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Clozapine for the treatment of levodopa-induced psychosis and dyskinesia in Parkinson's disease

Published online by Cambridge University Press:  13 June 2014

Isabelle Jalenques  and
André-Julien Coudert
Isabelle Jalenques
Affiliation:
Service de Psychiatrie A, Centre Médico-Psychologique, CHU Saint-Jacque BP 69, 63003 Clermont-Ferrand Cedex, France
André-Julien Coudert
Affiliation:
Service de Psychiatrie A, Centre Médico-Psychologique, CHU Saint-Jacques BP 69, 63003 Clermont-Ferrand Cedex, France
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Abstract

The treatment of psychosis in patients with Parkinson's disease (PD) is one of the most difficult problems in clinical psychiatry. Clozapine's low propensity to induce extrapyramidal side effects makes it an attractive treatment for psychotic patients with PD. A number of published uncontrolled studies suggest that low-dose clozapine is effective in these patients. However, the dose range, side effect profiles and length of treatment have varied in these reports. In this article, the authors review the literature and report on the effects of clozapine in a patient with Parkinson's disease and psychosis. Clozapine (50mg per day) resulted in a complete resolution of psychosis, improvement of motor function, reduction of “off” time and a major improvement in levodopa-induced dystonic dyskinesias. The only adverse effect was mild sedation during the first two weeks of clozapine treatment. The lack of acute blockade of striatal D2 receptors by clozapine and the failure of chronic clozapine treatment to suppress striatal dopamine release may account for its beneficial effect in Parkinson's disease. Additionally, an ameliorating effect of clozapine on parkinsonism might be due to its action on serotonergic systems leading to release of striatal dopamine.

Keywords

ClozapineParkinson's diseasePsychosisDyskinesia
Type
Clinical and Brief Reports
Information
Irish Journal of Psychological Medicine , Volume 11 , Issue 2 , June 1994 , pp. 83 - 88
Copyright
Copyright © Cambridge University Press 1994

