Summary of the Best Evidence for Safety Management in Patients with Parkinson's Disease Accompanied by Behavioral and Psychiatric Symptoms: A Systematic Review.

Purpose: To retrieve, screen, and summarize the best evidence for the safety management of patients with Parkinson's disease (PD) accompanied by behavioral and psychiatric symptoms (BPS). Safety management in this context refers to the systematic process of identifying, assessing, and mitigating risks of harm (eg, falls, self-harm, medication adverse effects) to ensure the physical and psychological well-being of patients. This review aims to provide an evidence-based foundation for clinical healthcare professionals to implement standardized safety management. Patients and Methods: A systematic search was conducted in domestic and international databases and websites for guidelines, expert consensuses, clinical decisions, evidence summaries, and systematic reviews related to the safety management of PD patients with BPS. The search period spanned from database inception to March 31, 2025, with no additional limits applied to the publication dates of the documents. Two researchers independently evaluated the quality of the literature, extracted and summarized the evidence, and rated the evidence level of the included documents. Results: Twenty-one documents were ultimately included: 6 guidelines, 5 expert consensuses, 5 clinical decisions, 4 systematic reviews, and 1 evidence summary. Thirty-two pieces of best evidence were summarized across five aspects: safety assessment and identification, safety management strategies, safe medication practices, safety intervention methods, and safe care environment. Key recommendations include the necessity of comprehensive risk assessment using standardized tools, the critical role of multidisciplinary care, the principle of starting low and going slow with antipsychotics, the integration of non-pharmacological interventions like cognitive-behavioral therapy and repetitive transcranial magnetic stimulation, and the importance of optimizing both the physical and psychosocial environment. Conclusion: This study summarizes the best evidence for the safety management of PD patients with BPS, providing a reference for clinical healthcare professionals to make scientific decisions and implement standardized safety management protocols. The main recommendations for managing these patients emphasize a proactive, multifaceted approach that integrates continuous assessment, multidisciplinary collaboration, judicious medication use, evidence-based non-pharmacological strategies, and environmental modifications, all while considering patient preferences.