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19 September 2022 : Case report  USA

[In Press] Neuroleptic Sensitivity in Dementia with Lewy Body and Use of Pimavanserin in an Inpatient Setting: A Case Report

Unusual clinical course, Mistake in diagnosis, Diagnostic / therapeutic accidents, Management of emergency care, Adverse events of drug therapy , Clinical situation which can not be reproduced for ethical reasons

Anthony Abadir1ADEF, Ryder Dalton ORCID logo2EF, Wanhong Zheng ORCID logo1ADEF, Jami Pincavitch ORCID logo3EF, Richa Tripathi ORCID logo45ABCDEF

DOI: 10.12659/AJCR.937397

Am J Case Rep In Press; DOI: 10.12659/AJCR.937397  

Available online: 2022-09-19, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

BACKGROUND
Antidopaminergic medications, including antipsychotics, are known to worsen motor and neuropsychiatric symptoms, including cognition and psychosis, in patients with dementia with Lewy body (DLB). The intensity of worsened clinical symptoms may vary and can result in mortality in certain situations. There have been some reports supporting clozapine, quetiapine and pimavanserin use in psychosis control in this population.
CASE REPORT
We describe the case of 75-year-old man with diagnosis of DLB and the post-treatment outcome with olanzapine for psychosis during hospitalization. He experienced worsened cognitive and motor functions. Discontinuation of olanzapine resulted in resolution of the clinical worsening. Further, re-initiation of Pimavanserin helped treat his hallucinations. He returned back to his baseline during a follow-up visit in the clinic at 1 month after discharge. Further, we incorporated the use of Best Practice Alert (BPA) as a part of the electronic health record (EHR) system to help providers identify patients prone to neuroleptic sensitivity and help select appropriate medications to treat psychosis in this patient population.
CONCLUSIONS
Administration of antipsychotics in patients with parkinsonism, especially DLB, requires close clinical monitoring and judicious use. Awareness of morbidity and mortality associated with such use is of importance, especially during hospitalization. From our experience, we incorporated use of BPA, which can help providers make judicious choices while treating this patient population. Pimavanserin, which is FDA-approved for psychosis in Parkinson’s disease, could be a potential safe and effective treatment option in this patient population.

Keywords: Lewy Body Disease; Psychotic Disorders; Neuroleptic Receptor

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923