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Comment & Response
September 2016

The Danger of Not Treating Parkinson Disease Psychosis—Reply

Author Affiliations
  • 1Parkinson’s Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
  • 2Mental Illness Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
  • 3Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
  • 4Department of Veterans Affairs, Health Services Research and Development, Center for Clinical Management Research, Ann Arbor, Michigan
  • 5Geriatric Research, Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
  • 6Department of Psychiatry, University of Michigan, Ann Arbor
  • 7Morton and Gloria Shulman Movement Disorder Centre, The Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
JAMA Neurol. 2016;73(9):1156-1157. doi:10.1001/jamaneurol.2016.2274

In Reply We appreciate the thoughtful comments by Malaty et al regarding our recent publication in JAMA Neurology reporting an increased risk for mortality associated with antipsychotic use in Parkinson disease (PD).1 They noted that the study did not focus on patients with PD and psychosis specifically, a potential limitation as psychosis itself confers an increased risk for mortality in PD.2 While that is true, we did include a comorbid diagnosis of psychosis as a covariate in all models, and the increased risk for mortality associated with antipsychotic use remained statistically significant even when controlling for the presence of psychosis. In addition, the similar, extensive, and well-accepted research reporting an association between antipsychotic use and mortality in patients with general dementia is not specific to patients with psychosis.3

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