Parkinson’s major physical motor symptoms are well known: tremors, bradykinesia (slow movement), rigidity, and postural instability (balance). People are less aware of PD non motor symptoms especially hallucinations and delusions. Parkinson’s Disease Psychosis (PDP) affects 50% of PWP during the course of the disease. Such a lovely disease. It is not enough for PD to turn us into physical wrecks. Symptoms keep developing and PD is not satisfied until half of us are psychotic as well.
Psychosis affects the way the brain processes information causing delusions and hallucinations. Hallucinations are seeing, hearing, or experiencing things that others don’t. Examples are seeing people (living and dead), animals (often rabbits), or objects, hearing voices, music, and sounds not heard by others. Delusions are believing things that are not true. Believing people are trying to steal your money or are talking about you and planning to harm you are typical delusions and can result in paranoia, fear, and violent reactions.
Diagnosing and treating PD Psychosis is tricky. Parkinson’s Disease Psychosis is considered a neuropsychiatric condition because it relates to both neurology (the nervous system) and psychiatry (mental, emotional, and behavioral health). It is a mental health condition (hallucinations and delusions) caused by a nervous system disease (Parkinson’s disease).
Researchers are not certain as to the exact cause of PD psychosis but believe that the side effects of dopamine drug therapy is the main cause and that the natural progression of PD can also be involved. Dopaminergic therapy increases dopamine levels in the brain helping improve motor symptoms in people with Parkinson’s disease. However, increasing dopamine levels can also cause chemical and physical changes in the brain. All current PD medications can potentially cause hallucinations and delusions.
Psychosis can also be caused by the chemical and physical changes in the brain that occur as a result of the progression of PD regardless of taking dopamine enhancing medication. Some of these changes occur naturally as Parkinson’s disease progresses. We cannot predict who will experience hallucinations or delusions but risk factors are age, duration of PD, severity of PD, and how long PD drugs are taken.
Psychosis in PD significantly reduces the quality of life for PWP. Psychotic symptoms are also associated with a higher risk of dementia and is the most important risk factor for transfer to a nursing home. It is associated with reduced survival and increased risk of death. It can also be hell on family, loved ones, and caregivers who have to deal with and witness the mental disintegration of the person with psychosis.
Up to 90% of PWP who are having hallucinations or delusions do not tell their doctor but it is the most important thing that you can do to combat it. Your medical team and caregivers should be aware of all your symptoms so they can best treat them. PD psychosis can be treated with antipsychotic medicine and by reducing or stopping PD medications.
The Parkinson’s Psychosis Rating Scale (PPRS) assesses the severity of specific symptoms of levodopa induced psychosis in PWP. The first five questions identify the type of hallucination (visual, auditory, smell, sense of presence) or delusion. The second five questions quantify the intensity, frequency, and impact of the worst psychotic feature. It takes ten minutes to do and is available on the internet.
