Parkinson’s disease psychosis

Abstract:

Parkinson’s disease is a progressive neurodegenerative disease characterized by loss of nigral dopaminergic neurons associated with rigidity, resting tremor, bradykinesia, and postural instability. In addition to the above motor symptoms, nonmotor manifestations are increasingly recognized as part of Parkinson’s disease pathology and contribute to overall symptom burden, morbidity, and mortality. Such nonmotor symptoms include autonomic dysfunction, impaired olfaction, gastrointestinal disturbances, and a variety of psychiatric symptoms including psychosis. Psychiatric symptoms may be inherent to the disease process itself, secondary to treatments aimed at restoring dopamine, or related to comorbid mental illness. Given that traditional medications used to treat psychosis are dopaminergic antagonists, pharmacologic treatment of these symptoms carries the risk of worsening the movement disorder, creating a challenge for providers. This review examines current literature regarding psychosis in the context of Parkinson’s disease including risk factors for psychosis, prognosis, and management of these challenging symptoms.

Keywords::

• antipsychotics
• delusions
• hallucinations
• non-motor symptoms
• paranoia

Disclosure

Dr Stacy reports grant/research support from Michael J. Fox Foundation, National Institutes of Health, and Parkinson Study Group; he has been consultant to Acorda, Allergen, Chelsea, General Electric, Genzyme, Eli Lilly, Merz, Osmotica, Pfizer, ProStraken, SK Life Sciences, UCB, and Vanda; he was a member of CD-PROBE (Allergan) Protocol Steering Committee; has gained royalties from Informa Press for Handbook of Dystonia; and has been employed by Duke University School of Medicine. Dr Jakel reports no conflicts of interest in this work.