Treatment Advances In Parkinsons Disease Psychosistransforming The Standard Of Care For Hallucinations And Delusions
Over half of patients with Parkinson’s disease will develop psychosis during the course of their disease. Characterized byhallucinations and delusions, Parkinson’s disease psychosis is clinically distinct from other psychotic disorders. Despite thehigh prevalence of PDP in patients with PD, patients often under-report symptoms of hallucinations and delusions, potentially dueto embarrassment or perceived stigma. It is necessary for physicians to discuss with patients with PD the symptoms of PDP. Parkinson’sdisease psychosis can begin with the patients retaining insight into their symptoms – e.g., that their hallucinations are not real – yet, asPDP progresses, insight is often lost and symptoms worsen. The atypical antipsychotic pimavanserin is the first and only US Food andDrug Administration-approved treatment for hallucinations and delusions associated with PDP. The mechanism of action of pimavanserinis unknown but is thought to be mediated through a combination of inverse agonist and antagonist activity at serotonin 5-HT2A receptors.Parkinson’s disease psychosis is thought to result from overactivation of serotonergic signaling in several regions of the brain, includingthe ventral visual pathway. Clinical trials have demonstrated that pimavanserin 34 mg once daily reduces hallucinations and delusions inpatients with PDP without impairing motor function.
Want To Learn More About The Latest Research In Parkinsons Disease Ask Your Questions In Our Research Forum
It’s caused by dementia.Parkinson’s disease patients who also have dementia are more likely to suffer from delusions and hallucinations. Dementia also alters the balance of chemicals in the brain which can lead to psychosis, particularly for those who have dementia with Lewy bodies.
It’s a result of delirium.Delirium is a short-term, reversible symptom brought on by a metabolic anomaly, a general medical condition, or a reaction to medications. It usually manifests as altered consciousness, disorganized thinking, unusual behavior, and occasionally hallucinations. Delirium can last anywhere between a few hours and a few days. Parkinson’s disease patients have an increased risk of delirium when they have to go to the hospital for a procedure or surgery.
Some of the most common reasons for delirium include:
- Infections such as pneumonia or urinary tract infection
- An imbalance of the body’s natural minerals and electrolytes
- Sensory changes such as vision or hearing loss
- Deficiency in vitamin B12
Pharmacologic Management Of Psychotic Symptoms Including Hallucinations & Delusions In Pd
Psychotic symptoms are common in PD and range from illusions, to hallucinations and paranoid delusions. The prevalence of these symptoms ranges from approximately 10–48% for hallucinations and 3–80% for delusions. Well-formed visual hallucinations have been found to be specific for PD amongst patients with parkinsonism and are thought to result from complex interactions between disease-related and pharmacological factors. Hallucinations may also be of other sensory modalities including auditory, tactile, olfactory, somatic or gustatory. Moreover, hallucinations of passage, a sense of presence, misidentification syndromes and visual illusions are also reported. Like other nonmotor PD symptoms, psychosis substantially impacts the quality of life of patients and their families. The presence of psychotic symptoms is frequently associated with nursing home placement.
The atypical antipschotic drugs quetiapine and clozapine have the least likelihood of causing extrapyramidal side effects in PD patients and are the most widely used in PD subjects. Use of this class of medication should be weighed against warnings for increased morbidity and mortality, although doses used in PD tend to be tenfold lower than those used in other psychiatric disorders. Both quetiapine and clozapine have been compared with placebo and there have also been two head-to-head trials. Based on these studies, clozapine is considered efficacious while data for quetiapine is inconsistent.
What Makes Some People With Parkinsons More Susceptible To Parkinsons Disease Psychosis
Not everyone living with Parkinson’s will experience hallucinations and/or delusions, but there are several things that can increase your risk. Here are a few to look out for. Be sure to speak to your doctors and care partners if you notice any changes.
- Decline in memory
- Increased sleep disturbances such as REM Sleep Behavior Disorder, sleep apnea, vivid dreaming and sleep interruptions
- Vision problems such as blurry or double vision
- Hearing problems
- Medication changes such as new medication, dosage changes and drug interactions
- Disease progression
Demystifying Hallucinations Night Terrors And Dementia In Parkinsons
This two-hour webinar includes extensive discussion about hallucinations, delusions, illusions and other examples of Parkinson’s psychosis in Parkinson’s. Presenters: Rohit Dhall, MD, MSPH and Vergilio Gerald H. Evidente, Director, Movement Disorders Center of Arizona in Scottsdale. Pay particular attention to Dr. Rohit Dhall’s description of the causes of PD psychosis as well as treatment options and what to discuss with your movement disorder specialist. Dr. Evidente gives a clear description on differences in PD dementia, Alzheimer’s and other dementias.
