How to treat hallucinations in parkinson's?
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STEP 1: Assessment and Plan
The first step in any treatment process is to assess the problem.
It must first be determined if the hallucinations and delusions are benign or problematic.
Some clinicians will choose to postpone treatment if the symptoms are infrequent, non-threatening and if the person with PD “retains insight”.
Other clinicians will start treatment based on the theory that hallucinations and delusions will get worse over time.
In addition, the clinician should consider the stage of PD, prior history of psychotic symptoms and social factors.
STEP 2: Adjust or Reduce PD Medications
The next standard step of the treatment process is to adjust prescribed PD medications.
The goal of this step is to reduce hallucinations and delusions without worsening PD motor symptoms.
The clinician may decide to skip this step and proceed to step 3 if the person with PD is unable to tolerate potential worsening of PD symptoms.
The following recommendations have been made for reducing or discontinuing PD medications for the management of hallucinations and delusions. Reduce or discontinue medications in the following order until psychosis resolves:
Anticholinergic medications (Artane, Cogentin)
Amantadine
Dopamine agonists (Mirapex®, Requip ®, Permax®, Parlodel ®)
COMT inhibitors (Comtan ®)
Selegiline
If the hallucinations and delusions do not resolve, reduce Sinemet doses.
There are a variety of techniques and measures that can be performed when adjusting PD medications.
This approach generally improves psychotic symptoms. However, if motor symptoms become worse, PD medications may need to be restarted or increased, with Sinemet being the core of therapy, and Step 3 started.
STEP 3: Initiation of Antipsychotic Therapy
Antipsychotic agents are designed to balance abnormal chemical levels in the brain.
They work by reducing excess dopamine, thereby alleviating psychosis. Up until the 1990s, the use of antipsychotics in PD had been controversial. This was because older (also known as “typical”) antipsychotic medications were found to cause dramatic worsening of Parkinsonian motor symptoms.
Fortunately, medications have become available that are better tolerated by PD patients. This newer class of medications is referred to as “atypical” antipsychotics.
There are now three antipsychotic medications that are considered safe for people with PD. They cause limited worsening of Parkinsonian symptoms while treating hallucinations and delusions. These medications are pimavanersin (NuplazidTM), clozapine (Clozaril ®) and quetiapine (Seroquel ®).
HOPE IT'S HELP YOU
The first step in any treatment process is to assess the problem.
It must first be determined if the hallucinations and delusions are benign or problematic.
Some clinicians will choose to postpone treatment if the symptoms are infrequent, non-threatening and if the person with PD “retains insight”.
Other clinicians will start treatment based on the theory that hallucinations and delusions will get worse over time.
In addition, the clinician should consider the stage of PD, prior history of psychotic symptoms and social factors.
STEP 2: Adjust or Reduce PD Medications
The next standard step of the treatment process is to adjust prescribed PD medications.
The goal of this step is to reduce hallucinations and delusions without worsening PD motor symptoms.
The clinician may decide to skip this step and proceed to step 3 if the person with PD is unable to tolerate potential worsening of PD symptoms.
The following recommendations have been made for reducing or discontinuing PD medications for the management of hallucinations and delusions. Reduce or discontinue medications in the following order until psychosis resolves:
Anticholinergic medications (Artane, Cogentin)
Amantadine
Dopamine agonists (Mirapex®, Requip ®, Permax®, Parlodel ®)
COMT inhibitors (Comtan ®)
Selegiline
If the hallucinations and delusions do not resolve, reduce Sinemet doses.
There are a variety of techniques and measures that can be performed when adjusting PD medications.
This approach generally improves psychotic symptoms. However, if motor symptoms become worse, PD medications may need to be restarted or increased, with Sinemet being the core of therapy, and Step 3 started.
STEP 3: Initiation of Antipsychotic Therapy
Antipsychotic agents are designed to balance abnormal chemical levels in the brain.
They work by reducing excess dopamine, thereby alleviating psychosis. Up until the 1990s, the use of antipsychotics in PD had been controversial. This was because older (also known as “typical”) antipsychotic medications were found to cause dramatic worsening of Parkinsonian motor symptoms.
Fortunately, medications have become available that are better tolerated by PD patients. This newer class of medications is referred to as “atypical” antipsychotics.
There are now three antipsychotic medications that are considered safe for people with PD. They cause limited worsening of Parkinsonian symptoms while treating hallucinations and delusions. These medications are pimavanersin (NuplazidTM), clozapine (Clozaril ®) and quetiapine (Seroquel ®).
HOPE IT'S HELP YOU
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