Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0040822 (tremor)
 18,428 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Psychosis only rarely occurs in patients with untreated Parkinson's disease. Much more commonly, psychosis is induced by drug therapy for Parkinson's disease and is the strongest known risk factor for nursing home placement. Delusions are less frequent than hallucinations, but are more concerning as they are often paranoid in nature. Treatment begins with a search for correctable infectious, toxic, and metabolic aetiologies. If symptoms persist, anti-Parkinson's disease medications are slowly reduced. However, withdrawal of these drugs usually worsens parkinsonism and is often not tolerated. Certain atypical antipsychotics can be used to treat psychosis without compromising motor function. The choice of atypical antipsychotic is largely based on ease of use and adverse effect profile as most have comparable efficacy in improving psychosis. Currently, there are five marketed atypical drugs - clozapine, risperidone, olanzapine, quetiapine and ziprasidone. Ziprasidone is the only agent whose adverse effect profile has not been reported in Parkinson's disease. The most common adverse effects of clozapine in Parkinson's disease are sedation, orthostatic hypotension and sialorrhoea. Sedation is generally helpful since these patients are frequently awake at night and tend to have worse behavioural problems then. Clozapine does not induce deterioration of motor function, but it has the potential to cause agranulocytosis, which is idiosyncratic and not dose-related. In risperidone-treated Parkinson's disease patients, reported adverse effects include somnolence, sialorrhoea, dizziness, palpitations, constipation, delirium, fatigue, leg cramps, depression, urinary incontinence and hypotension. Although in some Parkinson's disease studies, risperidone has been well tolerated, others have shown that many patients are unable to tolerate the drug due to deterioration of motor function. While an initial study of olanzapine in Parkinson's disease psychosis showed the drug to be effective without deterioration of motor function, succeeding reports demonstrated a deleterious effect of the drug on motor functioning. The most common adverse effects of quetiapine in Parkinson's disease patients are sedation and orthostatic hypotension. There is a lack of double-blind trials; however, cumulative reports involving >200 Parkinson's disease patients strongly suggest that quetiapine is well tolerated and effective. Unlike clozapine, it does not improve tremor and may induce mild deterioration of motor function. Recently, cholinesterase inhibitors have been reported to alleviate psychosis in Parkinson's disease. Although ondansetron, an antiemetic with antiserotonergic properties, has been reported to relieve psychosis in Parkinson's disease, its prohibitive cost has prevented further study in this population. Electroconvulsive treatment is generally reserved for the patient with psychotic depression who is unable to tolerate any pharmacological therapy.
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PMID:Treatment of psychosis in Parkinson's disease: safety considerations. 1281 32

What is the best treatment for adults with Graves' disease in 2016? To answer this question, we reviewed the literature using the standard Prescrire methodology. When the symptoms of hyperthyroidism are poorly tolerated, a beta-blocker relieves tachy- cardia, anxiety and tremor. Three treatments have been shown to be effec- tive in controlling hyperthyroidism: antithyroid drugs, radioiodine, and thyroidectomy. Carbimazole and its metabolite thiamazole are the antithyroid drugs with the best harm-benefit balance, except during the first trimester of preg- nancy. About 50% of patients are cured after 12 to 18 months of treatment. Antithyroid drugs carry a risk of rare but serious adverse effects, including agranulocytosis. Hepa- titis is more frequent with propylthiouracil. Radioiodine is administered as a single oral dose, in order to destroy the thyroid gland. Perma- nent cure is achieved in about 80% of cases, usu- ally after 1 or 2 months. Permanent hypothyroid- ism is frequent, occurring at various intervals after treatment. Radioiodine may exacerbate pre-existing oph- thalmopathy or provoke its onset, especially among smokers. Corticosteroid therapy reduces this risk. Protective measures are used for a few days or weeks in order to avoid radiation exposure among close contacts. Radioiodine is contraindi- cated during pregnancy. Surgical thyroidectomy may be total with little risk of recurrence, or subtotal with about an 8% risk of recurrence. The complications of surgery mainly consist of. hypoparathyroidism and permanent paralysis of the recurrent laryngeal nerve, which occur after 1% to 5% of procedures. In practice, the choice of treatment depends on the patient's preferences and situation, including a woman's desire to conceive, size of the goitre, the degree of hyperthyroidism, and the presence of ophthalmopathy.
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PMID:Graves' disease in adults Antithyroid drugs, radioactive iodine, or sometimes thyroidectomy. 3073 Jun 22


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