Parkinsons Disease Psychosis: Hallucinations Delusions And Paranoia
As part of Parkinson’s Disease and its treatment, hallucinations, illusions, delusions, suspiciousness and paranoid behaviors occur in over 50% of patients. In this 1-hour webinar Dr. Christopher Goetz suggests lifestyle changes, medication adjustments and a recently FDA approved drug to specifically treat psychosis in Parkinson’s Disease.
Why Isnt There A Greater Awareness Of Parkinsons Disease Psychosis
It’s not uncommon for people with Parkinson’s disease psychosis to remain silent about their experiences.2,4,9 In fact, only 10% to 20% actually report their symptoms to their physicians.4-9 Work continues to be done to raise awareness of this condition. You can find more information on the non-motor symptoms associated with Parkinson’s disease here.
Practical Tips For Caregivers Of People With Parkinson’s Psychosis
This 2-page tip sheet has bullet point suggestions for what to do if the person you care for experiences hallucination, delusions or confusion, or becomes agitated or aggressive. In addition, there are tips for how to best be prepared for a doctor’s appointment when you bring this behavior to the attention of your medical team.
Hallucinations And Rem Sleep Disorders In Parkinson’s Disease
At timestamp 1:58 in this recording of Thrive: HAPS 2020 Caregiver Conference, you will find a one hour talk by neurologist Joohi Jimenez-Shahed, MD. In it she delves into what REM sleep behavior disorder is and is not, and the distinctions between hallucinations, delusions, and delirium. Managment options for RBD and hallucinations are included.
How Commonly Do Parkinsons Disease Patients Develop Psychosis
Psychosis in Parkinson’s disease generally comes in two forms: hallucinations or delusions . When hallucinations occur, they are mostly visual . Sometimes, they can be threatening, but this is less common. Auditory hallucinations are rare in Parkinson’s disease and if they do occur, they are usually accompanied by visual hallucinations.
Delusions are usually of a common theme, typically of spousal infidelity. Other themes are often paranoid in nature Because they are paranoid in nature, they can be more threatening and more immediate action is often necessary, compared to visual hallucinations . It is not uncommon that patients actually call 9-1-1 or the police to report a burglary or a plot to hurt them.
Unfortunately, psychosis occurs in up to 40% of Parkinson’s disease patients . In the early stage of Parkinson’s disease psychosis, the patient often still has a clear understanding and retains their insight, but this tends to worsen over time and insight may eventually be lost. At later stages, patients may be confused and have impaired reality testing; that is, they are unable to distinguish personal, subjective experiences from the reality of the external world. Psychosis in Parkinson’s disease patients frequently occurs initially in the evening, then later on spills into the rest of the day.
What You Need To Know About Psychosis In Parkinson’s Disease Scientific Advisory Board
Psychosis doesn’t just affect individuals with psychiatric disorders such as schizophrenia. It also affects other illnesses, including Parkinson’s disease , a degenerative disorder that disturbs movement and balance.
Over five million people worldwide have PD, struggling with symptoms such as shaking, stiffness, slowness of movement and instability.
“Psychosis in Parkinson’s disease is very common,” according to Michael S. Okun, M.D., national medical director at the National Parkinson Foundation and author of the Amazon no. 1 bestseller Parkinson’s Treatment: 10 Secrets to a Happier Life.
In fact, psychosis may affect 1 in 5 Parkinson’s patients, he said. And as many as 2 out of 3 patients may experience minor symptoms, “such as non-bothersome visual illusions.”
“Patients primarily experience visual hallucinations,” said James Beck, Ph.D, the director of research programs at Parkinson’s Disease Foundation. A smaller number of patients — 10 to 20 percent — experience auditory hallucinations, he said.
