Prevalence of Psychotic Symptoms in a Community-Based Parkinson Disease Sample

Abstract

Objectives-To determine the prevalence of psychotic phenomena, including minor symptoms, in a Parkinson's disease (PD) sample and compare the clinical correlates associated with the various psychotic phenomena. To evaluate the extent to which cases met NINDS/NIMH proposed criteria for PD-associated psychosis.Methods-250 patients with idiopathic PD and MMSE>23 from three community-based movement disorder clinics underwent comprehensive research diagnostic evaluations by a geriatric psychiatrist as part of a study on mood disorders in PD. Psychotic symptoms were categorized using a checklist, which included a breakdown of hallucinations, delusions and minor symptoms. Clinical characteristics of groups with minor and other psychotic symptoms were compared. The NINDS/NIMH criteria for PD-psychosis were retrospectively applied.Results-Of the total sample, 26% of patients were found to have any current psychotic symptoms, with 47.7% of those having isolated minor symptoms, and 52.3% having hallucinations and/or delusions. Compared to those with no current psychiatric symptoms, minor symptoms were associated with more depressive symptoms and worse quality of life. 90.8% of those with psychotic symptoms fulfilled the NINDS/NIMH proposed criteria.Conclusions-Psychotic symptoms are common in PD patients, with minor psychotic phenomena present in nearly half of affected patients in a community-based sample. Psychotic symptoms, including minor phenomena, were clinically significant. The NINDS/NIMH PD- Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. ObjectivesPatients with Parkinson's disease (PD) commonly experience neuropsychiatric symptoms [1,2]. Psychotic symptoms are especially prevalent, and are associated with greater physical disability, cognitive and affective dysfunction, caregiver distress, nursing home placement, and mortality [3][4][5]. However, the temporal and clinical profile of psychosis in PD is different from other psychotic disorders, such as schizophrenia or mood disorders with psychotic features. Therefore, definitions and schemas applied to other psychiatric illnesses have limited utility for describing and quantifying the scope of psychotic phenomena in PD.Psychotic symptoms in PD include hallucinations and delusions, which define psychosis typically. There are also atypical symptoms, referred to as minor psychotic phenomena, which include sense of presence, passage hallucinations, and illusions (see Appendix). Furthermore, hallucinations are usually visual, although other sensory modalities can be involved. Cross-sectional prevalence estimates indicat...

Parkinson-Krankheit und Psychosen

“…Insbesondere die PDP ist durch eine ungünstige Prognose gekennzeichnet und mit einer verschlechterten Lebensqualität, erhöhter Behinderung, Pflegebedürftigkeit und Mortalität verbunden [2][3][4][5][6][7][8][9]. Psychotische Symptome treten bei etwa 30 % der Patienten mit PD auf [10][11][12][13][14][15][16].…”

Parkinson’s Disease Psychosis – Prevalence Patterns Across the EU-5

“…Common variations in study design identified from a targeted literature review (unpublished findings) include the criteria for patient selection, the definition of PDP, the symptoms of psychosis that were of interest to study investigators, differences in the methodology used to assess symptoms, and the timeframe over which symptoms were observed. For example, several studies have reported that inclusion of minor phenomena increases the observed prevalence rate of psychosis symptoms among patients with PD [47][48][49] and that standard assessment tools for PD symptomology, such as the thought disturbance item on the Unified Parkinson Disease Rating Scale (UPDRS) Part I have low sensitivity for capturing such phenomena. 50,51 The prevalence rates in the current study were estimated based on survey data reported retrospectively by medical practitioners.…”

Parkinson’s disease psychosis

“…16 In attempts to develop specific criteria for psychotic symptoms without confounding cognitive impairment, 250 patients with idiopathic PD and mini-mental status examination (MMSE) .23 from community-based clinics were evaluated for psychotic symptoms based on National Institute of Neurological Disorders and Stroke/National Institute of Mental Health criteria. 21 Of the total sample, 26% had current psychotic symptoms with less than half of those having minor symptoms such as illusions and false sense of …”