Clearing the Fog: A Review of Antipsychotics for Parkinson's-Related Hallucinations: A Focus on Pimavanserin, Quetiapine and Clozapine

Toufik Abdul-Rahman, Ranferi Eduardo Herrera-Calderón, Nicholas Aderinto, Mrinmoy Kundu, Andrew Awuah Wireko, Favour Tope Adebusoye*, Olabode Ekerin, Lukman Lawal, Nikitina Iryna Mykolaivna, Athanasios Alexiou*, Majed N. Almashjary, Asma Perveen, Ghulam Md Ashraf*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

Parkinson's disease is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms, including hallucinations. The use of antipsychotic medications is a common strategy to manage hallucinations associated with Parkinson's disease psychosis (PDP). However, careful consideration is necessary when selecting the most appropriate drug due to the potential risks associated with the available treatment options. Atypical antipsychotics (AAPs), such as Pimavanserin and Clozapine, have effectively controlled PDP symptoms. On the contrary, the support for utilizing quetiapine is not as substantial as other antipsychotics because research studies specifically investigating its application are still emerging and relatively recent. The broad mechanisms of action of AAPs, involving dopamine and serotonin receptors, provide improved outcomes and fewer side effects than typical antipsychotics. Conversely, other antipsychotics, including risperidone, olanzapine, aripiprazole, ziprasidone, and lurasidone, have been found to worsen motor symptoms and are generally not recommended for PDP. While AAPs offer favorable benefits, they are associated with specific adverse effects. Extrapyramidal symptoms, somnolence, hypotension, constipation, and cognitive impairment are commonly observed with AAP use. Clozapine, in particular, carries a risk of agranulocytosis, necessitating close monitoring of blood counts. Pimavanserin, a selective serotonin inverse agonist, avoids receptor-related side effects but has been linked to corrected QT (QTc) interval prolongation, while quetiapine has been reported to be associated with an increased risk of mortality. This review aims to analyze the benefits, risks, and mechanisms of action of antipsychotic medications to assist clinicians in making informed decisions and enhance patient care.

Original languageEnglish
Article number80
JournalJournal of Integrative Neuroscience
Volume23
Issue number4
DOIs
Publication statusPublished - 2024
Externally publishedYes

Keywords

  • antipsychotics
  • hallucinations
  • neurodegenerative disorders
  • Parkinson's disease

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