Early warning: Spotting symptoms of Parkinson’s psychosis

Last updated Sept. 16, 2024, by Lindsey Shapiro, PhD
Fact-checked by Patrícia Silva, PhD

The earliest signs of Parkinson’s psychosis — a group of symptoms that causes a person with Parkinson’s disease to have trouble distinguishing what is real from what isn’t — may be subtle.

The signs of this nonmotor symptom of Parkinson’s, including hallucinations (seeing what’s not actually there) and delusions (believing things that aren’t true), may at first be very mild and have limited impact on your family’s daily life. But psychosis can progress to the point where it has a major impact on quality of life for your spouse and you. That’s why it is important to learn how to spot the early signs of possible psychosis and help your spouse get prompt medical care.

Recognizing your loved one with Parkinson’s is showing signs of psychosis can be overwhelming. You may find it too distressing or difficult to bring up with healthcare providers.

Despite this, it’s important that you don’t wait to tell someone because Parkinson’s psychosis can be treated. Once doctors know that someone is experiencing Parkinson’s psychosis symptoms, they can suggest a care plan to help manage it.

Early signs of Parkinson’s psychosis

While Parkinson’s psychosis may be different in every person, it most often starts with mild changes in sleep, cognition, or perception. It then slowly progresses over time, and eventually, your spouse may begin to have hallucinations and/or delusions.

The early clues for psychosis may be subtle and not easy to spot in the context of all the other motor and nonmotor symptoms your spouse may be experiencing. But as a caregiver and spouse, you are the one who will most likely notice changes, big and small.

Before psychosis has truly emerged, there are a few early warning signs of its potential development, including:

• attentional changes 
• confusion at night
• sleep changes, as vivid dreams and nightmares may be an early sign of Parkinson’s psychosis.

Other sleep-related changes, such as sleep apnea (when breathing stops and starts repeatedly during sleep), insomnia, and REM sleep behavior disorder (when a person physically acts out dreams while asleep), also are considered risk factors for Parkinson’s psychosis.

It’s important to keep in mind these issues, such as confusion and changes in sleep, can be related to nonmotor symptoms of Parkinson’s and not a sign of developing psychosis.

This is why you need to mention any of these signs — and any other changes you notice — to your spouse’s doctors so they can start monitoring for Parkinson’s psychosis symptoms.

Most common symptoms

For most people with Parkinson’s psychosis, minor hallucinations and visual hallucinations are the most common early psychotic symptoms.

Minor hallucinations is a term that encompasses three different types of changes in perception:

• illusions, or brief misperceptions of things that really exist in the environment
• false sense of presence, or a temporary feeling that a person or animal is nearby when they’re not actually there
• passage hallucinations, when a nonspecific object moves by in the peripheral vision.

Minor hallucinations can eventually develop into full visual hallucinations, which is when a person sees things that are not actually there. Common Parkinson’s psychosis hallucinations involve seeing an animal or person in the room. In these earlier stages, your spouse is likely to have retained insight, meaning they are aware what they are seeing is not real.

It might not be easy to always notice that minor or full visual hallucinations are happening, especially because they are often temporary and not necessarily upsetting for your spouse.

You should keep an eye out for signs your spouse seems to be paying attention to or mentioning things that aren’t there or is frequently misinterpreting what they are looking at.

Delusions, while less common than hallucinations, are considered another main class of Parkinson’s psychosis symptoms.

When delusions are present, you may start to notice that your spouse is expressing beliefs not founded in reality, like accusing you of infidelity or not wanting to take medication because they think it has been poisoned. Delusions may be accompanied by other behavior changes including aggression, paranoia, or defiance.

Less common symptoms

Less common symptoms of Parkinson’s psychosis include hallucinations with other sensory symptoms. It is possible for hallucinations to affect any of the body’s other senses, including smell, hearing, taste, and touch. These hallucinations can be subtle and easy to miss.

You should look out for changes in your loved ones’ sensory perceptions that may include:

• hearing sounds or voices that are not there
• feeling sensations that aren’t real, such as something crawling on the skin
• perceiving smells — either pleasant or unpleasant — that don’t have a real source
• tasting something that isn’t there, such as a bitter taste.

Treating symptoms

A doctor may take a few different approaches to treating your loved ones’ psychosis symptoms, depending on the severity and cause.

First, they’ll want to understand the exact nature of the symptoms you’ve been noticing. It’s a good idea to be prepared to provide the doctor with the following information:   

• What are the symptoms you’ve noticed and when did they start?
• Have there been any recent changes to the patient’s medications?
• Have there been any other changes in the patient’s health status, such as illnesses?

In some cases, psychosis may be caused by delirium, where temporary psychosis symptoms are brought on by factors such as infections, illnesses, electrolyte imbalances, or substance use. This is usually reversible by addressing the underlying cause or trigger.

If there aren’t any known triggers, doctors will carefully evaluate the symptoms to decide what interventions, if any, are needed.

Early on, and if psychosis symptoms are mild and not seeming to affect daily life, it is possible your doctor won’t suggest any Parkinson’s psychosis treatment. In fact, sometimes people with visual hallucinations report that they’re not bothered by them and even find them amusing.

Even if this is true for your spouse, you still need to watch closely for changes or progression in symptoms. As a caregiver, you can help by keeping the healthcare team up to date about your spouse’s Parkinson’s psychosis symptoms.

In some cases, Parkinson’s psychosis treatment involves adjusting other Parkinson’s disease medications, as psychosis can be a side effect of these treatments. Doses may be adjusted or some therapies stopped altogether, with the goal of finding an optimal balance between motor symptom control and side effects.

Generally speaking, specific antipsychotic medications won’t be recommended in these earlier stages of psychosis. Those medications, which try to restore a more normal chemical balance in the brain, are usually only prescribed if Parkinson’s psychosis is persistent and becomes more intrusive, disruptive, or distressing in daily life.

Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.