October 2011 Archives

Quetiapine (Seroquel) for psychosis in PD

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I was doing some searching about drug therapy for psychosis in Parkinson's today and came across a few articles which demonstrate the complicated balancing act between evidence and practice.

First, in the article Patterns and trends in antipsychotic prescribing for Parkinson disease psychosis, it is reported that 66% of studied PD patients with psychosis seen between 2002 and 2008 were prescribed quetiapine and 2% received clozapine (the additional 30% were represented mainly by risperidone (17%), aripiprazole (12%), and olanzapine (11%)). Quetiapine is clearly the most prescribed antipsychotic for this population and clozapine the least, even though clozapine has been shown to be clearly effective (albeit the need for monitoring makes it less attractive).

As pointed out in that article, and in greater detail in the review Quetiapine in the treatment of psychosis in Parkinson's disease, the evidence for quetiapine's efficacy is mixed. Unblinded studies found it to be effective, it compared similarly to clozapine (though was less effective), yet 4/5 placebo controlled trials did not show a significant difference between it and placebo. Larger and better designed RCTs are needed to determine its true effectiveness. Despite the the mixed evidence, it may provide the best balance of safety, convenience, and efficacy.

Finally, I just wanted to point out the article Pimavanserin, a Serotonin2A Receptor Inverse Agonist, for the Treatment of Parkinson's Disease Psychosis. Pimavanserin is currently in phase III trials (no locations in Minnesota) and the study shows significant improvements over placebo in some measures, trends for other measures, and no significant differences for adverse effects. It seems like a good drug to keep an eye on.

While there are numerous case reports out there talking about specific manifestations, I was only able to find two reviews that attempted to pull them together.

Nervous system dysfunction in Henoch-Schonlein syndrome: systematic review of the literature
While this review is the more recent, I am not impressed by their search strategy and they missed some of the articles the much older review (below) caught.

Neurologic manifestations of Schoenlein-Henoch purpura: report of three cases and review of the literature

From Nervous system dysfunction in Henoch-Schonlein syndrome: systematic review of the literature

From Neurologic manifestations of Schoenlein-Henoch purpura: report of three cases and review of the literature

Posttransplantation Lymphoproliferative Disorder

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Online Books

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The library subscribes to thousands of online biomedical textbooks. They can be somewhat hard to find, however, since they come from many different packages and lack a unified interface. Here are a few tips and tricks for finding them.

As a note, all ebooks are available from on or off campus using your university ID and password. Some books can only be read in your browser while others can be downloaded as PDFs (exact copy of what appeared in the print version). If you have questions about a particular book, please let me know.

We have a general listing of ebooks at http://hsl.lib.umn.edu/ebooks. This page only lists highlights in each specialty. There is a search box at the top of the page, but this also only searches a subset of available online books (we hope to fix this shortly). To find the full set of available books, you need to go to each ebook package and search within it. The packages are at the bottom of the page under "EBook Collections."

Here are some links to take you directly to the neurology books within each package:
Springer (green titles are available)
Wiley (unlocked titles are available)
R2 Library

Selected neurology textbooks:
Adams and Victor's Principles of Neurology
Clinical Neurology
Clinical Neuroanatomy
Current Protocols in Neuroscience
Neurobiology of Disease (2007)
Neurology Board Review: An Illustrated Study Guide (2007)
Neurology in Clinical Practice

Please let me know if there are any other books you think should be added to the above listing.

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This page is an archive of entries from October 2011 listed from newest to oldest.

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