The Parkinson’s Disease Aspect You DON’T Know About — Psychosis

Tremors are the “tell-tale” sign of Parkinson’s disease, a progressive motor disorder disease commonly diagnosed in older adults (on average at age 62). But if you are a caregiver of someone living with this all-too-common disease, then you may not realize that non-motor symptoms (those unrelated to physical movement), such as psychosis, may develop as the disease progresses. It’s important to keep an eye out for symptoms of Parkinson’s disease Psychosis (PDP) because they impact quality of life for your loved one and for you.

What is Parkinson’s Disease Psychosis? 

As PD progresses, more than half of the approximately one million Americans living with the illness will develop psychotic symptoms, primarily hallucinations, but also delusions. Unfortunately, many patients are not diagnosed. Sometimes, the symptoms of PDP are misdiagnosed as a co-morbid condition, but other times, patients and their families may not be comfortable sharing the symptoms with their physician team.

What Causes PDP?

Sometimes, PDP is attributed to different infections (like bladder or pneumonia) and the medicines that treat them.  But some research suggests that PDP may also be caused by the PD medications – those that control the motor symptoms – themselves, although a causal relationship has not been established.  Also, it’s possible that PDP might be a naturally occurring aspect as the disease progresses.

Hallucinations

Hallucinations are false perceptions in one of our special senses (vision, hearing, taste and touch). For example, it’s quite common for patients to report seeing other people, often children, who are sitting or standing in the room, ignoring them. The patient may try to speak with the children or even approach them, but find they suddenly disappear. These types of hallucinations tend to occur more at night and are usually the same each time.

The hallucinations may look real, appear to be black and white, fuzzy or sharp and sometimes, the people may look somewhat odd, like cartoons.

Auditory hallucinations, or hearing things that are not there, are about half as common as visual hallucinations. Patients may hear a radio in another room or voices talking in the hallway. Less common are tactile hallucinations (e.g., feeling things on the skin), olfactory (e.g., smelling an aroma not detectable to others) and taste hallucinations.

Another type of experience is called a “presence hallucination,” which is when patients have a strong feeling of another person, or an animal, being behind them or to the side, but when they turn around, there isn’t anything there.

Delusions

Delusions are false, irrational beliefs. In PDP, delusions are more bothersome but less common. Surprisingly, in PDP, the delusions tend to be fairly similar from one patient to the next and are usually paranoid in nature. For example, a patient might be positive that his spouse has been attacked and is in need of assistance. Or, a spouse may be irrationally convinced that their partner is committing adultery.

Hallucinations and delusions are difficult for both the patient and their caregivers, particularly because it is impossible to convince someone who is delusional about what is really true. In fact, accusations of spousal infidelity are often the “last straw,” when caregivers find caring for their loved one too overwhelming. As a result, PDP patients are often transferred to long-term care facilities.

Treating PDP

One of the major problems in managing PDP is that the patient and the family often try to hide the problem – the patient for fear of being thought “crazy,” and the caregiver due to embarrassment. But when a PD patient has psychotic symptoms, his or her mental abilities will be otherwise normal. Therefore, when hallucinations or delusions occur, the treating doctor should be notified.

If the PDP symptoms don’t bother the patient, then they may not need immediate attention, but they should always be monitored. In some cases, physicians may alter PD medication doses to see if that positively affects the incidence of PDP symptoms without significantly worsening motor control. Currently, no drug is approved to treat PDP in the United States, though one may be on the horizon. The condition is often treated with atypical antipsychotics, which can worsen the symptoms of Parkinson’s disease and carry a black box warning for use in elderly patients with dementia-related psychosis due to increased morbidity and mortality.

Support Your Loved One and Yourself

PDP is also associated with increased caregiver stress and burden, nursing home placement and increased morbidity and mortality.  But, your loved one is certainly not alone in living with PDP, and an effective management plan can help. Seek out the support that he or she needs, but also make sure that you are getting the emotional care you personally need in order to be an effective advocate for your loved one.

For more information about PDP, visit the Parkinson’s Disease Foundation website. You’ll find additional information about psychosis and can view a video of brief descriptions by PD patients of their hallucinations: http://www.pdf.org/hallucinations.

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