Fernandez H, Trieschmann M, Okun MS. Rebound psychosis: Effect of discontinuation of antipsychotics in Parkinson’s disease. Movement Disorders 2005;20:104-05
PubMed link: https://www.ncbi.nlm.nih.gov/pubmed/15390047
Full text article: https://onlinelibrary.wiley.com/doi/full/10.1002/mds.20260
| Methods | Study design: Before-and-after study
Number of groups: One group |
| Participants | Number of participants: 6 enrolled, 1 completed
Age: 78 years (range 70 to 85) Sex: 2 female, 4 male Participants with dementia: No Inclusion criteria: · Idiopathic Parkinson’s Disease · Currently taking clozapine or quetiapine · History of drug-induced psychosis · Taking atypical antipsychotic drug for at least 6 months · Free of any ongoing psychosis as volunteered by the patient and confirmed by his or her accompanying caregiver Exclusion criteria: · Dementia in the first year of onset of parkinsonism (or other features suggestive of Dementia with Lewy Bodies) Concurrent medicine: levodopa, 690 mg daily (range 450 to 800 mg daily) Country: United States of America Setting: Community – single Movement Disorders Center |
| Interventions | Medicine: Atypical antipsychotic – average atypical antipsychotic exposure of 20 months
· Quetiapine at 25–125 daily, n=5 · Clozapine at 50 mg daily, n=1 Withdrawal schedule: On average, all patients were weaned off their antipsychotic medication by 4 weeks (range, 2–8 weeks) |
| Outcomes | Relapse |
| Dates | Study dates: Not described
Follow-up duration: Not stated |
| Funding sources | Not described |
| Notes | The trial was stopped prematurely after enrolling six patients out of 20.
The brief report nature makes it hard to ascertain much detail. A confoundingfactor in this study is that it looked at discontinuation of antipsychotics in Parkinson’s Disease while continuing levodopa. |
Risk of bias table
| Bias | Authors’ judgment | Support for judgment |
| Random sequence generation (selection bias) | High risk | A before-and-after the study is a non-randomized study design. |
| Allocation concealment (selection bias) | High risk | The open study, no allocation concealment was undertaken. |
| Blinding of participants and personnel (performance bias) | 5 out of 5 | As above. |
| Blinding of outcome assessment (detection bias) | 5 out of 5 | As above. |
| Incomplete outcome data (attrition bias) | 5 out of 5 | Study discontinued for ethical reasons after 6 patients were enrolled. |
| Selective reporting (reporting bias) | 5 out of 5 | Study discontinued for ethical reasons after 6 patients were enrolled. |
| Confounding (non-randomized) | 5 out of 5 | This study investigated deprescribing of antipsychotics in people taking dopamine for Parkinson’s Disease. The study was discontinued prematurely so there was a high risk of confounding. |
| Other bias | Unclear risk | The limited detail in the methods due to the short report format. |
| Newcastle-Ottawa scale | ||
| Selection bias | Representativeness of the exposed cohort | The detail is toolimited to ascertain the representativeness of the exposed cohort. |
| Selection of the non-exposed cohort | There was no concurrent control.
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| Ascertainment of exposure | Ascertainment of exposure appeared to be via secure record.
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| Demonstration that outcome of interest was not present at start of study | The researchers demonstrated that outcome of interest was not present at the startof the study. | |
| Comparability bias | Comparability of cohorts on the basis of the design or analysis | The studycontrols for antipsychotic discontinuation in the people with Parkinson’s Disease taking dopamine agonists. |
| Outcome bias | Assessment of outcome | Assessment of outcome was by self-report. |
| Was follow-up long enough for outcomes to occur | Follow-upappeared long enough for outcomes to occur. In fact, follow-up was prematurely discontinued as symptoms had re-emerged.
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| Adequacy of follow-up of cohorts | Complete follow-up – all subjects accounted for | |
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