Take a closer look at Parkinson’s disease psychosis

Parkinson’s disease psychosis (PDP) is a common nonmotor aspect of Parkinson’s disease (PD)1. Over 50% of patients with PD will develop psychosis over the course of their disease; however, PD psychosis continues to go unrecognized and underreported.1,2

Patients and caregivers who are aware that psychosis may be related to PD3

Patients with PD psychosis who spontaneously report symptoms to their physicians2,4

EXPAND TO SEE NINDS-NIMH
DIAGNOSTIC CRITERIA for PDP

Proposed NINDS-NIMH diagnostic criteria for PDP5

Characteristic Symptoms

Presence of at least one of the following symptoms:

  • Hallucinations
  • Delusions
  • Illusions
  • False sense of presence

Primary Diagnosis of PD

UK Parkinson’s Disease Society Brain Bank Criteria

Chronology of the Onset of Symptoms of Psychosis

Symptoms must occur after the onset of PD and must be recurrent or continuous for at least 1 month

Exclusion of Other Causes

Eliminate other causes, such as dementia with Lewy bodies; psychiatric disorders such as schizophrenia, schizoaffective disorder, delusional disorder, or mood disorder with psychotic features; or a general medical condition including delirium

Associated Features

  • With/without insight
  • With/without dementia
  • With/without treatment for PD (specify drug, surgical, other)

NINDS=National Institute of Neurological Disorders and Stroke
NIMH=National Institute of Mental Health

Receive the latest on PD psychosis and NUPLAZID.

PDP can be serious, regardless of severity, and even mild psychotic symptoms can negatively affect quality of life6

PD psychosis involves a wide spectrum of symptoms

Visual
Hallucinations7

Usually seeing actual people (living or deceased), or animals

Auditory
Hallucinations7

Often involves hearing voices or music

Olfactory
Hallucinations7

Smelling things that aren't there

Tactile
Hallucinations7

Includes the feeling of something touching or moving on the skin

Illusions8

Misidentification of actual stimuli, for example, believing that a belt is actually a snake

False Sense of Presence8

Experience that someone is present when nobody is actually there

Delusions of
Persecution9,10

Beliefs of conspiracy
(being followed, a room
being bugged, telephones
being tapped)

Delusions of
Jealousy9,10

Beliefs of infidelity
(a significant other is
having an affair
with someone)

Delusions of
Reference9,10

Beliefs that insignificant remarks
or statements refer to the patient
(walking into a room of people
laughing and assuming they are
laughing at him/her)

Meet David, a 72-year-old man, diagnosed with Parkinson’s disease 7 years ago. At times, David believes he sees his deceased wife in the room with him and talks with her in the evenings.

Actor portrayal

CURRENT MEDICATION

  • Carbidopa/levodopa

CONSIDERATIONS

  • Motor function is currently controlled with carbidopa/levodopa

CAREGIVER CONCERN

  • His children are concerned that he constantly talks about his deceased wife
  • He is aware that his wife has died when his children talk about her
When you see a patient like David, start treatment with NUPLAZID.

illustrative example

PD psychosis can have significant consequences

During the course of their disease, the majority of patients will develop symptoms of psychosis, which are associated with disability1,6

Loss of insight and the development of delusions can occur as PDP progresses11

PD patients with hallucinations have a 2.5-fold greater risk for nursing home admission.12
PDP often increases patient/caregiver distress and risk of nursing home placement12,13

Rethink the way you reduce symptoms of PD psychosis with NUPLAZID14

Important Safety Information for NUPLAZID (pimavanserin) 17-mg Tablets

WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS
Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. NUPLAZID is not approved for the treatment of patients with dementia-related psychosis unrelated to the hallucinations and delusions associated with Parkinson's disease psychosis.

Contraindication: NUPLAZID is contraindicated in patients with a history of hypersensitivity reaction to pimavanserin or any of its components. Reactions have included rash, urticaria, tongue swelling, circumoral edema, and throat tightness.

