Treating Parkinson’s disease psychosis involves making changes to existing medications and adding medication if psychosis symptoms continue. Hallucinations and delusions are the most common symptoms of Parkinson’s psychosis. Psychosis most commonly happens in older people with PD or those who need higher doses of dopaminergic medications.
Diagnosing Parkinson’s psychosis can be complex. A health care provider trained in managing PD needs to be involved in diagnosis and treatment for you or your loved one.
Hallucinations and delusions are the most common symptoms of Parkinson’s psychosis. Hallucinations involve a person seeing, hearing, feeling, smelling, or tasting something that isn’t really present. Most hallucinations in PD psychosis are visual, where someone sees a person or an animal.
Delusions are ongoing thoughts that are not based in the real world. A person with delusions does not intentionally try to have these thoughts. These may include being jealous, feeling persecuted, or fixating on one’s own body or health.
When describing their first hallucination, one MyParkinsonsTeam member said, “In my living room I saw a little boy covered in fur. Lasted a good eight seconds, vivid and defined. I wasn’t startled, just curious and absolutely believed it was real — until it vanished.”
Learn more about recognizing hallucinations and delusions.
To properly diagnose psychosis in Parkinson’s, a health care provider will rule out other diseases and disorders that can also cause psychosis, such as dementia with Lewy bodies, schizophrenia, delirium, or major depression with psychosis.
Once your health care provider has confirmed that the psychosis hasn’t come from another disease or disorder, they’ll also make sure of the following:
Psychosis in PD is a serious medical concern. A properly trained physician, such as a neurologist or psychiatrist, should be in charge of treating it. Once the physician has confirmed Parkinson’s psychosis, they will begin treatment.
One MyParkinsonsTeam member mentioned, “Please make sure your doctor knows about your hallucinations. They do have medicines for them.”
The first step in treating psychosis in Parkinson’s disease is to cut out or decrease the dosage of certain medications. “When I first started taking a new drug four times daily, the night hallucinations were dreadful,” one MyParkinsonsTeam member shared. “When I told my neurologist about these, she dropped the medication to three per day, and I have to take my last one no later than 5 p.m., otherwise I will hallucinate.”
Health care providers usually remove PD drugs in the following order:
Some clinicians may also cut out the following types of medications:
Often, when people with PD stop taking these medications, they experience an increase in the other PD symptoms the drugs had been keeping at bay. In these cases, a doctor may increase the dosage of levodopa. Levodopa helps to manage the movement problems of PD, so it can help counteract the increase in symptoms.
Many people with Parkinson’s psychosis will still have psychosis symptoms after making changes to their existing medication. These psychosis symptoms may be mild at this point, and the doctor may just want to monitor them for a while.
If hallucinations and delusions become serious, a health care provider may prescribe medications to manage these symptoms. Below are the primary drugs used to treat psychosis in people with Parkinson’s:
A MyParkinsonsTeam member reported, “Nuplazid is helpful for hallucinations and delusions. It’s expensive, but most insurance covers it with prior approval from the neurologist. My dad started it almost one month ago, and he is not hallucinating as much in the morning.”
Another member shared, “I am taking Seroquel for my hallucinations. No problems anymore.”
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Has your loved one been diagnosed with Parkinson’s psychosis? Do you have questions about Parkinson’s psychosis? Ask your question or share your experience in the comments below, or start a conversation by posting on your Activities page.