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Current Understanding of Psychosis in Parkinson’s Disease

  • Geriatric Disorders (W McDonald, Section Editor)
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Abstract

Psychosis in Parkinson’s disease (PD) is one of the greatest determinants of nursing home placement and caregiver stress. Traditionally associated with medications with dopaminergic effect, it has now been linked to other medications and other stressors e.g. systemic illnesses. The development of hallucinations in a PD patient can herald the onset of dementia and usually predicts increased mortality risk. Medication reduction in PD psychosis usually reduces the symptoms; however, this comes at the cost of worsening motor function. If gradually decreasing the patient’s medications does not resolve the psychosis, the treatment of choice is an atypical antipychotic. Though only clozapine has level A recommendation for this indication, other atypicals like quetiapine continue to get used for this purpose on account of the logistics involved with clozapine use. Cholinesterase inhibitors are also increasingly being used for PD psychosis on account of the association with dementia. The treatment of PD psychosis is an unmet need in PD management and search for suitable agents constitutes an active area of research in PD.

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Authors and Affiliations

  1. Neurology Unit, Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria

    Oluwadamilola O. Ojo

  2. Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA

    Oluwadamilola O. Ojo & Hubert H. Fernandez

  3. Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA

    Hubert H. Fernandez

  4. Department of Medicine, College of Medicine University of Lagos, P.M.B. 12003, Idi-araba, Lagos, Nigeria

    Hubert H. Fernandez

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  1. Oluwadamilola O. Ojo
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Correspondence to Hubert H. Fernandez.

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Conflict of Interest

Oluwadamilola O. Ojo declares no conflict of interest.

Hubert H. Fernandez has received grants from Abbvie, Acadia, Auspex, Biotie Therapeutics, Civitas, KYOWA/Prostrakan, the Michael J. Fox Foundation, Movement Disorders Society, NIH/NINDS, the Parkinson Study Group, Rhythm, Synosia and Teva. Dr. Fernandez has also received personal fees from Demos Publishing, Prime Education, Ohio State University, the International Parkinson & Movement Disorders Society, Carling Communications, Medscape, Biogen, GE Healthcare, Lundbeck, Merz Pharmaceuticals, and Pfizer Pharmaceuticals as well as non-financial support from Abbvie, Merz and IPSEN Pharmaceuticals. Dr. Fernandez also receives a stipend for serving as the Medical Editor of the MDS website.

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Ojo, O.O., Fernandez, H.H. Current Understanding of Psychosis in Parkinson’s Disease. Curr Psychiatry Rep 18, 97 (2016). https://doi.org/10.1007/s11920-016-0730-1

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