Pyschosis

Non-motor symptoms of Parkinson's that causes people to experience hallucinations and or delusions are often classified as Parkinson's disease psychosis, or PDP. Approximately 50% of all people living with Parkinson's experience some form of hallucinations or delusions, especially in more advanced stages.

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Hallucinations

A hallucination is something someone sees, hears, smells, tastes, or feels that's not there. Essentially, hallucinations are tricks the brain plays on the senses. Most of the time, these hallucinations are visual. They can appear very clear to the person with PD, but cannot be seen by anyone else. In some cases, visions may be disturbing and cause emotional distress, others may be friendly and joyful. Generally, a person knows that what they are seeing isn't real. However, in more advanced stages, hallucinations may be very real to the person with PD. It isn't uncommon that the person begins talking to them and interacting with them. In some cases, these hallucinations may cause aggressiveness.

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Dr. Friedman writes, " Visual hallucinations occur in about 30% of PD patients taking PD medications. The more activity there is in the environment, the less likely it is for hallucinations to appear. Not all hallucinations need to be treated and many times are the result of medication side effects."  A new drug was recently released to help treat hallucinations in Parkinson's patients called Nuplazid. "The decision to treat or not treat is then based on the effect the hallucinations have on the patient," concludes Friedman.

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Illusions

Illusions are another sensory misperception. Instead of seeing things that are not there, people with illusions misinterpret real external stimuli. They see or hear something wrong, such as mistaking hats on a coat rack for heads. Illusions can also be experienced as a "sense of presence" - when you have the feeling of a person or animal being nearby when there is no one around. These can also be triggered by unformed objects moving into your peripheral vision.

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Illusions and hallucinations are more likely to occur in low light / low visibility situations. To reduce risk, increase lighting, particularly in dark areas such as hallways.

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Delusions

Unlike hallucinations, delusions are specific and fixed beliefs that are very real and true to the person experiencing them, even though they contradict what is generally acceptable, reasonable, or logical. The person experiencing them believes they are true, and nothing can convince them otherwise. As a result, they may become suspicious or doubtful when it comes to believing their loved ones.

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Delusions occur less frequently than hallucinations in Parkinson's. Only a small percentage of people will experience them. Common delusions people with Parkinson's experience are:

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• The belief that their partner is being unfaithful

• The belief that their care partner is poisoning them with their medications

• The belief that people are stealing from them or planning to

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Should you experience any hallucinations or delusions, it's important to consult your medical provider for a clinical evaluation. Often reviewing medications and dosages can help reduce psychosis through adjustments. Additionally, there may be antipsychotic drug therapies that can be tried if hallucinations and delusions become particularly bothersome.

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Causes

There are three main contributors to the development of Parkinson's disease - associated psychosis. The most common trigger of PD psychosis is medication. Treatments used for PD to regulate dopamine can often come with side effects of hallucinations, illusions, or delusions. Working with your doctor to find a balance of administering these prescriptions may help reduce psychosis side effects.

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Dementia is also a condition that includes a group of symptoms associated with a decline in memory and thinking. Parkinson's disease dementia affects attention, recent memory, executive function, and visual and spatial relations. It usually develops years after the PD diagnosis. Dementia can play an added role to hallucinating, illusions and delusions.

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Delirium is a reversible medical condition that generally comes on and resolves quickly with treatment. It involves a state of altered alertness, disorganized thinking, unusual behavior and/or hallucinations. These can typically be resolved quickly once the trigger has been discovered as to what is causing the delirium.

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Preparing for Appointment to Discuss Psychosis

Consider the answers to these questions to prepare for your appointment with your neurologist when it comes to discussing symptoms of Psychosis:

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• When did you first experience hallucinations/delusions?

• Have there been any recent changes to your medication regimen?

• Have you started taking a new medication, or have there been changes in dose or timing of current medications?

• Have you experienced any recent changes in health?

• Have you had any changes in your sleep?

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Treatment

Treating Parkinson's disease-associated psychosis is a multi-step process that begins with talking to your healthcare team. They will follow a series of steps to figure out how to best address the symptoms.

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1. Step 1: Perform a clinical evaluation of symptoms considering history, disease stage and available support systems.

2. Step 2: Adjust current medications and work to find a balance to lessen the symptoms of psychosis while also finding balance for your motor symptoms.

3. Step 3: Antipsychotic therapy, including the use of drugs may be needed to rebalance chemical levels in the brain.