ABSTRACT
Twenty-nine elderly patients who failed treatment with clozapine, risperidone, or olanzapine entered this 24-week, single-center, open-label trial to assess the efficacy of quetiapine (12.5-400 mg/day) for psychosis in patients with Parkinson's disease (PD). Psychiatric, motor, and cognitive assessments were administered at baseline and at periodic intervals for 24 weeks. These included the Brief Psychiatric Rating Scale (BPRS), Neuropsychiatric Inventory (NPI), Unified Parkinson's Disease Rating Scale (UPDRS) and tests of intellectual functioning, attention, and memory. Repeated measures statistical analysis was used to assess change from baseline. The results revealed significant improvements in the 24-week BPRS total score and NPI psychosis subscale scores, with no decline in UPDRS total or motor subscale scores. There was also significant improvement in recall scores on cognitive measures. These results indicate that quetiapine may treat psychotic symptoms and improve cognition without worsening motor function in patients with PD, suggesting that quetiapine is an effective and well-tolerated antipsychotic in this population.
Subject(s)
Antiparkinson Agents/adverse effects , Antipsychotic Agents/therapeutic use , Dibenzothiazepines/therapeutic use , Levodopa/adverse effects , Parkinson Disease/drug therapy , Psychoses, Substance-Induced/drug therapy , Aged , Aged, 80 and over , Antiparkinson Agents/therapeutic use , Antipsychotic Agents/adverse effects , Brief Psychiatric Rating Scale , Delusions/chemically induced , Delusions/diagnosis , Delusions/drug therapy , Dibenzothiazepines/adverse effects , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Follow-Up Studies , Hallucinations/chemically induced , Hallucinations/diagnosis , Hallucinations/drug therapy , Humans , Levodopa/therapeutic use , Male , Middle Aged , Neurologic Examination/drug effects , Neuropsychological Tests , Parkinson Disease/psychology , Psychoses, Substance-Induced/diagnosis , Psychoses, Substance-Induced/psychology , Quetiapine FumarateABSTRACT
Previous studies have shown that the thalamic nucleus submedius (SM) contains nociceptive neurons and is interconnected with spinal, brain-stem and cortical regions associated with nociception. The present study was performed to examine the role of the SM in nociceptive-related behaviors. The effect of SM lesions on nociceptive responding in rats was assessed using both the radiant-heat tail-flick (TF) and the tail-shock 'pain-induced' vocalization (PIV) tests. The results of Exp. 1 indicated that the intensity of electrical shock required for vocalization responses was significantly decreased following SM lesions. No changes in vocalization responses were present in the sham-lesion group. In contrast, both the sham- and SM-lesion groups exhibited a significant post-lesion increase in TF latencies. A second experiment was performed to determine whether the effects of SM lesion on the tail flick may have been masked by conditioned antinociception associated with noxious electrical stimulation of the tail to produce PIV. The results indicated that there was no post-lesion change in TF latencies in either the SM- or sham-lesion group when the antecedent PIV test was omitted. The results suggest that the SM may play a role in supraspinally mediated inhibition of nociceptive input but not in spinally mediated responses to noxious stimuli.
