Parkinson’s psychosis may be challenging to manage, but medications may help to relieve these symptoms.
Parkinson’s disease is known for causing motor symptoms such as tremors and stiffness. But many people with this condition also have mental health symptoms, including depression and anxiety.
Psychosis is a more severe symptom in which people lose touch with reality.
Psychosis is rare in Parkinson’s disease, but people with Parkinson’s disease may have hallucinations as a medication side effect, or less often as part of the disease itself. Additionally, people with Parkinson’s disease may develop dementia in late stages.
People with Parkinson’s disease may experience episodes of delirium due to other medical illnesses. Sometimes hallucinations, dementia, or delirium could be mistaken for psychosis, but those are separate conditions.
Between 20 and 40 percent of people with Parkinson’s disease may have symptoms of psychosis. By the late stages, up to
Symptoms of psychosis are unique to each person who experiences them, but may include:
- a change in school work or job performance
- trouble thinking clearly or difficulty concentrating
- feeling paranoid or suspicious of others
- withdrawing from friends and loved ones
- sleep interruptions
- an influx of strange, new feelings, or no feeling at all
- difficulty separating reality from non-reality
- trouble communicating
- difficulty with sensory stimuli like touch, light, or noise
- disorganized behavior (behavior that does not seem to make sense or that is impulsive)
When you see your doctor for management of your Parkinson’s disease, it’s important to tell them about your movements, tremors, and any other symptoms that you’re experiencing.
These symptoms may include interrupted sleep, forgetfulness, seeing things that aren’t there (or if you’re not sure are there), or any unusual or concerning thoughts.
Your doctor will determine your diagnosis, or have you work with a mental health professional, and then establish a treatment plan.
There are two possible causes of Parkinson’s psychosis:
Dopamine is a chemical that helps your body move smoothly. People with Parkinson’s disease may have lower-than-normal levels of dopamine, which may cause their bodies to move stiffly.
Drugs that treat Parkinson’s improve movement by increasing dopamine levels. These medications may cause hallucinations as a side effect, and less often lead to psychosis.
There are other causes of psychosis that may impact a person with Parkinson’s disease. Since psychosis in Parkinson’s disease is relatively rare, it’s important to consider that schizophrenia may be what the person is experiencing.
There is also a risk of psychosis developing due to Parkinson’s, separate from medication side effect, and that distinction can be hard to untangle. Because Parkinson’s medications may cause hallucinations as a side effect for some people, and may less often cause psychosis as a side effect, it’s not known how many people with Parkinson’s develop psychosis due to the condition itself, and not as a medication side effect.
Symptoms of psychosis in Parkinson’s disease may be caused by the medications, and are less often related to the disease itself. Your doctor will start by making a diagnosis and may make some modifications to your treatment plan.
The approach for managing hallucinations in Parkinson’s disease is very complex and individualized. If you’re having a symptom, you would need to see a movement disorder neurologist or a psychiatrist, or both. Your doctors may adjust the dose of your Parkinson’s medication, may change to another Parkinson’s medication, or might add another an additional Parkinson’s medication to your treatment combination.
Sometimes Parkinson’s disease surgery is considered as an option to help improve your Parkinson’s symptoms while reducing side effects. Not everyone is a candidate for Parkinson’s disease surgery, depending on presurgical testing and other underlying medical conditions. Additionally, sometimes Parkinson’s hallucinations are treated with antipsychotics.
In 2016, the Food and Drug Administration approved pimavanserin (Nuplazid). It’s the first drug designed specifically to treat Parkinson’s disease psychosis. Nuplazid may reduce the number of hallucinations and delusions without affecting movement.
Nuplazid and other newer antipsychotic drugs do carry a
Parkinson’s psychosis may be one of the most challenging aspects of managing Parkinson’s disease, but is quite rare.
Global research on Parkinson’s psychosis has steadily increased since 2017, which may help support future management of this complex symptom.
Living with Parkinson’s disease is challenging. The condition has some treatments to help reduce symptoms, and symptoms affecting your thinking or sense of reality can be even more challenging.
It’s crucial to talk with your doctor about any of the symptoms if you or someone you’re taking care of develops hallucinations, delusions, confusion, or challenges and thinking. Treatments can help reduce your symptoms.