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PD & Psychosis

CAYLA VILA, MD

MOVEMENT DISORDERS FELLOW

UNIVERSITY OF ROCHESTER MEDICAL CENTER

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Outline

  • Symptom overview
  • What is psychosis
  • Causes of psychosis
  • Treatment of psychosis
  • Recommendations for care partners

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Motor Symptoms

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  • Tremor
  • Stiffness
  • Slowed movements
  • Walking and balance changes
  • Swallowing difficulties

Non-Motor Symptoms

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  • Constipation
  • Urinary changes
  • Lightheadedness
  • Dream enactment
  • Pain
  • Depression
  • Anxiety
  • Psychosis

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What is psychosis?

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Hallucinations

  • Seeing, hearing, or feeling things that are not there
  • Visual (most common)
      • Examples: shadows, animals, people
      • More common in low light environments
  • Auditory, olfactory, tactile, gustatory (less common)
  • Can range from mild to intense
  • Person with PD may or may not have insight/be aware these aren’t real

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Illusions

  • Misinterpret objects that ARE present
    • Example: thinking curtains are a tree
    • Example: perceiving movement in the corner of your eye
  • Feeling of presence
  • Also tend to occur more in low light settings

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Delusions

  • False beliefs that are not based in reality
  • Example: paranoid or persecutory themes
  • Not common, but occur in up to 8% of people with PD

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There is a spectrum, from mild �to fully formed and scary hallucinations/illusions/delusions

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How common is psychosis in PD?

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Prevalence

  • Up to 50% of people with PD have psychosis at some point
  • This includes those with temporary psychosis due to infection or medications
  • Not all 50% have persistent hallucinations
  • Not all have scary hallucinations

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Causes of psychosis

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Causes

Parkinson’s disease itself

  • More common in advanced Parkinson’s disease, PD dementia, or dementia with Lewy bodies
  • More likely in older patients

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Causes

Medications

  • Medicines that increase dopamine activity
    • Carbidopa-levodopa
    • Dopamine agonists (ie ropinirole, pramipexole)
  • Anti-cholinergic medications (ie Artane, amantadine)

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Causes

  • Infection
  • Delirium from various causes
    • Poor sleep
    • Pain
    • Post-surgery
  • Severe depression

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Treatment

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Treatment

  • Not all psychosis needs to be treated with medication
  • Look for reversible causes
    • Vision impairment
    • Untreated pain
    • Sleep deprivation
    • Fever or infection
    • Medication changes

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Treatment

When medication is needed:

  • Doctors may approach this differently
  • When psychosis becomes bothersome or scary, or when the person with PD loses insight into what is reality and what is not
  • Adjust Parkinson’s medications
  • Medications used:
    • Quetiapine (Seroquel)
    • Clozapine (Clozaril)
    • Pimavanserin (Nuplazid)
  • Many other antipsychotics can worsen the motor symptoms of PD by blocking dopamine in the brain

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Recommendations for care partners

  • Don’t argue with your loved one with PD, their reality may be different from yours
  • Stay calm and reassure them they are safe
  • If needed, acknowledge what they are experiencing
  • Improve lighting in the environment (ie use nightlights, prescription glasses)
  • Call 911 if you or your loved one with PD is unsafe
  • Seek support for yourself from loved ones, aides, counseling, respite programs, and other community supports like the RPN
    • RPN Respite Care Grant Program

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Thank you!