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Comment & Response |

The Danger of Not Treating Parkinson Disease Psychosis

Irene A. Malaty, MD1; Michael S. Okun, MD1; Michael Jaffee, MD1
[+] Author Affiliations
1University of Florida, Gainesville
JAMA Neurol. 2016;73(9):1156. doi:10.1001/jamaneurol.2016.2280.
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To the Editor Weintraub et al1 recently published an article in JAMA Neurology on the mortality risk associated with antipsychotic use in Parkinson disease (PD). We do not deny that the collective evidence has strongly suggested that neuroleptics are associated with increased mortality in elderly populations and in the setting of dementia.2,3 The Weintraub et al1 investigation addressed mortality associated with neuroleptic use in PD. The authors did the best they could with the available large data set; however, there was an important limitation. There was no clear comparator group of patients with PD and active psychosis who were not treated with neuroleptics. Additionally, very few patients in the sample were treated with the preferred drug clozapine, which does not worsen parkinsonism.

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September 1, 2016
Daniel Weintraub, MD; Helen C. Kales, MD; Connie Marras, MD, PhD
1Parkinson’s Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania2Mental Illness Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania3Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
4Department of Veterans Affairs, Health Services Research and Development, Center for Clinical Management Research, Ann Arbor, Michigan5Geriatric Research, Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan6Department of Psychiatry, University of Michigan, Ann Arbor
7Morton and Gloria Shulman Movement Disorder Centre, The Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
JAMA Neurol. 2016;73(9):1156-1157. doi:10.1001/jamaneurol.2016.2274.
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