Between 20 percent and 40 percent of people experience symptoms of Parkinson’s disease psychosis, like hallucinations and delusions. A person who has hallucinations may be hearing voices or seeing things that aren’t there. Delusions are persistent, illogical thoughts that aren’t based in reality. Both of these symptoms can be challenging to manage for people with Parkinson’s disease and caregivers.

If your loved one with Parkinson’s experiences hallucinations or delusions, help is available. Here are eight tips for managing these symptoms.

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1. Be Open and Honest With Your Doctor

Never hesitate to discuss your own psychosis symptoms or your loved one’s with your healthcare team. Unfortunately, fear or embarrassment can cause people to avoid sharing symptoms of Parkinson’s psychosis with their healthcare providers. It’s important to tell your doctor if you or a loved one experiences hallucinations or delusions so you can discuss possible solutions.

Identify the Cause

Your doctor can help determine the cause of hallucinations and delusions. Parkinson’s disease psychosis is often caused by dementia, delirium, and medication side effects.

Never hesitate to discuss your own psychosis symptoms or your loved one’s with your healthcare team.

People with Parkinson’s can experience a decline in their cognitive abilities, like thinking and memory. This is called dementia. Dementia causes changes in the brain that can lead to hallucinations and delusions.

Delirium is when someone has difficulty concentrating for a short period of time. Possible causes of delirium include infections, such as a urinary tract infection (UTI), heart or liver disease, and vitamin or electrolyte imbalances.

Medications used to manage Parkinson’s disease, like dopamine agonists and levodopa-carbidopa (Sinemet), and those used to manage unrelated health conditions can cause hallucinations and delusions in some people. In addition, anticholinergics and amantadine disrupt the chemical balance in the brain, which may trigger hallucinations in some people with Parkinson’s disease.

Hallucinations and delusions can also be from another condition, such as dementia with Lewy bodies. Dementia with Lewy bodies is a type of dementia that can be difficult to distinguish from Parkinson’s disease.

Work as a Team

Whatever the cause, your doctor can recommend treatment options or strategies to help you and your family cope with episodes of psychosis. One MyParkinsonsTeam member shared tips from their spouse’s doctor: “According to his neurologist, you should always be honest. His neurologist coaches him to listen to me because I am looking out for his best interests, and I will not lie to him about what is real and what is not. He seems content with that.”

2. Consider Medication Changes

Adding a new Parkinson’s medication or changing the dosage of an existing medication could lead to hallucinations or delusions. If this is the cause, your doctor may recommend making changes to treatment.

If you or your loved one is having hallucinations or delusions, your healthcare team will perform a clinical exam and medication review. To manage hallucinations and delusions, your healthcare team may suggest:

• Changing medications
• Adjusting medication dosages
• Adding antipsychotic medications to the treatment plan
• Going to therapy or counseling

Every medication comes with potential benefits and risks, and reducing or discontinuing drugs may lead to worse motor symptoms. Your loved one’s doctor can help weigh the risks and benefits as you find a treatment plan that works well.

3. Remain Calm and Patient

It can be hard to know how to respond to a hallucination or delusion while it’s happening. A member described a friend with delusions: “She believed that up to 10 children come and stay in her house, and she is responsible for their care. I didn’t know whether to tell her they are not real or just go along with her.”

Challenging a person’s reality during a delusion is not recommended. Try to stay calm and offer reassuring words.

The right response will vary, depending on the person and the particular circumstances. In all cases, doing your best to remain calm and patient will go a long way to helping manage the situation. One member explained how their spouse supported them during a disturbing hallucination: “The other day I had one scary one about mosquitos in my room, hundreds of them. My wife came and held my hand and laid down with me.”

4. Explain That a Hallucination Isn’t Real

If a person is experiencing hallucinations but has insight (the ability to recognize that these perceptions aren’t real), you can explain that they are hallucinations. One member shared this strategy when helping their spouse: “I just talk with him about what he is seeing and then show him that nothing is there.”

Another caregiver wrote, “If his hallucinations are during the day, I will tell him he is hallucinating and ask him to show me where or what is the problem. That way he ends up seeing there is nothing there.”

5. Avoid Challenging Delusions

Challenging a person’s reality during a delusion is not recommended. Do your best to stay calm and offer reassuring words. One member of MyParkinsonsTeam shared advice they’d received for caring for their spouse: “I was told not to argue with him or try to convince him that delusions are not real. Just calmly convince him that he is safe and will not come to harm.”

You can also ask questions about what the person is experiencing to help them feel supported and heard.

6. Distract With a Change of Scenery or New Activity

If the person has lost insight, it may be better not to challenge their reality. Instead, you can offer a distraction like moving to another room of the house or starting a new activity.

Visual hallucinations frequently occur in low light, so keeping lights on may help minimize the chance of visual hallucinations.

One caregiver explained, “If it’s the middle of the night and he wants to get dressed and go to work, I generally ask him to come and sit with me first so I can go to sleep.”

7. Use Strategies To Defuse Anger

Sometimes a person experiencing hallucinations or delusions will become angry or aggressive. The following coping strategies can help de-escalate the situation:

• Offer reassuring words, such as “You are safe.”
• Speak slowly, with a calm tone.
• Ask questions about the person’s feelings.
• Listen without interrupting.
• Avoid sudden movements and give the person space so they don’t feel threatened.

Think through an emergency plan in the event that your loved one becomes a danger to themselves or to you and others. Your family member’s neurologist or other healthcare providers can help you plan ahead.

8. Make Household Changes To Reduce Risk

Making changes around the house can help prevent episodes of psychosis and help minimize danger.

Increase Lighting

Visual hallucinations frequently occur in low light. Keeping lights on, especially at night, can minimize the chance of visual hallucinations. In addition, be mindful about where mirrors and other reflective surfaces are placed.

Secure Objects

Sometimes a person experiencing hallucinations or false beliefs can behave in ways that cause harm to themselves or others. Consider securing firearms, kitchen knives, tools, car keys, and other objects that a person could use in an unsafe way.

Control Access

Members of MyParkinsonsTeam report situations where a loved one tries to leave the home during a delusion. “My dad has now experienced two episodes (that we know of) where he got up, got dressed, and tried to leave the house. Thank God his difficulty in opening the front door awakened my mother!” one member shared.

Depending on the circumstances, it may be appropriate to restrict or supervise a person’s ability to exit the home. Always ask your doctor about what is appropriate before taking these measures.

Finding Support

Caring for a loved one with Parkinson’s requires a team. If you can, seek help from other family members, friends, or professional carers so the full responsibility isn’t on one person’s shoulders.

Connecting with other caregivers through support groups and on MyParkinsonsTeam can help you find understanding and answers to questions about your loved one’s behavior. Seeking support is an important part of taking care of yourself as you provide care for your loved one.

Join the Conversation

On MyParkinsonsTeam, people share their experiences with Parkinson’s disease, get advice, and find support from others who understand.

What are your tips for managing hallucinations and delusions? Let others know in the comments below.