Some patients also may experience delusions, or fixed false beliefs. According to Dr. Okun in his piece on managing psychosis in PD:
In the early stages of psychosis, patients tend to have insight into their symptoms, Beck said. In other words, they realize that what they’re seeing isn’t actually there. But this may worsen over time. According to Okun in the same piece:
Parkinsons Disease And Psychosis: Hallucinations Delusions Emma-Marie Smith
Parkinson’s disease psychosis occurs in around 50% of PD patients. In Parkinson’s disease, hallucinations and confusion are relatively common, often occurring as side-effects of Parkinson’s medications. These symptoms can also be indicative of Parkinson’s disease psychosis, however, so it’s important to consult your doctor if you think you might be delusional or psychotic. In the meantime, here is everything you need to know about Parkinson’s disease psychosis, including symptoms and treatment.
What Are The Primary Motor Symptoms Of Parkinsons Disease
There are four primary motor symptoms of Parkinson’s disease: tremor, rigidity, bradykinesia and postural instability . Observing two or more of these symptoms is the main way that physicians diagnose Parkinson’s.
It is important to know that not all of these symptoms must be present for a diagnosis of Parkinson’s disease to be considered. In fact, younger people may only notice one or two of these motor symptoms, especially in the early stages of the disease. Not everyone with Parkinson’s disease has a tremor, nor is a tremor proof of Parkinson’s. If you suspect Parkinson’s, see a neurologist or movement disorders specialist.
Walking or Gait Difficulties
Parkinson’s Disease Psychosis: The What When Why And How
Psychosis is a psychiatric term used in neurology to refer to a spectrum of abnormalities. Parkinson’s disease psychosis is where people experience hallucinations or delusions. Hallucinations is seeing, hearing, or smelling things that don’t exist. With tactile hallucinations, one can feel a presence that isn’t there. Delusions are believing something that is not true, like that a spouse is being unfaithful or caregivers are stealing. In this one-hour talk, movement disorder specialist Christopher Goetz, MD, focuses on hallucinations and spends a little time on delusions.
How To Talk To Someone With Hallucinations Or Delusions
- It is usually not helpful to argue with someone who is experiencing a hallucination or delusion. Avoid trying to reason. Keep calm and be reassuring.
- You can say you do not see what your loved one is seeing, but some people find it more calming to acknowledge what the person is seeing to reduce stress. For example, if the person sees a cat in the room, it may be best to say, “I will take the cat out” rather than argue that there is no cat.
Page reviewed by Dr. Chauncey Spears, Movement Disorders Fellow at the University of Florida, a Parkinson’s Foundation Center of Excellence.
What Are The Treatment Options For Parkinsons Psychosis
Because Parkinson’s drugs can cause psychosis, your doctor will likely start by taking you off your medications, one at a time, or adjusting the dose. Changing your medication may make your movement symptoms worse.
Your doctor will keep adjusting your medication. The goal is to get you to a dose that improves your movement without causing hallucinations and delusions.
If changing your medication doesn’t work, the next step is to go on an antipsychotic medication. These drugs prevent psychosis symptoms by altering levels of chemicals in your brain.
Older antipsychotic drugs can make Parkinson’s movement symptoms worse. Newer drugs, called atypical antipsychotics, are less likely to affect your movement. These drugs are off-label, meaning they’re not approved to treat Parkinson’s specifically. They include:
In 2016, the Food and Drug Administration approved pimavanserin . It’s the first drug designed specifically to treat Parkinson’s disease psychosis. Nuplazid reduces the number of hallucinations and delusions without affecting movement.
Nuplazid and other newer antipsychotic drugs do carry a black box warning. They can increase the risk of death in older people who have psychosis related to dementia. Your doctor will consider this and other risks before prescribing one of these drugs.
What Treatments Are Available For Parkinsons Psychosis
Your doctor may first reduce or change the PD medication you’re taking to see whether that reduces psychosis symptoms. This is about finding a balance.
People with PD may need higher doses of dopamine medication to help manage motor symptoms. But dopamine activity shouldn’t be increased so much that it results in hallucinations and delusions. Your doctor will work with you to find that balance.
Medications To Help Treat Parkinsons Disease Psychosis
Your doctor might consider prescribing an antipsychotic drug if reducing your PD medication doesn’t help manage this side effect.
Antipsychotic drugs should be used with extreme caution in people with PD. They may cause serious side effects and can even make hallucinations and delusions worse.
Common antipsychotic drugs like olanzapine might improve hallucinations, but they often result in worsening PD motor symptoms.
Clozapine and quetiapine are two other antipsychotic drugs that doctors often prescribe at low doses to treat PD psychosis. However, there are concerns about their safety and effectiveness.
In 2016, the approved the first medication specifically for use in PD psychosis: pimavanserin .
