Psychosis in Parkinson’s disease: ‘between a rock and a hard place’

Henderson, M. Todd; Mellers, John D. C.

doi:10.1080/09540260020002541

Cited by 39 publications

(26 citation statements)

References 190 publications

(200 reference statements)

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“…One group typically experiences mild visual perceptual changes (e.g., sensation of a presence or a sideways passage) or visual illusions or visual hallucinations only, although auditory hallucinations and, more rarely, olfactory and tactile hallucinations can also occur (5,13). Visual hallucinations are typically formed animal or human figures and are stereotyped for each patient.…”

Section: Presentationmentioning

confidence: 97%

“…A hierarchy for the propensity of specific agents to induce psychosis has been proposed, but there is limited controlled research to support this view (13). Both dopamine agonists and L-dopa, the two first-line treatments for the motor symptoms of PD and the most commonly used, have been associated with psychosis (18), and randomized comparative studies have found that psychosis occurs more commonly with dopamine agonists than with L-dopa (19).…”

Section: Etiology and Pathophysiologymentioning

confidence: 98%

“…Rarely, psychosis in PD may present as part of a manic episode, and psychosis early in the course of PD suggests a diagnosis of DLB (13). In DLB, hallucinations have been associated specifically with visuoperceptual impairment (2).…”

Section: Correlates and Risk Factorsmentioning

confidence: 99%

“…Correlates or risk factors for PD psychosis include exposure to PD medications (13); older age (8,9,14); increasing severity of executive impairment, global cognitive impairment, or a diagnosis of dementia (5-9, 12); increasing severity (6,8,9,12) and duration of PD (5,9); comorbid depression (5)(6)(7)(8) or anxiety (6); increasing daytime fatigue (5); comorbid sleep disorder, including REM sleep behavior disorder (9); visual impairment (15); and polypharmacy (13). Rarely, psychosis in PD may present as part of a manic episode, and psychosis early in the course of PD suggests a diagnosis of DLB (13).…”

Section: Correlates and Risk Factorsmentioning

confidence: 99%

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Presentation and Management of Psychosis in Parkinson’s Disease and Dementia With Lewy Bodies

Weintraub

Hurtig²

2007

AJP

101

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Treatment in Psychiatry begins with a hypothetical case illustrating a problem in current clinical practice. The authors review current data on prevalence, diagnosis, pathophysiology, and treatment. The article concludes with the authors' treatment recommendations for cases like the one presented.A 73-year-old man with a 10-year history of progressive Parkinson's disease is referred for psychiatric evaluation and treatment by a neurologist for new-onset confusion and visual hallucinations of strangers in his house. Treatment of the early Parkinson's symptoms began with a dopamine agonist, and L-dopa was added later to combat worsening tremor, rigidity, slowed mobility, and difficulty performing basic activities of daily living. A more detailed history elicits new-onset depression and vivid dreaming with insomnia. The patient's wife is concerned about the hallucinations, worsening cognitive impairment, and disturbed sleep, all of which have an impact on her quality of life. Treatment options for addressing these new symptoms include lowering the dosages of antiparkinsonian medications, which can cause or aggravate visual hallucinations and confusion, or adding quetiapine, the atypical antipsychotic drug that is least likely to worsen the parkinsonism. After discussions with the patient and his wife, the decision is made to initiate quetiapine at a dose of 50 mg at bedtime and not to change the antiparkinsonian medication regimen. However, after only a few doses, the patient stops taking the quetiapine because of excessive sedation and increased confusion. An attempt is then made to slowly taper the dopamine agonist, which is more likely than L-dopa to cause psychiatric complications and is less effective as an antiparkinsonian medication. The patient's parkinsonism worsens, however, so the dosage is restored to the previously effective level. The patient's condition continues to deteriorate because of increasing visual hallucinations (now accompanied by persecutory delusions regarding the strangers in the house), confusion, and disturbed sleep. An urgent follow-up evaluation is arranged. How does one differentiate between psychosis in Parkinson's disease (PD) and psychosis in dementia with Lewy bodies (DLB)? How does psychosis present in PD and DLB, and what are risk factors for its occurrence? What is the neuropathophysiology of psychosis in these disorders? What evidence exists for psychopharmacological treatment of psychosis in PD and DLB? How does one optimize the risk-benefit ratio of concomitant use of PD and psychiatric medications?Epidemiology PD is the second most common neurodegenerative disease after Alzheimer's disease, affecting up to 1% of the elderly population. DLB, which may be indistinguishable from PD neuropathologically and has similar clinical features (e.g., dementia, spontaneous parkinsonism, and attentional impairment), is now thought to be the second most common dementing illness after Alzheimer's disease in Western countries. Dementia also occurs commonly in PD, affecting up to 75% of PD ...

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Section: Presentationmentioning

confidence: 97%

Section: Etiology and Pathophysiologymentioning

confidence: 98%

Section: Correlates and Risk Factorsmentioning

confidence: 99%

Section: Correlates and Risk Factorsmentioning

confidence: 99%

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Presentation and Management of Psychosis in Parkinson’s Disease and Dementia With Lewy Bodies

Weintraub

Hurtig²

2007

AJP

101

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“…Psychosis very early in the disease course suggests a diagnosis of dementia with Lewy bodies [72]. Exposure to dopaminergic therapy has been implicated as the major cause of psychosis in PD [73], and DAs are more prone to cause psychosis than L -dopa even in early PD.…”

Section: Treatment Of Non-motor Symptomsmentioning

confidence: 99%

Treatment of Early Parkinson’s Disease

et al. 2009

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The management of early Parkinson’s disease (PD) involves the treatment of motor symptoms, and, increasingly, non-motor symptoms. Given the fast pace of clinical research in PD, clinicians are faced with the challenge of integrating the latest findings into the ongoing care of individual PD patients. Part 1 of this 2-part article reviews efficacy and safety data for the newest PD treatment options, as well as for established therapies. Part 2 of the article, presented here, reviews key data relevant to the assessment of potential neuroprotective therapies and the treatment of non-motor symptoms.

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