Diagnostic and Treatment Options for Psychosis in Lewy Body and Parkinson Disease

Course Description

Symptoms of psychosis, including visual hallucinations and delusions, occur in up to 90% of patients with Parkinson’s Disease (PD), Parkinson’s Disease dementia (PDD), and dementia with Lewy bodies (DLB). The theme across these disorders includes the presence of alpha-synuclein pathology, and the pathophysiologic impact on converging brain networks. Identifying and managing these symptoms of psychosis represent a considerable challenge. Therapeutic limitations arise from the paucity of efficacious agents, deterioration in motor function due to dopamine receptor antagonism from conventional antipsychotics, interaction of sleep dysfunction and psychosis presentation, among other factors. As the management of psychosis can be complicated, many of these patients may seek specialized neuropsychiatric care; thus, psychiatric and neurologic pharmacists should be familiar with treatment strategies and pharmacotherapy utilized based on patient diagnosis.

Learning Objectives

  1. Describe clinical presentation of Parkinson’s Disease (PD), PD dementia (PDD), and dementia with Lewy bodies (DLB).
  2. Discuss prevalence and qualitative information related to psychosis in PD, dementia with Lewy bodies, and other atypical parkinsonian syndromes.
  3. Identify treatment strategies to manage psychotic symptoms in relationship to safety, efficacy, and currently available evidence.
  4. Outline information related to pimavanserin and its suggested indication for management of psychosis in dementia-related psychosis.

Target Audience

If you are a pharmacist, nurse practitioner, or other health care professional involved in the comprehensive medication management of individuals living with mental health and/or substance use disorders, we invite you to participate in this online course.

Faculty

Daniel O. Claassen, MD
View biographical information

Daniel O. Claassen, MD
Professor of Neurology
Vanderbilt University Medical Center
Nashville, TN

Dr. Claassen is a board-certified Neurologist, with subspecialty training in behavioral neurology and movement disorders, who specializes in the diagnosis and treatment of neurodegenerative disorders characterized by disruptions to cognition, behavior, and movement. The theme of his work is to understand the biologic basis of how humans regulate of behavior, and the cognitive processes intrinsic to this nature. His research efforts are focused in patients that suffer from neurodegenerative conditions, and current studies assess therapeutic outcomes in various neurodegenerative disorders, such as Parkinson, Huntington, and Alzheimer disease. He leads an active basic research lab which investigates the neurobiological basis neurodegeneration through innovative cognitive neuroscience, neuroimaging tools and biomarker discovery using patient biofluids. His expertise is in neuroimaging, neuropsychology methods, and clinical trials that assess therapeutic efficacy. Current research funding is from the National Institutes of Health, Department of Defense, Michael J Fox Foundation, Griffin Family Foundation, and several industry-academic partnerships.

No Relevant Financial Relationships to Disclose
 
My presentation will include discussion of off-label, experimental, and /or investigational use of drugs or devices: Melatonin, Anticholinesterase inhibitors, Quetiapine

Course Requirements

To receive ACPE credit for this session, you must:

  • Register for this course.
  • Review the full content of the activity and reflect upon its teachings.
  • Complete the evaluation at the end of the activity.
  • Provide the necessary details in your profile to ensure correct reporting by AAPP to CPE Monitor.

Continuing Education Credit and Disclosures

Activity Date: 04/26/2022
ACPE Contact Hours: 1
ACPE Number: 0284-0000-22-050-H01-P (Knowledge)
Nursing Credit Reminder: Note that ACPE credit is accepted for ANCC Certification Renewal and AANPCB advanced practice provider content. For specific questions related to your organization's acceptance of ACPE continuing education units, please contact your organization directly.

ACPEThe College of Psychiatric and Neurologic Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

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View planning committee disclosures

2022 Program Committee

Elayne D. Ansara, PharmD, BCPP, BCPS
Clinical Pharmacy Specialist
Veteran Health Indiana
Indianapolis, IN
No Relevant Financial Relationships to Disclose
Jolene R. Bostwick, PharmD, BCPP, BCPS
Program Administrative Chair
Assistant Dean for Co-Curriculum and Professional Development & Clinical Professor
University of Michigan College of Pharmacy
Ann Arbor, MI
No Relevant Financial Relationships to Disclose

Bridget Bradley, PharmD, BCPP
Associate Professor
Pacific University School of Pharmacy
Hillsboro, OR
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: ACCP PSAP May 2021, Neurology and Psychiatry Book
Educational Grants, Research Grants or Contracts: NACDS Community Pharmacy Residency Grant

Austin R. Campbell, PharmD, BCPP
Program Committee Chair

Clinical Pharmacy Specialist - Psychiatry
University of Missouri Health Care
Columbia, MO
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Sunovion Pharmaceuticals Inc. Speakers Bureau
Financial Interests: Up To Date Contributor "Pharmacotherapy for schizophrenia: Long-acting injectable antipsychotic drugs"
Non-Financial Interests: Extension for Community Healthcare Outcomes, Show-Me ECHO Project

Chelsea N. Carr, PharmD, BCPP
Advanced Practice Pharmacist - Psychiatry
University of Maryland School of Pharmacy
Catonsville, MD
No Relevant Financial Relationships to Disclose
Dana Chiulli, PharmD, BCPP
Clinical Pharmacist - Mental Health
VISN 06 Mental Health Clinical Resource Hub
Savannah, GA
No Relevant Financial Relationships to Disclose
Jordan Cooler, PharmD, BCPP
Clinical Assistant Professor
University of South Carolina College of Pharmacy
Columbia, SC
No Relevant Financial Relationships to Disclose

