Ziprasidone therapy in elderly patients with psychotic mood disorders and Parkinson's disease

To illustrate and discuss issues relevant to treatment of four elderly psychotic patients with multiple comorbidities, including a history of mood disorder and some level of movement disorder.

Four patients diagnosed with a major mood disorder and comorbid Parkinson's disease were treated successfully with adjunctive ziprasidone at doses of 80 to 160mg/d. Two of the patients had major depressive disorder, recurrent, with psychotic features (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV] DSM-IV 296.34) and two had bipolar disorder, not otherwise specified (DSM-IV 296.8) and presented with psychotic and manic features. In three of the four patients, prior treatment with olanzapine or risperidone or both had failed to adequately control psychotic or manic symptoms; in some cases, the treatment worsened the Parkinson's symptoms.

In all four patients, ziprasidone greatly improved psychosis and mood disturbances within days. All of the patients were also treated with other medications for comorbidities; these included one or more antiparkinsonian drugs, antidepressants, and, in one case, quetiapine for insomnia. There were no observed serious adverse events, extrapyramidal side effects, or worsening of movement disorder symptoms with the administration of ziprasidone in these patients. All patients remained stable on ziprasidone combination therapy for as long as they were followed, which ranged from several months to three years.

These results indicate that ziprasidone may be an efficacious and well tolerated therapy in patients with comorbid Parkinson's disease and psychiatric illness.