QT Interval Prolongation: NUPLAZID prolongs the QT interval. The use of NUPLAZID should be avoided in patients with known QT prolongation or in combination with other drugs known to prolong QT interval including Class 1A antiarrhythmics or Class 3 antiarrhythmics, certain antipsychotic medications, and certain antibiotics. NUPLAZID should also be avoided in patients with a history of cardiac arrhythmias, as well as other circumstances that may increase the risk of the occurrence of torsade de pointes and/or sudden death, including symptomatic bradycardia, hypokalemia or hypomagnesemia, and presence of congenital prolongation of the QT interval.

Adverse Reactions: The most common adverse reactions (≥2% for NUPLAZID and greater than placebo) were peripheral edema (7% vs 2%), nausea (7% vs 4%), confusional state (6% vs 3%), hallucination (5% vs 3%), constipation (4% vs 3%), and gait disturbance (2% vs <1%).

Drug Interactions: Strong CYP3A4 inhibitors (eg, ketoconazole) increase NUPLAZID concentrations. Reduce the NUPLAZID dose by one-half. Strong CYP3A4 inducers may reduce NUPLAZID exposure, monitor for reduced efficacy. Increase in NUPLAZID dosage may be needed.

Renal Impairment: No dosage adjustment for NUPLAZID is needed in patients with mild to moderate renal impairment. Use of NUPLAZID is not recommended in patients with severe renal impairment.

Hepatic Impairment: Use of NUPLAZID is not recommended in patients with hepatic impairment. NUPLAZID has not been evaluated in this patient population.

Pregnancy: Use of NUPLAZID in pregnant women has not been evaluated and should therefore be used in pregnancy only if the potential benefit justifies the potential risk to the mother and fetus.

Pediatric Use: Safety and efficacy have not been established in pediatric patients.

Dosage and Administration

Recommended dose: 34 mg per day, taken orally as two 17-mg tablets once daily, without titration.

Indication

NUPLAZID is an atypical antipsychotic indicated for the treatment of hallucinations and delusions associated with Parkinson’s disease psychosis.

To report SUSPECTED ADVERSE REACTIONS, contact ACADIA Pharmaceuticals Inc. at 1-844-4ACADIA (1-844-422-2342) or FDA at www.fda.gov/medwatch , or call 1-800-FDA-1088.

Please read the full Prescribing Information including Boxed WARNING.

This website is intended for use by US residents.

Important Safety Information for NUPLAZID (pimavanserin) 17-mg Tablets

WARNING: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS
Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. NUPLAZID is not approved for the treatment of patients with dementia-related psychosis unrelated to the hallucinations and delusions associated with Parkinson's disease psychosis.

Contraindication: NUPLAZID is contraindicated in patients with a history of hypersensitivity reaction to pimavanserin or any of its components. Reactions have included rash, urticaria, tongue swelling, circumoral edema, and throat tightness.

QT Interval Prolongation: NUPLAZID prolongs the QT interval. The use of NUPLAZID should be avoided in patients with known QT prolongation or in combination with other drugs known to prolong QT interval including Class 1A antiarrhythmics or Class 3 antiarrhythmics, certain antipsychotic medications, and certain antibiotics. NUPLAZID should also be avoided in patients with a history of cardiac arrhythmias, as well as other circumstances that may increase the risk of the occurrence of torsade de pointes and/or sudden death, including symptomatic bradycardia, hypokalemia or hypomagnesemia, and presence of congenital prolongation of the QT interval.

Adverse Reactions: The most common adverse reactions (≥2% for NUPLAZID and greater than placebo) were peripheral edema (7% vs 2%), nausea (7% vs 4%), confusional state (6% vs 3%), hallucination (5% vs 3%), constipation (4% vs 3%), and gait disturbance (2% vs <1%).

