Admission of Parkinsonian patients to a neurological ward in a community hospital.

Hospitalization is a significant factor contributing to health care costs related to management of Parkinson's disease (PD) patients. We reviewed reasons for admission of PD patients to our Neurological Department over a 6-year period. Thereafter, we applied an "open door" policy to try to diminish the number of hospitalizations. Case records including patient data, disease duration, staging, reasons for admission, and motor, mental and general medical status of PD patients admitted to the Neurology Department over a 6-year period were reviewed. Out of 1,920 admissions, 143 were PD patients. All PD admissions were through the emergency department (non-elective). Motor complications were the reason for admission in 37%, psychosis in 24%, general medical problems in 14%, and a combination of motor and psychiatric in 25%. Drug-induced psychosis was the most significant cause of repeated and prolonged admissions (29% of patients). As motor and psychiatric complications are the commonest causes for admission, improved community-based care to "fine tune" medication appeared to be a priority. After analyzing our results, we instituted an "open door" policy, where patients are free to come to the Parkinson's clinic without appointment. This policy should improve control of PD symptoms and diminish hospitalizations.

Effect of quetiapine in psychotic Parkinson's disease patients: a double-blind labeled study of 3 months' duration.

This double-blind randomized study examined the effect of quetiapine (QTP) on drug-induced psychosis (DIP) in Parkinson's disease (PD). Conventional antipsychotic drugs are associated with adverse extrapyramidal effects. QTP is a new atypical antipsychotic drug used in the treatment of psychosis in PD. A total of 58 consecutive psychotic PD patients (mean age, 75 +/- 8.3 years; mean disease duration, 10.5 +/- 6.4 years; 29 with dementia) were randomly assigned to 2 groups: 30 were treated with QTP (mean dose, 119.2 +/- 56.4 mg) and 28 received placebo for 3 months. The motor part of the Unified Parkinson's Disease Rating Scale, the Brief Psychiatric Rating Scale, the Mini-Mental State Examination, the Hamilton Rating Scale for Depression, the Epworth Sleepiness Score, and the Clinical Global Impression Scale were administered before and during the study. No significant difference was found between the groups in all parameters. There were 32 PD patients (55%) completed the 3-month study (15 [26%] QTP and 17 [29%] placebo). Treatment was interrupted in 15 patients in the QTP and 11 in the placebo groups. This double-blind study did not show a beneficial effect of QTP for the treatment of DIP in PD. The high rate of withdrawal probably influenced the results. Larger double-blind studies are required.

Long-term follow-up (24 months) of quetiapine treatment in drug-induced Parkinson disease psychosis.

OBJECTIVES: To evaluate the long-term outcome of quetiapine (QTP) use for drug-induced psychosis in Parkinson disease as assessed by the primary caregiver using the Clinical Global Impression Scale. METHODS: Thirty-five patients (mean age+/-SD, 76.1+/-5.9 years; mean disease duration+/-SD, 10.3+/-5.3 years; 19 with dementia) were followed up over a 24-month period. RESULTS: At 6 months, 20 (57%) responded to QTP, of whom 11 (31%) maintained their improvement in the long term (for 24 months). Altogether, 15 patients (43%) responded to QTP in the long term (11 were still on treatment at 24 months, 3 stopped because of improvement and medication was no longer required, and 3 stopped because of financial reasons [one was responding positively by the time of stopping medication]). The medications of nonresponding patients (n=15) were switched to clozapine, with a positive response in 12 patients (80%). CONCLUSIONS: In long-term follow-up, 31% of parkinsonian patients with psychosis treated with QTP were still on QTP therapy at 24 months. For those failing to respond to QTP, clozapine was an effective alternative therapy.