Comparative Physical Morbidity and Mortality Risks of Antipsychotics in Patients with Parkinson’s Disease

  • 梁 薰尹

Student thesis: Master's Thesis


Background: Use of antipsychotics is a common treatment for psychosis in patients with Parkinson’s disease (PD) However the decreased binding between dopamine and receptors caused by antipsychotics warrants attentions on worsening movement symptoms of PD Objectives: To compare the risks of physical morbidity and mortality in Taiwanese PD patients receiving different antipsychotics for controlling psychiatric symptoms Methods: We conducted a retrospective cohort study using the Taiwan’s National Health Insurance Research Database (NHIRD) from 2004-2012 Study population consisted of patients aged 40 years and older who diagnosed with PD newly receiving antipsychotic medications The outcomes of interests were hospitalization due to physical morbidity (i e non-psychiatric hospitalization) all-cause mortality and all-cause hospitalization Quetiapine was selected as reference group for comparisons because it was the most commonly used antipsychotics for patients with PD We performed Cox proportional hazards models with adjustments of covariates such as age sex and baseline PD treatments to compare the physical morbidity and mortality risks between antipsychotic groups Results: We identified a cohort of 10 232 patients with the mean age of 76 31 years (SD 8 97) and 50 54% female Quetiapine (44 41%) was the most frequently used antipsychotics followed by risperidone (17 46%) haloperidol (16 86%) sulpiride (7 70%) and trifluoperazine (3 05%) We found the risks of physical morbidity hospitalization were higher in haloperidol (adjusted hazard ratio 1 14; 95% CI 1 05-1 24) and risperidone (1 12; 1 04-1 21) compared with quetiapine We found patients receiving aripiprazole (0 56; 0 38-0 82) had significantly lower risks compared with quetiapine users In addition we found the mortality risks were higher in olanzapine (1 32; 1 05-1 66) risperidone (1 27; 1 16-1 40) haloperidol (1 26; 1 13-1 41) and sulpiride (1 20; 1 04-1 38) while lower in aripiprazole (0 52; 0 29-0 92) compared with quetiapine Conclusions: The findings indicated risperidone haloperidol sulpiride and olanzapine should not be used for psychosis in patients with PD because of the increased risks of physical morbidity and mortality We found aripiprazole posed lower physical morbidity and mortality risks which could be a good potential drug of choice for psychosis in PD patients The study could be a strong ground for future research evaluating cost-effectiveness of aripiprazole for the patients with PD
Date of Award2018 Aug 15
Original languageEnglish
SupervisorEdward Lai (Supervisor)

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