Objective: To assess the prevalence of antipsychotic (AP) use in people with Parkinson’s disease (PwP), and identify factors associated with AP prescription and differences in choice of AP between sub-specialties.

Background: In PwP, psychosis symptoms can decrease quality of life and increase the risk of hospitalization (1). Classic pharmacologic antipsychotics are dopamine receptor antagonists which can exacerbate parkinsonism and are associated with increased mortality risk in PwP, which is significantly higher for those taking typical antipsychotics as opposed to atypical antipsychotics (2). The newer antipsychotic agent pimavanserin acts as a selective serotonin 5HT2a inverse agonist and is therefore not associated with extrapyramidal symptoms (EPS) (3).

Method: A single-center retrospective chart review was performed to assess the prevalence of AP prescription amongst PwP between January 2020 to January 2021. Analysis of demographic factors linked to AP use was conducted using simple logistic regression. For each AP prescription, the prescriber specialty and associated diagnoses were recorded, and the data was analyzed using fisher’s exact test or simple logistic regression.

Results: Amongst 946 PwP, 64.7% had at least one AP prescribed over the one-year period. There was a higher rate of AP use amongst males (68.5% vs. 58.7% in females, OR 1.5348, p=0.0020). AP use prevalence significantly differed by race with highest use in Black/African American patients (73.1% vs. White 65.8%, Asian 61.3%, Other 54.1%, p=0.036). The odds of having an AP prescribed was 2.8 (95% CI: 1.06-7.38) times higher for PwP in a psychiatry clinic versus movement disorders (MD) clinic (p=0.004). Pimavanserin was prescribed nearly exclusively in MD clinics (79 of 80 prescriptions, p < 0.0001). Typical and atypical APs were significantly more likely to be prescribed by psychiatrists than MD specialists: risperidone prescription OR 36.4, aripiprazole OR 19.4, haloperidol OR 8.4, and olanzapine OR 7.5 (p < 0.0001). Quetiapine had less inter-specialty prescription difference with OR 2.4 (p = 0.0002)

Conclusion: In this single-center study, AP use prevalence for PwP significantly differed based on sex and race. The specific type of APs prescribed differed between subspecialities; the novel 5HT2a agonist pimavanserin was prescribed almost exclusively in MD clinics, and typical/atypical APs were prescribed more frequently in psychiatry clinics.

References: 1) Factor SA, Feustel PJ, Friedman JH, et al. Longitudinal outcome of Parkinson’s disease patients with psychosis. Neurology 2003; 60: 1756–1761
2) Marras C, Gruneir A, Wang X, et al. Antipsychotics and mortality in Parkinsonism. Am J Geriatr Psychiatry 2012;20:149‐158.
3) Cummings J, Isaacson S, Mills R, et al. Pimavanserin for patients with Parkinson’s disease psychosis: a randomised, placebo-controlled phase 3 trial. Lancet 2014;383:533-540.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/antipsychotic-use-in-parkinsons-disease-a-single-center-retrospective-chart-review/