In clinical studies , pimavanserin was shown to decrease the frequency and severity of hallucinations and delusions without worsening the primary motor symptoms of PD.
The medication shouldn’t be used in people with dementia-related psychosis due to an increased risk of death.
Psychosis symptoms caused by delirium may improve once the underlying condition is treated.
There are several reasons someone with PD might experience delusions or hallucinations.
How To Care For Someone Who Experiences Hallucinations
If the person you care for experiences a hallucination, there are a few things you’ll want to do in the moment and others you’ll want to do when the moment passes.
The most important thing to remember is to never try and talk the person with Parkinson’s out of their hallucination. They are actively experiencing it and by trying to talk them out of it, they may either feel like they aren’t being heard or that their experience is being diminished.
What matters in the moment is their safety and your reassurance that they’re going to be okay. You might calmly say, “I understand that you’re seeing X. I’m not having that experience, and I just want you to know that everything is going to be okay, there’s nothing dangerous happening here and you’re safe.”
Other strategies Dr. Joanne Hamilton, PhD, ABPP-CN of Advanced Neurobehavioral Health of Southern California, shared with us are to:
Here are a few actions you can take once the hallucination has passed:
Whats The Treatment For Parkinsons Disease Psychosis
The single most important thing to do when it comes to Parkinson’s disease psychosis is to tell your care providers and partners the minute you notice changes in your vision, hearing, thinking and behavior. The earlier they know what’s going on, the sooner they can begin interventions to help you feel better.
Once you bring your concerns up to your doctor, they will typically do a clinical evaluation, review your medications and dosage, assess your lifestyle and determine the severity of your symptoms. Depending upon what they find, they may refer you to counseling or therapy, adjust your medication, change your medication, eliminate medication or do all of the above. If none of those strategies work, they may try antipsychotic drug therapy to see if they can adjust chemical levels in the brain. This can bring with it an entirely different set of problems so it’s important to be invested every step along the way and be sure you’re well-informed before you move in that direction.
What Causes Psychotic Symptoms In Parkinsons Disease
Psychotic symptoms in people with PD are usually caused as a side effect of medications used to treat PD. All of the current PD medications can potentially cause psychotic symptoms. Hallucinations and delusions may also be caused by the chemical and physical changes that occur in the brain as a result of PD. 3
Parkinsons Disease And Sex Issues: Libido Sex Drive Emma-Marie Smith
Parkinson’s disease and sex is a complicated topic. No matter your age, gender or relationship status, sex plays a significant part in many people’s lives. Sexual desire does not go away with a diagnosis of Parkinson’s disease, and most people are perfectly able to continue having intimate relationships. However, you may experience changes to your libido or physical ability during sex. As with all Parkinsonian symptoms, it helps to be prepared so that you’re aware of your options. With this in mind, here’s what to expect from Parkinson’s disease and sex.
Hallucinations And Delusions In Parkinsons Disease
It might be surprising to learn that 20 to 30 percent of people with Parkinson’s disease will experience visual hallucinations. While typically not a symptom of PD itself, they can develop as a result to a change in PD medication or as a symptom of an unrelated infection or illness. It is important to know the signs of hallucinations and how to manage them.
Hallucinations and other more severe perceptual changes can be distressing to family — often more so than to the person experiencing them. For the well-being of people with PD and caregivers, it is important to identify hallucinations as early as possible and take steps to reduce them.
The following article is based on the latest research and a Parkinson’s Foundation Expert Briefings about hallucinations and delusions in Parkinson’s hosted by Christopher G. Goetz, MD, Professor of Neurological Sciences, Professor of Pharmacology at Rush University Medical Center, a Parkinson’s Foundation Center of Excellence.
A Caregivers Guide To Parkinsons Disease Psychosis
While more than 50% of those taking carbidopa-levodopa may experience psychosis , medication management of these symptoms is a balancing act. First, families must bring psychotic behavior to the attention of your medical team. Medical causes of the behavior, like infection must be ruled out, followed by a review of medications and possible medication adjustments before a lifestyle changes and possible medications for treatment are added.
Tips For A Better Sex Life With Parkinsons Disease
- Communicate: Be open with your partner about your feelings and discuss your physical needs. If the topic of sex causes upset or arguments, it might be worth seeing a sex therapist.
- Consider changing your medication: If your medication is having an impact on your sex life, talk to your doctor about an alternative treatment. Your sex life is important, so it should be given as much attention and care as your general health and wellbeing.