Bennett J. Doughty, PharmD, BCPP, BCPS
Clinical Assistant Professor
Binghamton University School of Pharmacy and Pharmaceutical Sciences
Binghamton, NY
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Achieve CE - CE provided for compensation
Educational Grants, Research Grants or Contracts: SUNY Germination Space Grant. $50,000. Awarded July 2019.
Non-Financial Interests: New York State American College of Clinical Pharmacists Executive Board

Amber R. Douglass, PharmD, BCPS, BCPP
Clinical Pharmacy Specialist - Mental Health
VISN 1 Clinical Resource Hub - VA Connecticut Healthcare System
West Haven, CT
No Relevant Financial Relationships to Disclose

Megan J. Ehret, PharmD, BCPP, MS
BCPP Program Director

Professor
University of Maryland
Baltimore, MD
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Psych U Section Advisor, Lexi-Comp Consultant/Reviewer
Educational Grants, Research Grants or Contracts: FDA/University of Maryland CERSI, Maryland Behavioral Health Department, NIH

Kristen N. Gardner, PharmD, BCPP
Clinical Pharmacy Specialist - Behavioral Health
Kaiser Permanente Colorado
Denver, CO
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Biostrategies - one time consultant re:LAIAs (2019)
Educational Grants, Research Grants or Contracts: ACCP PSAP author (2021-2022); ACCP annual meeting speaker (2020)

Michelle L. Geier, PharmD, BCPP
Psychiatric Clinical Pharmacist Supervisor
San Francisco Department of Public Health
San Francisco, CA
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Weitzman Institute Project ECHO Faculty
Nicole Hahn, PharmD, BCACP
Clinical Pharmacy Specialist - Neurology
Kaiser Permanente
Denver, CO
No Relevant Financial Relationships to Disclose
Kayla D. Johnson, PharmD, BCPP, BCPS
Vanderbilt University Medical Center
Thompsons Station, TN
No Relevant Financial Relationships to Disclose
Erin D. Knox, PharmD, BCPP
Director of Experiential Education
UCI School of Pharmacy & Pharmaceutical Sciences
Irvine, CA
Non-Financial Interests: Santa Ana Community College, Pharmacy Technology Program, Advisory Committee
Marketa Marvanova, PharmD, PhD, BCGP, BCPP, FASCP
Dean and Professor
University of Montana, Skaggs School of Pharmacy
Missoula, MT
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Editorial Board member: Continuum: Lifelong Learning in Neuroilogy,
consultant for Lexicomp as a clinical specialist in neurology and psychiatry
Melissa Mitchell, PharmD, BCGP, BCPP, BCPS
Senior Clinical Pharmacist
RUHS MC
Moreno Valley , CA
External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Neurocrine Speakers Bureau - Ingrezza,
Janssen Speakers Bureau - Spravato, Otsuka - PsychU.org Speaker
Thea R. Moore, PharmD, BCPP
Associate Professor
University of South Florida
Tampa, FL
No Relevant Financial Relationships to Disclose
Lindsey Peters, PharmD, BCPS
Associate Professor of Pharmacy Practice
Ohio Northern University
Ada, OH
No Relevant Financial Relationships to Disclose
Kristina Reinstatler, PharmD, BCPP, MBA
Clinical Pharmacy Specialist
UC Health University of Cincinnati Medical Center
Cincinnati, OH
Educational Grants, Research Grants or Contracts: HEALing Communities NIH grant- pharmacy lead Athens Cty, Ohio
Michael D. Shuman, PharmD, BCPP
Staff Pharmacist
Central State Hospital
Lousiville, KY
No Relevant Financial Relationships to Disclose
Taylor A. Thomas, PharmD, BCPP
Clinical Pharmacy Specialist- Mental Health
VA Northern Indiana Health Care System
Fort Wayne, IN
No Relevant Financial Relationships to Disclose
Nina Vadiei, PharmD, BCPP
Assistant Professor
University of Arizona Colleges of Pharmacy and Medicine
Tucson, AZ
No Relevant Financial Relationships to Disclose

All relevant relationships have been mitigated.

View disclaimer and disclosure of off-label use

Off-Label Use: This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA (see faculty information). The opinions expressed in the educational activity do not necessarily represent the views of AAPP and any educational partners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Presentation-Specific Disclosure: My presentation will include discussion of off-label, experimental, and /or investigational use of drugs or devices: Melatonin, Anticholinesterase inhibitors, Quetiapine

View fair balance and integrity statement

It is the policy of AAPP to ensure independence, balance, objectivity, scientific rigor, and integrity in continuing education activities. Those involved in the development of this continuing education activity have made all reasonable efforts to ensure that information contained herein is accurate in accordance with the latest available scientific knowledge at the time of accreditation of this continuing education activity. Information regarding drugs (e.g., their administration, dosages, contraindications, adverse reactions, interactions, special warnings, and precautions) and drug delivery systems is subject to change, however, and the reader is advised to check the manufacturer’s package insert for information concerning recommended dosage and potential problems or cautions prior to dispensing or administering the drug or using the drug delivery systems.

Fair balance is achieved through ongoing and thorough review of all materials produced by faculty, and all educational and advertising materials produced by supporting organizations, prior to educational offerings. Approval of credit for this continuing education activity does not imply endorsement by AAPP for any product or manufacturer identified.