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References

1.Rondot, P, de Recondo, J, Coignet, A, Ziegler, M. Mental disorders in Parkinson's disease after treatment with L-DOPA. Adv Neurol 1984; 40: 259–69.Google ScholarPubMed
2.Friedman, JH. The management of the levodopa psychoses. Clin Neuropharmacol 1991; 14: 283–95.CrossRefGoogle ScholarPubMed
3.Hurwitz, TA, Calne, RB, Waterman, K. Treatment of dopaminomimetic psychosis in Parkinson's disease with electroconvulsive therapy. Can J Neurol Sci 1988; 15: 32–4.CrossRefGoogle ScholarPubMed
4.Andersen, K, Balldin, J, Gottfried, CG. A double blind evaluation of electroconvulsive therapy in Parkinson's disease with “on/off” phenomena. Acta Neurol Scand 1987; 76: 191–9.CrossRefGoogle ScholarPubMed
5.Scholz, E, Dichgans, J. Treatment of drug-induced exogenous psychosis in Parkinsonism with clozapine and fluperlapine. Europ Arch Psychiat Neurol Sci 1985; 235: 60–4.CrossRefGoogle ScholarPubMed
6.Ostergaard, K, Dupont, E. Clozapine treatment of drug induced psychotic symptoms in late stages of Parkinson's disease. Acta Neurol Scand 1988; 78: 349–50.CrossRefGoogle ScholarPubMed
7.Roberts, HE, Dean, RC, Stoudemire, A. Clozapine treatment of psychosis in Parkinson's disease. J Neuropsych Clin Neurosci 1989; 1(2): 190–2.Google ScholarPubMed
8.Friedman, JH, Lannon, MC. Clozapine in treatment of psychosis in Parkinson's disease. Neurology 1989; 39: 1219–21.CrossRefGoogle ScholarPubMed
9.Friedman, JH, Lannon, MC. Clozapine-responsive tremor in Parkinson's disease. Mov Disord 1990; 5: 225–9.CrossRefGoogle ScholarPubMed
10.Fischer, PA, Baas, H, Hefner, R. Treatment of parkinsonian tremor with clozapine. J Neural Transm Park Dis Dement Sect 1990; 2: 233–8.CrossRefGoogle ScholarPubMed
11.Pfeiffer, RF, Kang, J, Graber, B, Hofman, R, Wilson, J. Clozapine for psychosis in Parkinson's disease. Mov Disord 1990; 5: 239–42.CrossRefGoogle ScholarPubMed
12.Bernardi, F, Del Zompo, M. Clozapine in idiopathic Parkinson's disease [letter]. Neurology 1990; 40: 1151–2.CrossRefGoogle ScholarPubMed
13.Kahn, N, Freeman, A, Juncos, JL, Manning, D, Watts, RL. Clozapine is beneficial for psychosis in Parkinson disease. Neurology 1991; 41: 1699–700.CrossRefGoogle Scholar
14.Factor, A, Brown, D, Stewart, A. Clozapine prevents recurrence of psychosis in Parkinson's disease. Mov Disord 1992; 7: 125–31.CrossRefGoogle ScholarPubMed
15.Wolters, ECh, Hurwitz, TA, Mak, E, Teal, P, Peppard, FR, Remick, R, Calne, S, Calne, DB. Clozapine in the treatment of parkinsonian patients with dopaminomimetic psychosis. Neurology 1990; 40: 832–4.CrossRefGoogle ScholarPubMed
16.Rosenthal, SH, Fenton, ML, Harnett, DS. Clozapine for the treatment of levodopa-included psychosis in Parkinson's disease. Gen Hosp Psychiatry 1992; 14: 285–6.CrossRefGoogle ScholarPubMed
17.Parsa, MA, Ramirez, LF, Loula, EC, Meltzer, HY. Effect of clozapine on psychotic depression and parkinsonism. J Clin Psychopharmacol 1991; 11: 5, 330–1.CrossRefGoogle ScholarPubMed
18.Caine, ED, Polinsky, RJ, Kartzinel, R, Eben, MH. The trial use of clozapine for abnormal involuntary movement disorders. Am J Psychiatry 1979; 136: 317–20.Google ScholarPubMed
19.Farde, L, Nordstrom, AL, Wiesel, FA, Pauli, S, Halldin, C, Sedvall, G. Positron emission tomographic analysis of central D1 and D2 dopamine receptor occupancy in patients treated with classical neuroleptics and clozapine: relation to extrapyramidal side effects. Arch Gen Psychiatry 1992; 49: 7, 538–44.CrossRefGoogle ScholarPubMed
20.Farde, L, Wiesel, FA, Nordstroem, AL, Sedvall, G. D1 and D2 dopamine receptor occupancy during treatment with conventional and atypical neuroleptics. Psychopharmacol 1989; 99: S28–31.CrossRefGoogle ScholarPubMed
21.Andersen, PH, Nielsen, EB, Gronvald, FC, Braestrup, C. Some atypical neuroleptics inhibit (3H) SCH 23390 binding in vivo. Eur J Pharmacol 1986; 120: 143–4.CrossRefGoogle ScholarPubMed
22.Andersen, PB, Braestrup, C. Evidence for different states of the dopamine D1 receptor: clozapine and fluperlapine may preferentially label an adenylate cyclase coupled state of the D1 receptor. J Neurochem 1986; 47: 1822–31.CrossRefGoogle ScholarPubMed
23.Ellenbroek, BA, Artz, MT, Coles, AR. The involvement of dopamine D1 and D2 receptors in the effects of the classical neuroleptic haloperidol and the atypical neuroleptic clozapine. Eur J Pharmacol 1991; 196: 103–8.CrossRefGoogle ScholarPubMed
24.Van Tol, HHM, Bunzow, JR, Guan, HC, Sunahara, RK, Seeman, P. Niznik, HB, Civelli, O. Cloning of the gene for human dopamine D4, receptor with high affinity for the antipsychotic clozapine. Nature 1991; 350: 610–19.CrossRefGoogle ScholarPubMed
25.Miller, RJ, Hiley, CH. Anti-dopaminergic and anti-muscarinic effects of dibenzodiazepines: relationship to drug-induced parkinsonism. Arch Pharm 1976; 292: 289–93.CrossRefGoogle ScholarPubMed
26.Meltzer, HY, Gudelsky, GN. Dopaminergic and serotonergic effects of clozapine. Drug Res 1992; 42: 268–72.Google ScholarPubMed
27.Meltzer, HY. Clozapine: mechanism of action in relation to its clinical advantages. In: Kales, A, editor. Recent advances in schizophrenia. New York: Springer-Verlag, 1990: 237–56.CrossRefGoogle Scholar
28.Meltzer, HY, Matsubara, S, Lee, JC. Classification of typical and atypical antipsychotic drugs on the basis of dopamine D1, D2 and serotonin 2 PK-I values. J Pharmacol Exp Ther 1989; 251: 238–46.Google Scholar
29.Ashby, CR, Edwards, E, Harkins, KL, Wang, RY. Differential effect of typical and atypical antipsychotic drugs on the suppressant action of 2-methylserotonin on medial prefrontal cortical cells: a microiontophoretic study. Eur J Pharmacol, 1989; 166: 583–4.CrossRefGoogle Scholar
30.Blandina, P, Goldfarb, J, Green, JP. Activation of a 5-HT3 receptor releases dopamine from rat striatal slice. Eur J Pharmacol, 1988; 155: 349–50.CrossRefGoogle ScholarPubMed
31.Meltzer, HY. Novel antipsychotic drugs. Raven Press, 1992; 1: 6.Google Scholar