Psychosis in Parkinson’s disease: how is it treated?

Delusions and hallucinations may accompany other typical symptoms, such as tremors.

Mental illnesses, especially those of a neurodegenerative nature, affect the brain functions of patients in ways that still continue to surprise the medical and scientific community. This is the case of psychosis caused by Parkinson's disease.

Although it is not the most common, sometimes the dementia that can accompany Parkinson's disease can the dementia that can accompany Parkinson's disease develops into psychosis, causing all kinds of symptoms of Parkinson's disease.causing all kinds of symptoms typical of Parkinson's disease. In this article we will talk about these symptoms and the possible treatments that exist to combat them.

When Parkinson's disease precedes psychosis

As a general rule, Parkinson's disease is considered to be a neurodegenerative disorder which is distinguished by causing a series of movement disorders. The most characteristic symptoms of this disease are those affecting motor function and are manifested by very characteristic tremors, difficulties with gait and problems initiating movement.

However, in addition to motor symptoms, this disease is also characterized by symptoms related to cognition and mood. It is therefore not uncommon for psychotic symptoms associated with Parkinson's disease to appear in certain cases.

In some Parkinson's patients, a progressive dementia known as Lewy body dementia appears. These bodies consist of abnormal agglomerations in the brain of a protein known as synuclein. Although this element is usually found in the substantia nigra region, the dispersion of Lewy bodies outside the substantia nigra has been associated with non-motor symptoms and the development of progressive dementia.

It is estimated that 20-30% of Parkinson's patients who develop dementia may develop psychotic symptoms. However, there are also reported cases of psychosis, there are also reported cases of psychosis in the absence of dementia.. Finally, as Parkinson's disease worsens, so does the severity of psychotic symptoms.

Typically, psychotic symptomatology usually appears after the disease has progressed over the years, especially when the disease is in its most severe stages. However, there is the possibility of these symptoms appearing at any time, even soon after starting treatment for Parkinson's disease.

What are these psychotic symptoms associated with Parkinson's?

Traditionally, psychosis has been defined as a mental or psychiatric disorder in which the patient experiences some type of delusions and/or hallucinations of any kind. In addition, when this symptomatology appears within the evolution of Parkinson's disease, the person may also manifest states of mental or psychiatric disorders.the person can also manifest states of confusion.

This psychotic symptomatology is preceded by a series of alteration and changes in sleep patternsThis is distinguished by a parasomnia in which there is a lack of Muscle atonia in the REM phase. It is also accompanied by strong and sudden movements and by the experience of violent dreams.

The following is an explanation of how psychotic symptoms appear in patients with Alzheimer's disease.

1. Hallucinations

Hallucinations are one of the most characteristic symptoms of psychotic conditions. These cause the person to perceive stimuli that are not really there.. In the specific case of Parkinson's these hallucinations can be visual, auditory or even tactile.

At the onset of hallucinations, they can be very frightening for the patient, as they are often related to the perception of deceased persons or extremely strange elements. Unfortunately, the severity of these hallucinations tends to increase, the severity of these hallucinations tends to increase with the development of the disease, provoking real states of anxiety and anxiety.causing real states of anxiety and panic in the patient.

2. Delusions

In Parkinson's patients with psychotic symptomatology, delusions or delusional ideas are usually paranoid in nature. are usually paranoid in nature. The content of these is usually related to the idea that you are being watched, persecuted or that one or more people are trying to harm you in any way.

3. Confusional states

In states of confusion or confusional symptoms, the patient experiences alterations in his state of consciousness. One of the signs that the patient is beginning to manifest psychotic symptoms is that he/she tends to experience fluctuations between alertness and wakefulness, concentration problems, and a kind of disconnection from everything. and a kind of disconnection from everything around them.

This type of disorganized thinking tends to favor the aforementioned paranoid ideas. In addition, if this happens in elderly patients or in those with comorbidity with other diseases, it can reach severe delirium states.

Is there any treatment?

Before initiating any type of intervention to alleviate the psychotic symptoms of Parkinson's, the causes that are causing these symptoms must be specifically defined. Usually, these are caused by the antiparkinsonian medication itself; however, they can also be the consequence of an infection that triggers the symptoms.However, they can also be the result of an infection that triggers delirium or the dementia that accompanies Parkinson's disease.

Once the origin has been determined, the first treatment measures can begin. Since the medication itself is responsible for the onset of delirium and hallucinations, the first steps to be taken are to adjusting the dosage of the medication. However, this is a very complicated process; if the medication is lowered too much, the motor symptoms of Parkinson's may increase dramatically. But if no change is made, psychotic symptomatology will increase.

If psychotic symptoms cannot be reduced by adjusting Parkinson's medication, the physician may decide to resort to antipsychotic medication. However, this choice is also not without risk.

The drugs used for the treatment of psychotic symptoms are often effective because they they block dopamine receptors in limbic areas of the brain. However, they can also block dopamine in the brain regions that manage motor functions, such as the striatum, which will lead to the appearance of more abnormal Parkinson's-like movements.

Even so, if these psychotic symptoms are severe enough to require the use of medication, the use of typical antipsychotics such as haloperidol is discouraged, and atypical antipsychotics such as clozapine or quetiapine are much more effective and have fewer side effects.

In recent years, a drug for the treatment of psychotic symptoms in people with Parkinson's disease has been developed and approved by the FDA (Food and Drug Administration). This drug decreases the psychotic symptoms associated with this disease without worsening the motor symptoms. Known as pimavanserinthis drug influences psychotic symptoms without directly blocking the flow of dopamine. However, this drug is a very recent development, so time will tell how effective and safe it can be.