Parkinson’s disease psychosis, one of the non-motor symptoms of Parkinson’s disease, results in patients experiencing hallucinations and/or delusions.

Hallucinations mean that people see, hear or feel things that do not exist, and can happen at any time a person is awake, including daytime.

Delusions are illogical or irrational views that are not based on reality. They may include, for example, accusations of marital infidelity or fear of being poisoned by medications or food.

More than half of all people with Parkinson’s disease eventually develop these symptoms, which may get worse in sickness, hospitalizations, or unfamiliar environments.

How is Parkinson’s disease psychosis diagnosed?

Diagnosing Parkinson’s disease psychosis can be complex. It is considered a neuropsychiatric condition that is related to neurology and psychiatry. However, in the majority of cases, it occurs as a side effect of Parkinson’s disease medication.

It is important to determine whether psychosis is a side effect of medication, or of dementia or delirium. However, this distinction is difficult to determine because the conditions overlap and cause similar symptoms. (Delirium is usually diagnosed when the person goes through a change in their level of concentration or attention). If psychosis occurs early in the disease process, Lewy bodies dementia should be considered. There currently are no brain scans or medical tests that can definitively diagnose Lewy body dementia, other than a brain autopsy after death.

Parkinson’s disease psychosis is usually diagnosed following a medical history and examination, medical tests (to rule out other diseases and hormone or vitamin deficiencies that can be associated with cognitive changes), brain imaging that can detect brain or structural abnormalities, and neuropsychological tests that assess memory and other cognitive functions.

How is Parkinson’s disease psychosis treated?

Parkinson’s disease medications help relieve motor symptoms by increasing dopamine in the brain. However, high dopamine levels can lead to Parkinson’s disease psychosis. Treatment of Parkinson’s disease psychosis often involves balancing Parkinson’s disease medicines. Sometimes high dopamine levels may be needed to control motor symptoms, and other times they may need to be reduced to alleviate psychosis, which may be a difficult three-step process:

  1. Assessment and plan – determining if the psychosis is benign or problematic and considering the stage of the disease, prior history of psychotic symptoms, and social factors.
  2. Adjusting prescribed medications, aiming to reduce hallucinations and delusion without worsening motor symptoms.
  3. Use of anti-psychotic agents to help balance abnormal chemical levels in the brain. Nuplazid (pimavanserin), Clozaril (clozapine), and Seroquel (quetiapine) are considered safe for people with Parkinson’s disease.

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