- Be open with your doctor: Don’t be afraid to talk about sex with your doctor – that’s what your healthcare team is there for, and they will have dealt with these types of concerns before.
- Deal with fatigue and depression: Depression and fatigue can negatively impact your sex life, so look at ways of treating these symptoms. A combination of therapy and antidepressant medications may help, so talk to your doctor.
Section Header Managing Psychosis With Medication
Don’t keep hallucinations or delusions a secret from your doctor. Medications — or changes to the medications you take — can help manage Parkinson’s psychosis.
Streamlining your meds. The first thing your doctor may want to do is stop or lower your Parkinson’s medication dose. They may boost dopamine levels in your brain. That improves motor symptoms but can also cause changes in your emotions or the way you act.
Antipsychotics. These medications balance your brain chemicals. Only a few are considered safe for people with Parkinson’s disease. These include quetiapine and clozapine .
Pimavanserin . Another antipsychotic, this first-in-class drug was approved by the FDA in 2016 to treat hallucinations and delusions in Parkinson’s disease linked with psychosis.
If you see a doctor who isn’t part of your usual care team — say, in the emergency room or an urgent care setting — tell them you have Parkinson’s disease and what medications you take for it.
Parkinsons Disease And Sex: What You Need To Know
There is no reason why you cannot continue to have a healthy sex life with Parkinson’s disease. However, studies suggest that around 70 to 80% of those with PD experience sexual dysfunction. These common sexual problems are believed to result from Parkinson’s medication side-effects and psychological issues.
Men and women experience different issues when it comes to Parkinson’s disease and sex. In men, common problems include erectile dysfunction, lower sex drive, premature ejaculation and inability to orgasm. Women may experience pain during intercourse, as well as lack of sexual arousal, inability to orgasm and reduced lubrication.
In addition, the motor symptoms of Parkinson’s disease can create physical challenges during sex. Many people with PD experience slowed movement and rigidity that makes any movement difficult. Tremors and involuntary movement can also occur during sexual activity.
How To Care For Someone Who Experiences Delusions
If the person you’re caring for experiences confusion or delusions, here’s what you can do in the moment:
- Stay as calm and patient as you can and remember that this belief has nothing to do with you and only with what is going on in their mind
- Remove any objects in the room that could pose a danger to them or to anyone else
- Clear space so there are no tripping hazards and it’s easy for the person to move around
- Do not try to reason with the person or convince them why their belief is false
- Reassure them that everything is going to be okay
- If the person becomes aggressive, minimize your movements and remain calm
- Ask the person to talk to you about what they are feeling and really listen to them so they don’t feel threatened
- If you feel like you or they are in danger, call 911
Here are a few actions you can take once the delusion has passed:
- Inform their doctor immediately
- Educate others who may care for the person how to handle the situation if it happens
- If the person is open to it, discuss it with them and ask them to explain what the experience is like for them and if there’s anything different you could do next time
- Seek expert advice if you feel like you need support in managing these episodes
Managing Psychotic Symptoms In Parkinsons Disease
Any psychotic symptoms, such as hallucinations, delusions, or paranoia, that are experienced by a person with PD should be reported to a doctor, even if the symptoms are not bothersome. Managing these symptoms may include reducing or withdrawing the use of PD medications that may be causing the symptoms or adding an antipsychotic medication.1,2
What Are The Types Of Parkinsons Hallucinations
Hallucinations can affect any of the five senses:
- Sight . Seeing something that isn’t there, such as insects crawling on the walls or a deceased relative.
- Hearing . Hearing voices or sounds that aren’t real.
- Smell . Smelling an odor that isn’t there, like cookies baking or a skunk’s spray.
- Feeling . Feeling imaginary things, like bugs crawling on your skin.
- Taste . Having a strange taste in your mouth that isn’t from something you’ve eaten or a medical condition.
Some people sense the presence of a person or an animal nearby. Others see real objects transform into other things — for example, a vase changes into a dog.
It’s more common to have hallucinations at night, when the darkness creates shadows. Hallucinations can last anywhere from a few seconds to a few minutes.
Early in the disease, most people with Parkinson’s psychosis have insight, which means they understand that what they’re experiencing isn’t real. Later in the disease, often people lose insight and believe that what they see, hear, or feel is real.
