Article Text
Abstract
Objective To evaluate the prevalence of psychosis associated with Parkinson's disease (PSY-PD) in its early stages, its incidence over a 24 month follow-up period and the association with motor and non-motor clinical features.
Methods PRIAMO is a 2 year longitudinal observational study that has enrolled patients with parkinsonism in 55 Italian centres. A cohort of 495 patients with early disease stage PD (baseline Hoehn and Yahr score ≤2, disease's duration (median) 3.4 years) were followed for 2 years. PSY-PD was evaluated by means of a clinician rated questionnaire and defined as the presence of at least one of the following symptoms occurring for at least 1 month: illusions, hallucinations, jealousy ideas and persecutory ideas. Patients with and without PSY-PD were compared on several clinical variables, encompassing motor and non-motor features.
Results The prevalence of PSY-PD at baseline was 3%; the incidences at 12 and 24 months were 5.2% and 7.7%, respectively. Longer disease duration and prescription of dopamine agonists at baseline were associated with the development of PSY-PD over the 24 month period. At this follow-up time, worse disease severity, decline in cognitive performances, presence of depressive symptoms and anxiety were more frequently observed in PSY-PD.
Conclusions Psychotic type symptoms may occur in the early stages of PD although less frequently than in later stages. Beyond dopaminergic treatment, there are disease related factors, such as disease severity and the occurrence of cognitive and depressive symptoms, which may underlie the onset of psychotic type symptoms from the earliest stages.
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Footnotes
↵* For PRIAMO Study Group see appendix 1 at the end of the article.
Funding This study was supported by an educational grant issued by Boehringer Ingelheim, Italy.
Competing interests LM has received honoraria for lectures and educational activities from UCB Pharma, Glaxo Smithkline and serves on scientific advisory boards for Boehringer Ingelheim. CC received honoraria from serving on the scientific advisory board of Boehringer Ingelheim Pharmaceuticals, Ipsen Pharmaceuticals, Novartis Pharmaceuticals and UCB/Schwarz, and received royalties from CIC Edizioni Internazionali Publishers. RM received honoraria from serving on the scientific advisory board of Boehringer Ingelheim, serves as an editorial board member of the Journal of Neurodegenerative Disorders and has received honoraria for speaking engagements from Boehringer Ingelheim, Glaxo Smithkline, Lundbeck and UCB Pharmaceuticals. AA has received honoraria for consulting services and symposia from Abbott, Boehringer Ingelheim, GSK, Lundbeck, UCB, Novartis and Merck Serono. GM received institutional support from Ministero dell'Istruzione, dell'Università e della Ricerca (MIUR). MP received honoraria for speaking engagements from Boehringer Ingelheim. FEP received honoraria for speaking engagements from Boehringer Ingelheim, Novartis, GSK and received institutional support from Ministero dell'Istruzione, dell'Università e della Ricerca (MIUR). GA received honoraria from serving on the scientific advisory board of Boehringer Ingelheim and Novartis, serves as a member of scientific committee of the journal Equilibri, received honoraria for speaking engagements from Novartis, Lundbeck, Glaxo Smith Kline, UCB and Boehringer Ingelheim, and received institutional support from Ministero dell'Istruzione, dell'Università e della Ricerca. EB received funding for a trip from Novartis and Lilly and received honoraria for speaking engagements from Lilly, GSK, Boehringer Ingelheim and Sanofi Aventis. AB received honoraria for speaking engagements from Boehringer Ingelheim and received institutional support from MIUR. FM receives research support from Neureca Onlus, Milan. PB received honoraria for serving on the scientific advisory board of Boehringer Ingelheim, Merck Serono, Novartis Italy, UCB Italy and Lundbeck Italy, serves as an editorial board member of Journal of Neurodegenerative Disorders and Parkinson's Europe, received honoraria for speaking engagements from Boehringer Ingelheim, Merck Serono, Novartis Italy, UCB Italy and Lundbeck Italy, and received research support from Boehringer Ingelheim, Merck Serono, Novartis Italy, UCB Italy and Lundbeck Italy.
Ethics approval The ethic committees of each participating site approved the study.
Provenance and peer review Not commissioned; externally peer reviewed.