Diagnostics and treatment of impulse control disorders, psychosis and delirium: systemic review-based recommendations - guideline "Parkinson's disease" of the German Society of Neurology
- PMID: 39046524
- PMCID: PMC11588934
- DOI: 10.1007/s00415-024-12576-x
Diagnostics and treatment of impulse control disorders, psychosis and delirium: systemic review-based recommendations - guideline "Parkinson's disease" of the German Society of Neurology
Abstract
Background and objective: Impulse control disorders (ICD), psychosis and delirium are part of the spectrum of behavioural changes associated with Parkinson's disease (PD). The diagnostic and therapeutic management of these rather complex neuropsychiatric conditions has been updated in the clinical guideline by the German Society of Neurology (DGN).
Methods: Recommendations are based on a systematic literature reviews, other relevant guidelines and expert opinion.
Results: Patients receiving dopamine agonists (DA) therapy should be informed about the symptoms and risks of an ICD and should be routinely screened for ICD symptoms. In the presence of an ICD, DA should be reduced or discontinued and psychotherapeutic treatment may be considered. Non-oral therapies (levodopa/carbidopa intestinal gel infusion or deep brain stimulation) may also be an option for appropriate candidates. Psychosis in PD often has a gradual onset. Cognitive and affective disorders, psychiatric and medical comorbidities as well as polypharmacy are risk factors for a psychosis. Non-pharmacological treatments should be implemented as soon as possible and anti-parkinsonian medications should be adjusted/reduced if feasible. For psychosis associated with PD, quetiapine or clozapine should be used on an as-needed basis and for as short a time as is necessary, with safety monitoring. Delirium in PD may be underdiagnosed due to an overlap with chronic neuropsychiatric features of PD. Although transient by definition, delirium in PD can lead to permanent cognitive decline, motor impairment and increased mortality. Management of delirium includes pharmacological and non-pharmacological interventions.
Conclusion: The updated guideline encompasses the evidence-based diagnostic, non-pharmacological and pharmacological management of ICD, psychosis and delirium in PD.
Keywords: Delirium; Guideline; Impulse control disorder; Parkinson’s disease; Psychosis.
© 2024. The Author(s).
Conflict of interest statement
Declarations. Conflict of interest: K.W. has received funding from the Deutsche Forschungsgemeinschaft (German Research Association) and STADAPHARM GmbH outside the present study. He has received honoraria for presentations/advisory boards/consultations from BIAL, Indorsia, Boston Scientific and STADAPHARM GmbH, outside the present study. He has received royalties from Thieme Press and Elsevier Press. He serves as an editorial board member of Wileys “Parkinson’s Disease”, “Behavioural Neurology” and PLOSone. J.L. reports speaker fees from Bayer Vital, Biogen, EISAI, TEVA, Zambon, Esteve, Merck and Roche; consulting fees from Axon Neuroscience, EISAI and Biogen; author fees from Thieme medical publishers and W. Kohlhammer GmbH medical publishers and is inventor in a patent “Oral Phenylbutyrate for Treatment of Human 4-Repeat Tauopathies” (PCT/EP2024/053388) filed by LMU Munich. In addition, he reports compensation for serving as chief medical officer for MODAG GmbH, is beneficiary of the phantom share programme of MODAG GmbH and is inventor in a patent “Pharmaceutical Composition and Methods of Use” (EP 22 159 408.8) filed by MODAG GmbH, all activities outside the submitted work. T.v.E. received funding from the German Research Foundation (DFG) and the Brandau-Laibach Stiftung. He received honoraria for consulting and advisory work from Lundbeck Foundation and Lundbeck Pharma, Orion Pharma, GT Gain Therapeutics SA and ICON. He received materials from Life Molecular Imaging and Lilly. He owns stocks in NVIDIA, Microsoft and I.B.M. A.H. was a member of advisory boards of Boehringer Ingelheim, Lundbeck, Janssen, Otsuka, Rovi and Recordati and received paid speakership by these companies as well as by AbbVie and Advanz. He is editor of the German schizophrenia guideline. G.E. has received honoraria for presentations (advisory boards/consultations) from AbbVie Pharma, BIAL Pharma, Boehringer GmbH, Britannia Pharma, Desitin Pharma, ESTEVE Pharma, Neuraxpharm GmbH, STADAPHARMA GmbH and Zambon Pharma. He has received royalties from Kohlhammer Press and Thieme Press.
References
-
- Agid Y, Arnulf I, Bejjani P, Bloch F, Bonnet AM, Damier P, Dubois B, Francois C, Houeto JL, Iacono D, Karachi C, Mesnage V, Messouak O, Vidailhet M, Welter ML, Yelnik J (2003) Parkinson’s disease is a neuropsychiatric disorder. Adv Neurol 91:365–370 - PubMed
-
- Höglinger G, Trenkwalder C, et al. (2023) Parkinson-Krankheit, S2k-Leitlinie, 2023. In: Deutsche Gesellschaft für Neurologie (ed) Leitlinien für Diagnostik und Therapie in der Neurologie. https://dgn.org/leitlinie/parkinson-krankheit. Accessed 25 March 2024
-
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften / Working Group of the Scientific Medical Societies, AWMF-Regelwerk Leitlinien. https://www.awmf.org/regelwerk/stufenklassifikationen. Accessed 02 Jul 2024
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