Journal of Neurology

, Volume 252, Issue 7, pp 753–764

Psychotic symptoms in Parkinson’s disease

From description to etiology

DOI: 10.1007/s00415-005-0918-5

Cite this article as:
Papapetropoulos, S. & Mash, D.C. J Neurol (2005) 252: 753. doi:10.1007/s00415-005-0918-5


Psychotic symptoms are common in Parkinson’s disease (PD) and occur in at least 20% of medication-treated patients. Benign visual hallucinations usually appear earlier, while malignant hallucinations, confusional states, delusions, paranoid beliefs, agitation, and delirium become more frequent with disease progression. Virtually all antiparkinsonian drugs may produce psychotic symptoms. Cognitive impairment, increased age, disease duration and severity, depression, and sleep disorders have been consistently identified as independent risk factors for their development. Although the precise pathoetiologic mechanisms remain unknown, we review evidence that links ventral dopaminergic pathway dysfunction (overactivity) together with the involvement of other neurotransmitter system imbalances as likely contributors. The clinical importance of the proposed mechanism is that successful management of psychotic symptoms in PD may rely on a multitarget approach to restore neurotransmitter imbalances rather than focusing exclusively on the dopaminergic dysfunction.

Key words

Parkinson’s disease psychotic symptoms hallucinations etiology 

Copyright information

© Steinkopff-Verlag 2005

Authors and Affiliations

  1. 1.Department of NeurologyUniversity of Miami, School of Medicine, Room 4004Miami (FL)USA

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