Drug Interactions: Strong CYP3A4 inhibitors (eg, ketoconazole) increase NUPLAZID concentrations. Reduce the NUPLAZID dose by one-half. Strong CYP3A4 inducers may reduce NUPLAZID exposure, monitor for reduced efficacy. Increase in NUPLAZID dosage may be needed.

Renal Impairment: No dosage adjustment for NUPLAZID is needed in patients with mild to moderate renal impairment. Use of NUPLAZID is not recommended in patients with severe renal impairment.

Hepatic Impairment: Use of NUPLAZID is not recommended in patients with hepatic impairment. NUPLAZID has not been evaluated in this patient population.

Pregnancy: Use of NUPLAZID in pregnant women has not been evaluated and should therefore be used in pregnancy only if the potential benefit justifies the potential risk to the mother and fetus.

Pediatric Use: Safety and efficacy have not been established in pediatric patients.

Dosage and Administration

Recommended dose: 34 mg per day, taken orally as two 17-mg tablets once daily, without titration.

Indication

NUPLAZID is an atypical antipsychotic indicated for the treatment of hallucinations and delusions associated with Parkinson’s disease psychosis.

To report SUSPECTED ADVERSE REACTIONS, contact ACADIA Pharmaceuticals Inc. at 1-844-4ACADIA (1-844-422-2342) or FDA at www.fda.gov/medwatch , or call 1-800-FDA-1088.

Please read the full Prescribing Information including Boxed WARNING.

This website is intended for use by US residents.

References:

  1. Forsaa EB, Larsen JP, Wentzel-Larsen T, et al. A 12-year population-based study of psychosis in Parkinson disease. Arch Neurol. 2010;67(8):996-1001.
  2. Fenelon G, Mahieux F, Huon R, Ziégler M. Hallucinations in Parkinson’s disease: Prevalence, phenomenology and risk factors. Brain (2000);123:733-745
  3. Data on file, ACADIA MARKET RESEARCH ATU.
  4. Fenelon G, Alves G. Epidemiology of psychosis in Parkinson's disease. J Neuro Sci. 2010;289(1-2):12-17.
  5. Ravina B, Marder K, Fernandez HH, et al. Diagnostic criteria for psychosis in Parkinson’s disease: report of an NINDS, NIMH work group. Mov Disord. 2007;22(8):1061-1068.
  6. Mack J, Rabins P, Anderson K, et al. Prevalence of psychotic symptoms in a community-based Parkinson disease sample. Am J Geriatr Psychiatry. 2012;20(2):123-132.
  7. Fenelon G. Psychosis in Parkinson's disease: phenomenology, frequency, risk factors, and current understanding of pathophysiologic mechanisms. CNS Spectr. 2008;13(3)(suppl 4):18-25.
  8. Fernandez HH, Aarsland D, Fenelon G, et al. Scales to assess psychosis in Parkinson's disease: critique and recommendations. Mov Disord. 2008;23(4):484-500.
  9. Andreasen NC. Scale for the assessment of positive symptoms (SAPS). Iowa City, IA: University of Iowa; 1984.
  10. Voss T, Bahr D, Cummings J, Mills R, Ravina B, Williams H. Performance of a shortened scale for assessment of positive symptoms for Parkinson’s disease psychosis. Parkinsonism Relat Disord. 2013;19(3):295-299.
  11. Goetz CG, Fan W, Leurgans S, Bernard B, Stebbins GT. The malignant course of "benign hallucinations" in Parkinson disease. Arch Neurol. 2006;63(5):713-716.
  12. Aarsland D, Larsen JP, Tandberg E, Laake K. Predictors of nursing home placement I Parkinson’s disease: a population-based, prospective study. J Am geriatr Soc. 2000;48(8):938-942.
  13. Hermanowicz N, Edwards K. Parkinson’s disease psychosis: symptoms, management, and economic burden. Am J Manag Care. 2015;21(10)(suppl):S199-S206.
  14. NUPLAZID® (pimavanserin) prescribing information, ACADIA.