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Psychosis Due to Neurologic Conditions.

David B. Arciniegas1, Jeannie L. Topkoff, Kerri Held

  • 1Departments of Psychiatry and Neurology, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Campus Box C268-68, Denver, CO 80262, USA. david.arciniegas@UCHSC.edu

Current Treatment Options in Neurology
|June 8, 2001
PubMed
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Treating psychosis in neurologic conditions like Alzheimer's disease and epilepsy requires careful medication management. Antipsychotic selection must consider potential worsening of underlying neurological symptoms and cognitive function.

Area of Science:

  • Neurology
  • Psychiatry

Background:

  • Psychosis frequently occurs in neurologic conditions, complicating treatment due to potential adverse effects on the underlying disease.
  • Secondary psychoses are most common in Alzheimer's disease and epilepsy, and also seen with Parkinson's disease therapies.

Purpose of the Study:

  • To review the treatment strategies for psychosis secondary to neurologic conditions.
  • To outline first-line and alternative pharmacologic interventions for psychosis in Alzheimer's disease, Parkinson's disease, and epilepsy.

Main Methods:

  • Literature review of treatment guidelines and clinical evidence for managing psychosis in specific neurologic disorders.
  • Analysis of medication efficacy and safety profiles, focusing on potential interactions with neurologic conditions.

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Main Results:

  • For Alzheimer's disease psychosis, risperidone is first-line, followed by haloperidol, olanzapine, quetiapine, and cautiously, clozapine.
  • In Parkinson's disease, tapering dopaminergic therapy is primary; quetiapine or clozapine are options if needed.
  • For epilepsy, optimizing anticonvulsants is first-line; atypical antipsychotics are used cautiously for persistent psychosis.

Conclusions:

  • Treatment of psychosis in neurologic conditions necessitates a tailored approach, balancing efficacy with the risk of exacerbating the primary neurologic disorder.
  • Careful selection of antipsychotics, considering their specific side effect profiles, is crucial for optimal patient outcomes.