TY  - JOUR
AU  - Witt, Karsten
AU  - Levin, Johannes
AU  - Eimeren, Thilo
AU  - Hasan, Alkomiet
AU  - Ebersbach, Georg
TI  - Diagnostics and treatment of impulse control disorders, psychosis and delirium: systemic review-based recommendations - guideline 'Parkinson's disease' of the German Society of Neurology.
JO  - Journal of neurology
VL  - 271
IS  - 12
SN  - 0367-004X
CY  - Heidelberg
PB  - Springer
M1  - DZNE-2024-01377
SP  - 7402 - 7421
PY  - 2024
AB  - 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).Recommendations are based on a systematic literature reviews, other relevant guidelines and expert opinion.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.The updated guideline encompasses the evidence-based diagnostic, non-pharmacological and pharmacological management of ICD, psychosis and delirium in PD.
KW  - Humans
KW  - Psychotic Disorders: therapy
KW  - Psychotic Disorders: diagnosis
KW  - Psychotic Disorders: etiology
KW  - Psychotic Disorders: drug therapy
KW  - Parkinson Disease: therapy
KW  - Parkinson Disease: complications
KW  - Parkinson Disease: diagnosis
KW  - Delirium: therapy
KW  - Delirium: diagnosis
KW  - Delirium: etiology
KW  - Disruptive, Impulse Control, and Conduct Disorders: etiology
KW  - Disruptive, Impulse Control, and Conduct Disorders: therapy
KW  - Disruptive, Impulse Control, and Conduct Disorders: diagnosis
KW  - Germany
KW  - Societies, Medical: standards
KW  - Neurology: standards
KW  - Practice Guidelines as Topic: standards
KW  - Antiparkinson Agents: therapeutic use
KW  - Antiparkinson Agents: administration & dosage
KW  - Delirium (Other)
KW  - Guideline (Other)
KW  - Impulse control disorder (Other)
KW  - Parkinson’s disease (Other)
KW  - Psychosis (Other)
KW  - Antiparkinson Agents (NLM Chemicals)
LB  - PUB:(DE-HGF)16
C2  - pmc:PMC11588934
C6  - pmid:39046524
DO  - DOI:10.1007/s00415-024-12576-x
UR  - https://pub.dzne.de/record/273018
ER  -