Background: Several factors determine the choice of medications in patients with Parkinson’s disease (PD). We aimed to analyze the pattern of prescription of drugs in patients with PD before attending a tertiary-care center. Methods: The study included chart review of 800 PD patients attending the Department of Neurology of the National Institute of Mental Health and Neurosciences in Bangalore, India. Results: The mean age at onset was 51.1±11.8 years. The mean duration of illness was 41.7±43.6 months. At first visit, 79.4% (group 1, n=635) of patients were on medications, 10% (group 2, n=80) were on medications but later discontinued, and 10.6% (group 3, n=85) were drug-naïve. Overall, levodopa was prescribed in 94.8%, trihexyphenidyl in 40.4%, dopamine agonists in 23.2%, and amantadine in 17.2% either as monotherapy or in combination. In group 1, 37.8% were on monotherapy, with levodopa being the most commonly used agent (33.1%), followed by trihexyphenidyl (2.2%), dopamine agonists (1.6%), and amantadine (0.6%). Among those on polytherapy, levodopa plus trihexyphenidyl was the preferred combination (23.9%). In group 2, levodopa monotherapy was also most common (72.5%), followed by trihexyphenidyl monotherapy (7.5%). Conclusions: Levodopa and trihexyphenidyl were the most commonly prescribed drugs in our patients. A higher use of trihexyphenidyl could be due to its easy availability, low cost, and better tolerability in our patients, who were relatively young at the time of onset of their disease. The choice of antiparkinsonian medications at the primary and secondary care levels in India may be inappropriate, and newer guidelines tailored to the Indian context are warranted.

In this first part of a review on drug-induced psychosis in Parkinson's disease, the etiology, the clinical features and the therapeutic strategies will be discussed. The drugs used in the therapy of Parkinson's disease may lead to non-motor complications, such as delirium or hallucinations. Especially anti-cholinergics, respectivily dopaminometics, play an important role. Lowering the dose or even discontinuing the medication is the main therapeutic measure. The use of an atypical antipsychotic drug (clozapine) may be indicated.

Urinary incontinence is a common symptom in women, more so in older people, with a significant impact on physical health and wellbeing. About 1 in 5 people have impaired continence. Symptom categorization at initial assessment is the key to guiding further therapy. Non-pharmacological options (bladder training for 6 weeks with guidance from a trained physiotherapist) are preferred and can be supported with biofeedback. If unsuccessful, anticholinergics are added and, rarely, surgical options need consideration.

Anticholinergics are the mainstay of pharmacological management of urge incontinence. The National Institute of Health and Clinical Excellence (NICE) recommends immediate release oxybutynin as the first-line agent, with recourse to others if there are adverse effects. The pharmacology, efficacy and adverse effect profile of the various anticholinergic drugs is reviewed, allowing the reader to make an informed choice of appropriate anticholinergics for urge incontinence.

Background: Suboptimal prescribing in older psychiatric patients causes iatrogenic morbidity. The objectives of this study were to compare the prevalence of suboptimal prescribing before and after admission to a geropsychiatry inpatient unit and to evaluate a possible correlation between optimal medication use and functional improvement in patients with dementia.

Methods: The study sample comprised 118 consecutively admitted patients to a 14-bed university hospital-based geropsychiatry inpatient unit over a period of 20 months who met the DSM-IVTR criteria for an Axis I psychiatric illness and co-morbid dementia. At admission demographic information, Mini-mental State Examination (MMSE) Score, Mattis Dementia Rating Scale Score (DRS), and number of active medical illnesses were recorded. At admission and discharge the number and type of medications, number of Revised Beers Criteria (RBC) medications (a published list of potentially inappropriate medications in older adults independent of diagnoses or conditions), Global Assessment of Functioning (GAF) scores, and Scale of Functioning (SOF) scores were tabulated. χ2 tests, paired t-tests and Pearson correlations were used to test the medication prevalence and associations between measures of clinical function and other variables.

Results: The mean age (standard deviation) of the sample was 81.5 (6.2) years. The mean scores on the MMSE and DRS were 22.1 (6.2) and 116.6 (18.7), respectively. From admission to discharge, the mean number of RBC medications per patient decreased significantly from 0.8 (1.1) to 0.4 (0.6). There was also a significant correlation between reduction in Beers criteria medications and improved SOF score from time of admission to time of discharge.

Conclusion: Suboptimal medication use is a potential source of decreased function in older patients with dementia.