About Parkinson's Disease Psychosis

Patients with PD commonly do not disclose their nonmotor symptoms1

In one study,* the highest percentage of undeclared symptoms was in the hallucinations and delusions domain.

*An international study determined the proportion of patients (N=242) who did not declare nonmotor symptoms to healthcare providers through self-completion of the validated NMSQuest (Nonmotor Symptom) screening questionnaire. Fifty percent of symptoms recorded in the hallucinations/delusions NMSQuest domain were not reported during provider consultations.

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Approximately 50% of patients with PD may develop hallucinations and/or delusions over the course of their disease2†

As determined by a prospective, longitudinal, cohort study which followed community-based PD patients (N=230) in Norway for 12 years to determine PDP prevalence as assessed by UPDRS ≥2 or antipsychotic use for PDP.

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PD psychosis may add to the burden of caring for a patient with PD3

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The hallucinations and delusions associated with PD psychosis can be serious and can progress4

The importance of symptom recognition in PD psychosis

Proactively discussing the link between PD and the possibility of PD psychosis can help you identify and manage symptoms.5

As you know, the symptoms of Parkinson's disease psychosis may change over time4,6

Hallucinations

Abnormal perceptions without a physical stimulus that can involve any sensory modality5

  • Visual hallucinations: Seeing things that aren't there, such as people (living or deceased), animals, or objects5,7

  • Auditory hallucinations: Hearing things that others don't, like hearing voices or music5,7

  • Olfactory hallucinations: Smelling things that aren’t there, like unusual odors5,7

  • Tactile hallucinations: Feeling something that isn't there, like something touching or moving on the skin5,7

  • Gustatory hallucinations: Tasting something that isn't there, like experiencing an unusual taste in the mouth5,7

Delusions

False, fixed, idiosyncratic beliefs that are maintained despite evidence to the contrary5

  • Delusions of persecution: Beliefs of conspiracy (being followed, a room being bugged, telephones being tapped)5,8,9

  • Delusions of jealousy: Beliefs of infidelity (a significant other is having an affair with someone)5,8,9

  • Delusions of reference: 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)5,8,9

See the data on NUPLAZID.

Download a fact sheet about Parkinson’s disease psychosis for your patients.

IMPORTANT SAFETY INFORMATION and INDICATION

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 a hypersensitivity reaction to pimavanserin or any of its components. Rash, urticaria, and reactions consistent with angioedema (e.g., tongue swelling, circumoral edema, throat tightness, and dyspnea) have been reported.
  • Warnings and Precautions: 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 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:

    • Coadministration with strong CYP3A4 inhibitors (e.g., ketoconazole) increases NUPLAZID exposure. Reduce NUPLAZID dose to 10 mg taken orally as one tablet once daily.

    • Coadministration with strong or moderate CYP3A4 inducers reduces NUPLAZID exposure. Avoid concomitant use of strong or moderate CYP3A4 inducers with NUPLAZID.

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

Dosage and Administration Recommended dose: 34 mg capsule taken orally once daily, without titration.

NUPLAZID is available as 34 mg capsules and 10 mg tablets.

Please read the full Prescribing Information, including Boxed WARNING.

References:
  1. Chaudhuri KR, Prieto-Jurcynska C, Naidu Y, et al. The nondeclaration of nonmotor symptoms of Parkinson's disease to health care professionals: an international study using the nonmotor symptoms questionnaire. Mov Disord. 2010;25(6):704-709.
  2. 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.
  3. Martinez-Martin P, Rodriguez-Blazquez C, Forjaz MJ, et al. Neuropsychiatric symptoms and caregiver’s burden in Parkinson’s disease. Parkinsonism Relat Disord. 2015;21(6):629-634. doi:10.1016/j.parkreldis.2015.03.024.
  4. 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.
  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. Goetz CG, Stebbins GT, Ouyang B. Visual plus nonvisual hallucinations in Parkinson's disease: development and evolution over 10 years. Mov Disord. 2011;26(12):2196-2200.
  7. Fénelon G, Soulas T, Zenasni F, Cleret de Langavant L. The changing face of Parkinson's disease-associated psychosis: a cross-sectional study based on the new NINDS-NIMH criteria. Mov Disord. 2010;25(6):755-759.
  8. 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.
  9. Andreasen NC. Scale for the Assessment of Positive Symptoms (SAPS). Iowa City, IA: University of Iowa; 1984.