Parkinson’s disease psychosis: presentation, diagnosis and management

Written by Ruth B Schneider , Julia Iourinets & Irene H Richard

Parkinson’s disease is a neurodegenerative disorder characterized by motor and nonmotor symptoms. Psychosis is a common feature of Parkinson’s disease. Parkinson’s disease psychosis (PDP) encompasses minor phenomena (illusions, passage hallucinations and presence hallucinations), visual and nonvisual hallucinations and delusions. PDP is associated with reduced function and quality of life. The initial management approach should focus on identification and treatment of any contributory medical factors, reduction or discontinuation of medications with potential to induce or worsen psychosis, nonpharmacological strategies and consideration of acetylcholinesterase inhibitor treatment in the setting of dementia. Pimavanserin, quetiapine and clozapine may all be considered for use in PDP. In this review, we discuss the presentation, diagnosis and management of PDP.
Parkinson’s disease (PD) is a neurodegenerative disorder characterized by motor and nonmotor features, including psychiatric symptoms such as depression, anxiety and psychosis. The prevalence of PD increases with age [1] and the lifetime risk of PD is 2.0% for men and 1.3% for women [2]. The prevalence of psychosis in cross-sectional studies of PD is 13–60% [3–12], depending on the selected diagnostic criteria and specific population, and the lifetime prevalence is 47–60% [13,14]. Parkinson’s disease psychosis (PDP) negatively impacts quality of life [9], contributes to disability [9,14–15] and is associated with increased caregiver burden and distress [16–18]. We review the presentation, diagnosis and management of PDP.

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