Long Term Outcome of Treatment for Psychosis

Goetz and Stebbins (5) described 11 PD patients in a nursing home with hallucinations, all of whom were never discharged from the nursing home and died within two years. In an open-label extension of the U.S. double-blind clozapine trial, only 25% of completers died over a 26-month observational period. Forty-two percent were in nursing homes, 68% were demented, and 69% were still psychotic (4). A separate study of 39 parkinsonian patients, treated with clozapine for psychosis, found that only 15% had died over a span of five years and 33% had been admitted to nursing homes (115).

There are few studies looking at whether or not patients can be weaned off their antipsychotic medications. Fernandez et al. tried to wean off clozapine or que-tiapine in psychiatrically stable PD patients with a history of drug-induced psychosis. The study had to be aborted after enrolling only six patients, who had all been on their antipsychotics for an average of 20 months (116). Five experienced worsened psychosis, where three of these patients had a more severe psychosis than at baseline, suggesting the possibility of a "rebound psychosis." In contrast, a five-year follow-up of 32 PD patients with psychosis on clozapine found that nine were able to discontinue the clozapine without recurrence of psychosis (61). More research in this area is needed, but a recent six-year longitudinal study of PD patients with hallucinations found that hallucinators at baseline continued to have hallucinations at the end of study observation (16). Therefore, once patients start antipsychotic medications, it is likely that they will require treatment indefinitely.

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