-7-6-262-b32","article-title":"Nuplazid","year":"2017","journal-title":"Redbook Online [Internet]"},{"issue":"6","key":"2020060307342172500_i2168-9709-7-6-262-b33","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1177\/0091270007299431","article-title":"Pharmacokinetics, tolerability, and safety of ACP-103 following single or multiple oral dose administration in healthy volunteers","volume":"47","author":"Vanover","year":"2013","journal-title":"J Clin Pharmacol"},{"issue":"6","key":"2020060307342172500_i2168-9709-7-6-262-b34","doi-asserted-by":"publisher","first-page":"473","DOI":"10.2165\/11587800-000000000-00000","article-title":"Assessing QT interval prolongation and its associated risks with antipsychotics","volume":"25","author":"Nielsen","year":"2011","journal-title":"CNS Drugs"},{"issue":"7","key":"2020060307342172500_i2168-9709-7-6-262-b35","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1212\/01.wnl.0000215428.46057.3d","article-title":"Practice parameter: evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology","volume":"66","author":"Miyasaki","year":"2006","journal-title":"Neurology"},{"issue":"Suppl 3","key":"2020060307342172500_i2168-9709-7-6-262-b36","doi-asserted-by":"publisher","first-page":"S42","DOI":"10.1002\/mds.23884","article-title":"The Movement Disorder Society evidence-based medicine review update: treatments for the non-motor symptoms of Parkinson's disease","volume":"26","author":"Seppi","year":"2011","journal-title":"Mov Disord"},{"issue":"9169","key":"2020060307342172500_i2168-9709-7-6-262-b37","doi-asserted-by":"crossref","first-page":"2041","DOI":"10.1016\/S0140-6736(99)00860-0","article-title":"Clozapine in drug-induced psychosis in Parkinson's disease: the French Clozapine Parkinson Study Group","volume":"353","year":"1999","journal-title":"Lancet"},{"issue":"10","key":"2020060307342172500_i2168-9709-7-6-262-b38","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1056\/NEJM199903113401003","article-title":"Low-dose clozapine for the treatment of drug-induced psychosis in Parkinson's disease","volume":"340","author":"Parkinson Study Group","year":"1999","journal-title":"N Engl J Med"},{"issue":"1","key":"2020060307342172500_i2168-9709-7-6-262-b39","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1192\/bjpo.bp.115.000927","article-title":"Antipsychotics for the management of psychosis in Parkinson's disease: systematic review and meta-analysis","volume":"1","author":"Jethwa","year":"2015","journal-title":"BJPsych Open"},{"key":"2020060307342172500_i2168-9709-7-6-262-b40","unstructured":"Indications and important selected safety information about clozapine-containing products [Internet]. Phoenix: Clozapine REMS Program; 2015[cited 2017 Apr 13]. Available from: https:\/\/www.clozapinerems.com\/CpmgClozapineUI\/rems\/pdf\/Clozapine_REMS_ISI.pdf"},{"key":"2020060307342172500_i2168-9709-7-6-262-b41","unstructured":"Recommended monitoring frequency and clinical decisions by ANC level [Internet]. Phoenix: Clozapine REMS Program[cited2017Apr 13]. Available from: https:\/\/www.clozapinerems.com\/CpmgClozapineUI\/rems\/pdf\/resources\/ANC_Table.pdf"},{"issue":"3","key":"2020060307342172500_i2168-9709-7-6-262-b42","doi-asserted-by":"publisher","first-page":"e91545","DOI":"10.1371\/journal.pone.0091545","article-title":"An eight-year clinic experience with clozapine use in a Parkinson's disease clinic setting","volume":"9","author":"Hack","year":"2014","journal-title":"PLoS One"},{"key":"2020060307342172500_i2168-9709-7-6-262-b43","first-page":"285","article-title":"Systematic literature review of quetiapine for hallucinosis \/ psychosis in Parkinson's disease (PD) [abstract]","volume":"29","author":"Chen","year":"2016","journal-title":"J Pharm Pract"},{"issue":"3","key":"2020060307342172500_i2168-9709-7-6-262-b44","first-page":"276","article-title":"Parkinson's disease-related visual hallucinations unresponsive to atypical antipsychotics treated with cholinesterase inhibitors: a case series","volume":"41","author":"Sobow","year":"2007","journal-title":"Neurol Neurochir Pol"},{"issue":"1","key":"2020060307342172500_i2168-9709-7-6-262-b45","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1007\/s100720200022","article-title":"Donepezil in the treatment of hallucinations and delusions in Parkinson's disease","volume":"23","author":"Fabbrini","year":"2002","journal-title":"Neurol Sci"},{"issue":"24","key":"2020060307342172500_i2168-9709-7-6-262-b46","doi-asserted-by":"publisher","first-page":"2509","DOI":"10.1056\/NEJMoa041470","article-title":"Rivastigmine for dementia associated with Parkinson's disease","volume":"351","author":"Emre","year":"2004","journal-title":"N Engl J Med"}],"container-title":["Mental Health Clinician"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/meridian.allenpress.com\/mhc\/article-pdf\/7\/6\/262\/2095912\/mhc_2017_11_262.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/meridian.allenpress.com\/mhc\/article-pdf\/7\/6\/262\/2095912\/mhc_2017_11_262.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,15]],"date-time":"2024-11-15T11:23:11Z","timestamp":1731669791000},"score":1,"resource":{"primary":{"URL":"https:\/\/mhc.kglmeridian.com\/view\/journals\/mhcl\/7\/6\/article-p262.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11,1]]},"references-count":46,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2017,11,1]]}},"URL":"https:\/\/doi.org\/10.9740\/mhc.2017.11.262","relation":{},"ISSN":["2168-9709"],"issn-type":[{"value":"2168-9709","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11,1]]}}}