Treatment For Parkinsons Disease And Sex Issues
Treatment for erectile dysfunction in men might include medications like Viagra, as well as physical or psychological therapy. In some cases, surgical implants may also be used. Women’s sexual health in Parkinson’s is slightly more complex due to their hormonal makeup.
Treatment options for women are somewhat restricted, but they include adding lubrication and seeing a therapist. Many women find timing sex during their ON periods to be helpful.
In terms of reproductive health, there is no evidence to suggest that Parkinson’s disease causes problems with pregnancy – although there have been no studies into the safety of PD medication during pregnancy.
Parkinson’s disease and sex can be challenging, but there are plenty of treatments and solutions that can work for both men and women. It’s important to communicate with your partner and talk through any feelings you might be experiencing, especially if you’re struggling with body image or confidence issues. Navigating sex during Parkinson’s disease can be difficult for partners, too, so remember to keep the dialogue open in your relationship.
APA ReferenceSmith, E. . Parkinson’s Disease and Sex Issues: Libido, Sex Drive, HealthyPlace. Retrieved on 2021, August 11 from https://www.healthyplace.com/parkinsons-disease/effects/parkinsons-disease-and-sex-issues-libido-sex-drive
What Triggers Psychosis In Parkinsons Disease
Psychosis in Parkinson’s disease is believed to be due to long term use of parkinsonian medications especially dopaminergic and anticholinergic drugs . However, significant medication exposure is no longer a pre-requisite in Parkinson’s disease psychosis . The “continuum hypothesis” states that medication-induced psychiatric symptoms in Parkinson’s disease starts with sleep disturbances accompanied by vivid dreams, and then develops into hallucinations and delusions, and ends in delirium. However this theory is now being challenged .
How Are These Mental Health Problems Treated
Your doctor will first want to check if your hallucinations, delusions, or paranoia are caused by other medical conditions. They’ll check for imbalances in chemicals in your blood that help send nerve signals.
Other medications that you may be using, including over-the-counter drugs, could also play a role in your mental health. Tell your doctor about all the medicines you take, including herbs and supplements.
Often the medications used to treat Parkinson’s disease can cause mental health problems. Your doctor may suggest you switch to a different drug or change your dose. If changing your Parkinson’s medication causes your Parkinson’s symptoms to get worse, your doctor may recommend you stick with it but take antipsychotic drugs at the same time.
There’s a chance that an antipsychotic medicine you take is making your Parkinson’s worse. If that happens, you have alternatives. The medication pimavanserin was approved by the FDA to specifically treat psychosis that goes along with Parkinson’s disease. Other drugs, such as olanzapine , quetiapine , and clozapine can control hallucinations at low doses without making your Parkinson’s symptoms worse.
If you feel depressed or notice any mental health problems, talk to your doctor right away. There’s likely a remedy that will make you feel better.
Talk About Your Hallucinations And Delusions
Your hallucinations or delusions can be distressing for those around you. They may be unsure how to react so let them know what you are going through and how best they can help you. They will be more able to support you if you share your experiences with them, particularly if you know what the most common triggers are and what can be done to make the hallucinations or delusions go away.
Counselling can sometimes be helpful, particularly if the hallucinations or delusions strain relationships. Your doctor will be able to advise on the available types of counselling.
Management Of Psychosis In Parkinson Disease Sam Adler, MDPsychiatric Times
For some patients with Parkinson disease, the neuropsychiatric complications are a greater source of morbidity than the motor dysfunction. This article focuses on the management of psychosis in Parkinson disease.
The diagnosis of Parkinson disease is based on the observation of a constellation of motor abnormalities and the exclusion of other secondary causes of parkinsonism. The disease is classified as a “movement disorder,” but for many patients with PD the motor problems are only the tip of the iceberg. A host of neuropsychiatric disorders are intrinsic to PD or occur as a complication of the dopaminergic therapies or anticholinergic medications used to treat the motor symptoms . For some patients with PD, the neuropsychiatric complications are a greater source of morbidity than the motor dysfunction.1,2
The neuropsychiatric disorders associated with dopaminergic therapies are important to recognize, because they are at least partially iatrogenic and can often be successfully managed by adjustment of the patient’s PD medications. This article focuses on the management of psychosis in PD-a problem with significant morbidity. Psychosis in PD and Parkinson-related disorders is an independent predictor for the need for institutionalization and increased mortality.
Susceptibility to psychosis
Pros and cons of pharmacological treatment
Fluctuating motor symptom responses