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Nizon D, Abdel Ahad P, Chauviré V, Godier E, Gohier B, Kazour F. Treatment with pimavanserin of Lewy body dementia related psychosis with previous clozapine intolerance - A case report. L'ENCEPHALE 2024; 50:358-359. [PMID: 38311485 DOI: 10.1016/j.encep.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/16/2023] [Accepted: 11/06/2023] [Indexed: 02/06/2024]
Affiliation(s)
- Dorian Nizon
- Department of Adult Psychiatry and Addictology, Angers University Hospital, CHU of Angers, 4, rue Larrey, 49100 Angers, France
| | - Pierre Abdel Ahad
- Department of Adult Psychiatry and Addictology, Angers University Hospital, CHU of Angers, 4, rue Larrey, 49100 Angers, France
| | - Valérie Chauviré
- Department of Neurology, Angers University Hospital, CHU of Angers, Angers, France
| | - Edouard Godier
- Department of Adult Psychiatry and Addictology, Angers University Hospital, CHU of Angers, 4, rue Larrey, 49100 Angers, France
| | - Bénédicte Gohier
- Department of Adult Psychiatry and Addictology, Angers University Hospital, CHU of Angers, 4, rue Larrey, 49100 Angers, France
| | - François Kazour
- Department of Adult Psychiatry and Addictology, Angers University Hospital, CHU of Angers, 4, rue Larrey, 49100 Angers, France.
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Baker M, Song W, Fusick A. Pimavanserin Use in Lewy Body Dementia: A Case Report Demonstrating the Medication's Efficacy. Cureus 2023; 15:e46356. [PMID: 37920617 PMCID: PMC10619331 DOI: 10.7759/cureus.46356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 11/04/2023] Open
Abstract
Pimavanserin is an antipsychotic that is approved for use in Parkinson's disease psychosis. Working as a serotonin 2A inverse agonist, pimavanserin allows patients to improve their psychotic symptoms without worsening the motor symptoms of Parkinson's. This mechanism is mediated via serotonin receptors and may allow for pimavanserin to be considered for use in other disease processes that present with psychosis. Here, the authors describe the case of a 75-year-old man with Lewy Body Dementia (LBD) who was started on pimavanserin. The response of the patient to the medication was measured over a six-week time course using the Scales for the Assessment of Positive Symptoms of Schizophrenia (SAPS). Overall, pimavanserin was shown to be effective in this patient with LBD. The authors also provide a review of the sparse literature attesting to other off-label uses for this unique antipsychotic.
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Affiliation(s)
| | - Wenxin Song
- Mental Health, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Adam Fusick
- Mental Health and Behavioral Services, James A Haley Veteran Affairs, Tampa, USA
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Rothenberg KG, McRae SG, Dominguez-Colman LM, Shutes-David A, Tsuang DW. Pimavanserin Treatment for Psychosis in Patients with Dementia with Lewy Bodies: A Case Series. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e939806. [PMID: 37775968 PMCID: PMC10549935 DOI: 10.12659/ajcr.939806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 08/11/2023] [Accepted: 07/27/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Many patients with dementia with Lewy bodies (DLB) experience cholinesterase inhibitor- and antipsychotic-resistant psychosis. The new second-generation antipsychotic pimavanserin has been used with some success in the treatment of psychosis in other forms of dementia, including Alzheimer disease and Parkinson disease dementia. It is possible that pimavanserin may also be useful in the treatment of psychosis in DLB. We sought to describe the disease course and treatment of psychosis in 4 patients with DLB who were prescribed pimavanserin after other medications failed to reduce the frequency or severity of hallucinations and delusions. CASE REPORT This is a case series of 4 male patients (ages 56 to 74 at the beginning of the reports) who developed DLB and psychosis (eg, visual illusions, visual and olfactory hallucinations, and paranoid delusions). All 4 patients were prescribed cholinesterase inhibitors (eg, donepezil or rivastigmine) prior to pimavanserin, and only 1 patient experienced improved psychosis while on cholinesterase inhibitors. All 3 patients who were prescribed first-generation antipsychotics (eg, haloperidol) or traditional second-generation antipsychotics (eg, olanzapine, risperidone, or quetiapine) experienced initial or lasting side effects with no improvement of psychosis. Conversely, all 4 patients tolerated pimavanserin well, and 3 of the 4 patients experienced significant improvement of psychosis (eg, fewer hallucinations, fewer delusions, reduced paranoia, and/or reduced distress or agitation related to hallucinations and delusions) when prescribed pimavanserin. CONCLUSIONS This case series suggests that pimavanserin is tolerable in older males with DLB and that it may be useful for the reduction of distressful hallucinations, delusions, and paranoia in patients with DLB.
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Affiliation(s)
- Kasia Gustaw Rothenberg
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sharon G. McRae
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
- Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Liza M. Dominguez-Colman
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Andrew Shutes-David
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
- Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Debby W. Tsuang
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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