Taking a Symptom-Based Approach to Parkinson Disease Psychosis: Aaron Ritter, MD

WATCH TIME: 3 minutes

"The first symptom that individuals may often report is seeing people or animals out of the corner of their eyes, often at night, and sometimes in low light situations. They come and go, and may be related to their dopamine therapies, including most commonly, dopamine agonists."

After years of using off-label atypical antipsychotics to treat Parkinson disease (PD) psychosis, the FDA approved its first specific therapy for the condition in 2016, greenlighting Acadia’s pimavanserin (Nuplazid). The therapy is designed as a selective serotonin inverse agonist and antagonist preferentially targeting 5-HT2A receptors, which have been thought to play an important role in neuropsychiatric disorders. The FDA recently sent a complete reponse letter to Acadia for its application to seek an expanded indication to include the treatment of patients with Alzheimer disease psychosis.

PD psychosis, a common issue for this patient population, most commonly takes the form of visual hallucinations and minor sensory disturbances such as illusions or “passage” and “sense of presence” hallucinations. Symptoms tend to recur and worsen over time, and insight is ultimately lost. Despite the approval of pimavanserin, there are still complexities with the management of PD psychosis, including the use of other off-label antipsychotics that carry potential safety risks. Earlier this year, the PMD Alliance put on an educational course for clinicians addressing the safety and efficacy of pimavanserin and other agents used to treat.

Led by Aaron Ritter, MD, and Kelly Papesh, DNP, the free course included 1.5 hours of video content, 18 lessons, with credits available for attendees. Ritter, director of the Memory & Cognitive Disorders Clinic at Hoag Neuroscience Institute, sat down for an interview following the event to discuss the earliest signs of PD psychosis neurologists should be aware of, and whether treatment as early as possible may potentially impact long-term outcomes.