Indu Subramanian, MD, is a movement disorder neurologist and integrative medicine doctor in Los Angeles. She shares practical ways that caregivers can help to limit Parkinson’s psychosis symptom frequency and assess how much intervention loved ones need.

The time frames in which these things start is often at night, in that sort of, what we call sundowning period. And that is a time when many bad things happen. Patients sometimes get sleep disturbances. They get confused in general.

And so trying to keep a lot of the medications away from that time frame, minimizing levodopa or other Parkinson medicines in excess quantities toward that nighttime or bedtime time frames and overnight is a start.

Keeping the room either dark or well lit, in some ways, having nightlights or things can be helpful because if there’s some partial lighting, patients can sometimes get confused and see things in the shadows.

Having a way to calmly reassure the patient is helpful and to really get a sense of how bad these hallucinations are — I think there’s a sense that hallucinations are benign, what we call benign hallucinations, and the patient retains insight into the fact that these aren’t real. And the patient will say something like, “Oh, I know it’s a cat and it’s not a big deal. And I don’t want to change my medicines.”

And that’s fine. We can decide not to intervene. But it’s definitely helpful to get a clear report of what we’re actually dealing with because sometimes these hallucinations are actually very traumatic for the patient.

I’ve had a patient who was nightly witnessing his mom being killed. And he would have this every night and be crying and screaming out for help because he saw his mother being killed in front of him. And that can’t be easy to live with at all.

So I think we have to really validate these symptoms when the caregiver or the patient brings them to us,  express, you know, compassion and understanding and say that this can be really difficult and not that they’re going crazy. This is part of the Parkinson’s; this is a part of the medications that we give. And really sort of work together with the person living with the disease to sort of formulate the best path forward.