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Psychotic Symptoms in Parkinson’s Disease

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Arpit Aggarwal, MD, speaks at the 9th Annual Parkinson’s Disease Patient and Caregiver Conference.

Good morning everyone so doctor idle well well get a psychiatrist at mu healthcare so i’m going to talk about the psychotic symptoms in parkinson’s disease so you’ve already heard about you know that parkinson do it can have motor symptoms and normal the symptoms so the doctor sadiq he mention motor symptoms are something that everyone can see readily and that’s

The more focus but no one motor symptoms are as important as well so dr. brand just mentioned about depression and the treatment and later on you’re gonna hear about the gi issues with the constipation sexual dysfunction but for this topic the focus of the psychosis so most of you might know but i thought it would be a good idea to give you a general overview of

What what different term means you know some people say you’re psychosis i i don’t know what it means so in general psychosis can be defined or means as it’s it’s an altered thinking so the way you think it’s it’s altered and also you cannot distinguish what’s real and what’s unreal towards there if you’re seeing something of hearing something if it’s in actuality

There so that’s the broader term of psychosis hallucination is a big part and what hallucinations means it’s it’s a false perception so there’s nothing out there but you can you can either see it hear it feel it or perceive it but there’s nothing out there in reality so a related term is it’s not on the slide but it’s also called illusion so something is there

But you perceive it as something different like if there’s if there’s a rope there and you think it’s a snake the smell coming at you think something’s burning but it’s like a coffee so in that illusion and that that can be real symptom of parkinson’s as well delusions delusions is like a fixed belief which is not true also they can alter thinking most commonly

In park identities that illusion can be towards a spouse like a spouse is cheating or it can be the paranoid delusion which means people are out there who get me or people are against me so more on the theme of like fear suspiciousness and concerns about safety or like like that be is after me or something like that so these are the most common type of psychotic

Symptoms that we see it’s good to have an idea but we are talking about and you need words more so what is parkinson’s disease psychosis so as with the depression it’s very common it can affect about half of all the people with advanced parkinson’s disease about 40 to 50 percent of people and dr. siddiqui mention its more common in the advanced stages of degrees

The most common presentation are visual hallucinations so that’s a main difference between people who have psychosis who do not have the disease and people who have psychosis with parkinson’s disease so visions hallucinations are not as common with other psychotic diseases like schizophrenia for example what kind of visual hallucinations so parkinson disease

Psychosis present with patients seeing people animals in the room when in reality there is nothing there vivid colors you know that they would describe i see like a new color that tend to describe but again hallucination so it’s not really there or sometimes it can be frightening hallucinations so i’ve seen some kind of a like a feared object but again it’s not

There delusions are also common but not as common as hallucinations most commonly the hallucinations and delusions are present at the same time more common in the advanced population and people start getting memory to dementia and as i mentioned previously they’re more commonly either in towards a spouse or a significant other like they’re not being faithful or

The paranoid type like people are after me or you know just trying to harm me or hurt me so what causes psychosis i won’t go into details but in general brain chemicals and receptors you’ve heard dopamine several times the dopamine and serotonin it can be a side effect of the medications used to treat parkinson’s disease itself or it can be a natural outcome of the

Deal in advanced stages so let me talk about side effect of dopamine therapy so at a very basic level parkinson disease is caused by having less dopamine you give dopaminergic medication to kind of restore that balance but if you overshoot and you have more dopamine your brain you can get psychotic symptoms so that’s a make a very simplified thing to remember so

Less dopamine you have sci parkinson disease you give dopamine medicine for the overshoot you can have the psychotic symptoms so the the dopaminergic therapy can improve the motor symptoms but if it if you get too much of it you can have the hallucinations and the delusions who that the risk will be psychotic symptoms so advanced age people who have the start of

The parkinson disease later in their life who have more severe parkinson disease and for longer duration they are under watches for psychosis people who have cognitive impairments for example they have memory problems or thinking problems already depression people who have had to press it before alright creators for psychosis pre-existing visual disorders which

Means if someone has problems at sea even before having parkinson disease they are more likely to perceive things differently and if someone is taking more medications somebody’s using illegal drugs they are all and/or is called psychosis so when we talk about treatment there are medication treatment and then supportive therapy so before you could be going to

Medications make sure that good sleeping habit or sleep hygiene is increased keep lights on to decrease misinterpretation or misinterpretation of shadows which means you know just have a basic minimum lighting on people are at high risk and then the change in their normal routine like if they go to hotel or just for an overnight with it or this place that they

Are not familiar with so keeping that to a minimum coping strategies for patients it’s important to recognize that hallucinations do not mean that i’m going really it’s it’s a treatable symptom there’s no shame or guilt with it most commonly it’s a medication side effect i definitely doesn’t mean that somebody’s going crazy if you do not react to these visions

Or sounds and then caregivers should correct them and not engage in that thought process so i think doctors i think you mentioned briefly the psychosis that i am focusing on they say that the advanced stages of the disease but sometimes with like a transient infection or a hospitalization you can have something that we call that delirium so that is the temporary

Pardon but we treat the infection like pneumonia or the uti so that the transient delirium should get better other treatment include if someone is taking medications like our teen or other anticholinergic medications if they can be stopped so they can help with the confusion if someone is taking illegal drugs or any psychoactive medications event if they should

Be stopped so again treatment of psychosis working closely with our neurology colleagues if the dopaminergic medications can be adjusted for the motor if the doses can be lowered down so that we can have that balance that would be great if you can reduce their doors or maybe stop those medications for for the dopaminergic medication that by itself can improve the

Psychotic symptoms but if not that we need two more new antipsychotic medications so then the other class if you prescribe any anti-psychotic medication there’s an fda post warning this is not to scare anyone but it’s a class effect that people who have dementia and elderly people and taken antipsychotic medications are dead for other illnesses like heart problems

Or some infection but overall and the psychotic medications are very infected so these are the three most commonly used antipsychotic medications you planet or the mentoring that is the newest one it is approved by the fda for parkinson’s disease psychosis it is the only improve fda-approved medication because it’s a newer medicine it’s very expensive sometimes we

Have problems getting this through the insurance but it’s very effective as well cute irb non-spherical is more commonly prescribed to being in the market for at least 10 to 15 years now it’s very effective as well it’s not fda approved but it’s more commonly used and clozapine or plural if you need more frequent monitoring like a weekly blood draw so it’s less

Commonly used but it is very effective as well and avoid about the caregivers so psychotic symptoms affect the patients and the family of the caregivers as well hallucinations are developing the caregiver burden and stress becomes you know more some psychotic behaviors can be targeted at caregivers so you know the paranoid delusions that we talk about it can be

Targeted toward a caregiver that you know you’re not trying to help me you’re just just trying to make sure that i don’t get better so that really gets tricky and it’s targeted toward a caregiver so there the need to protect sleep and give respite for caregivers as well and that can be done matic fighting over night supervision or a day of staff caregivers

Transcribed from video
Psychotic Symptoms in Parkinson's Disease By MU Health