Why early treatment matters with Parkinson’s psychosis

Some people with Parkinson’s disease experience Parkinson’s psychosis, which can come in the form of hallucinations, delusions, and strange smells or sounds. These symptoms can range from mild and passing to extremely distressing.

If you’re experiencing these symptoms, early treatment for Parkinson’s psychosis is available, which can reduce the symptoms and prevent them from becoming worse.

Understanding Parkinson’s psychosis

Psychosis, defined as a mental break from reality, has a range of causes and can be common in other types of conditions, such as dementia or various illnesses.

Parkinson’s psychosis is diagnosed if someone has Parkinson’s and has experienced episodes of hallucinations, delusions, or perceptual changes for at least a month, and other causes, such as infections, have been ruled out.

The causes of Parkinson’s psychosis vary. The medications used to manage motor symptoms are often the main cause. Neurochemical changes due to Parkinson’s alone can also trigger symptoms.

The most common psychosis symptoms include:

• illusions and perceptual changes: This can include sensing that someone is nearby, seeing faces in shadows, or misinterpreting real objects.
• hallucinations: These involve perceiving things that are not actually present, such as seeing, hearing, feeling, smelling, or tasting things that aren’t real.
• delusions: These are false beliefs not based on reality. For instance, feeling like someone is stealing from them or out to harm them, or that a spouse is unfaithful.

If Parkinson’s psychosis progresses, it can strain relationships with care partners, increase hospitalizations, and lead to primary nursing home placement.

Fortunately, Parkinson’s disease psychosis treatment options can reduce symptoms and keep them from progressing.

What early treatment means

Early treatment for Parkinson’s psychosis refers to a series of interventions designed to reduce symptoms and improve quality of life early on when you or your care partner first notices symptoms.

Managing hallucinations in Parkinson’s disease typically involves adjusting medications while making lifestyle and environmental changes. It can also include adding medications to reduce symptoms.

The benefits of early treatment for Parkinson’s psychosis include:

• improved quality of life: Early interventions — medical, environmental, and lifestyle — reduce distress for the person experiencing symptoms and their care partner.
• better care planning: Slowing progression can allow more time for care planning and shared decision-making.
• improved long-term outcomes: Medication to reduce psychosis can potentially be more effective when given earlier in the disease course rather than later.

When to seek help for Parkinson’s psychosis symptoms

Talking with your doctor about Parkinson’s psychosis symptoms and treatment is important. The following are early signs of psychosis, or indications that they are getting worse:

• hallucinations that become more vivid, detailed, or frequent
• delusions that increase in intensity
• an increase in fear or suspicion, or an urge to act based on hallucinations or delusions

Early interventions can prevent more serious progression.

Note that immediate medical attention is needed in cases that involve:

• psychosis that leads to aggressive, threatening, or violent behavior
• acting on delusions (e.g., wandering or leaving the house unexpectedly)
• acute confusion and disorientation or delirium (not recognizing familiar people or places)

Parkinson’s psychosis treatment options

Managing hallucinations in Parkinson’s disease requires a tailored approach that begins with an evaluation to ensure there are no other underlying medical causes. Input from care partners and family members can help to identify potential triggers.

Parkinson’s disease psychosis treatment options are reviewed after other medical conditions are ruled out. A treatment approach typically includes:

• assessing and adjusting medications that may be causing psychosis
• supportive changes that can improve sensory perception, such as increasing lighting in the home to prevent shadows and misperception
• adding an atypical antipsychotic medication if needed

Managing hallucinations and daily life

Changes in environment and lifestyle are important parts of managing hallucinations and delusions. Shadows, clutter, and a lack of sleep can trigger or worsen hallucinations. Some basic approaches to limit them include:

• keeping rooms clutter-free and well-lit. Shadows and visual “noise” can trigger or worsen hallucinations. Use nightlights in bedrooms, hallways, and bathrooms.
• removing objects that can be misinterpreted (such as patterned rugs or mirrors).
• supporting healthy sleep habits.
• tracking triggers and patterns, such as specific situations, lighting conditions, activities, and medications. This helps clinicians adjust medications or environments to reduce triggers.

All symptoms of psychosis should be reported and openly discussed with a doctor. They are common and manageable, and getting early care can prevent them from worsening.