Psychosis In Parkinson’s Disease: How Is It Treated?
Mental illnesses, especially those of a neurodegenerative nature, affect patients’ brain functions in ways that 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, on some occasions the dementia that can accompany Parkinson’s disease turns into a psychosis, causing all kinds of symptoms typical of this. In this article we will talk about these symptoms and the possible treatments that exist to combat them.
Typically, Parkinson’s disease It is considered a neurodegenerative condition which is distinguished by causing a whole series of movement alterations. The most characteristic symptoms of this are those that affect motor function and are manifested by very characteristic tremors, difficulties with walking and problems initiating movement.
However, in addition to motor symptoms, this disease is also characterized by causing symptoms related to cognition and mood. Therefore, it is not strange that in certain cases psychotic symptoms associated with Parkinson’s disease appear.
In some Parkinson’s patients, a progressive dementia known as Lewy body dementia develops. These bodies consist of abnormal clumps in the brain of a protein known as synuclein. Although this element is usually found in the region of the substantia nigra, the dispersion of Lewy bodies outside of it has been associated with non-motor symptoms and the development of progressive dementia.
It is estimated that between 20 and 30% of Parkinson’s patients who develop dementia may present psychotic symptoms. Nevertheless, There are also recorded cases of psychosis in the absence of dementia Finally, as Parkinson’s disease worsens, so does the severity of psychotic symptoms.
Usually, psychotic symptoms usually appear after the passage of years of the illness, especially when it is in its most serious stages. However, there is a possibility that these may appear at any time, even shortly after starting treatment for Parkinson’s.
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. Besides, when this symptomatology appears within the evolution of Parkinson’s disease the person may also manifest states of confusion.
This psychotic symptomatology is preceded by a series of disturbance and changes in sleep patterns, such as REM sleep behavior disorder, which is distinguished by being a parasomnia in which there is a lack of muscle atonia in the REM phase. Likewise, it is also accompanied by strong and sudden movements and by experiencing violent dreams.
Next, we will explain how psychotic symptoms appear in patients with Alzheimer’s disease.
1. Hallucinations
Hallucinations are one of the most characteristic symptoms of psychotic conditions. Are They 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 beginning of the appearance of hallucinations, they can become very terrifying for the patient, since they are usually related to the perception of already deceased people or extremely strange elements. Unfortunately, The severity of these tends to increase with the development of the disease causing true states of anxiety and panic in the patient.
In Parkinson’s patients with psychotic symptoms, delusions or delusional ideas They are usually paranoid in nature The content of these is usually related to the idea that you are being watched, pursued, or that one or more people are trying to do you some kind of harm.
3. States of confusion
In states of confusion or confusional symptoms, the patient experiences alterations in their state of consciousness. One of the signs that the patient is beginning to manifest psychotic symptoms is that he or she tends to experience fluctuations between alert and wakeful states, problems concentrating and a kind of disconnection from everything around him.
This type of disorganized thinking tends to favor the paranoid ideas mentioned above. Furthermore, if this happens in elderly patients or in those with comorbidity with other diseases, they can reach severe states of delirium.
Is there any treatment?
Before starting any type of intervention to alleviate the psychotic symptoms of Parkinson’s, the causes that are causing these symptoms must be specifically defined. These are usually caused by the antiparkinsonian medication itself ; However, they can also be a consequence 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 to be adopted. Because the medication itself is responsible for the appearance of delusions and hallucinations, the first steps to follow consist of adjust the dose of this However, this is a really complicated process; Since if the medication is reduced too much, the motor symptoms of Parkinson’s can increase drastically. But if some change is not made, psychotic symptoms will increase.
If the psychotic symptoms cannot be reduced with an adjustment in the Parkinson’s medication, the doctor may decide to resort to antipsychotic medication. However, this choice is not without risks either.
Drugs used to treat psychotic symptoms are often effective because block dopamine receptors in the limbic areas of the brain. However, they can also block dopamine in brain regions that manage motor functions, such as the striatum, which will lead to the appearance of more abnormal movements similar to those of Parkinson’s.
Even so, if these psychotic symptoms are severe enough to require the use of medication, the use of typical antipsychotics such as haloperidol is not recommended, with atypical antipsychotics such as clozapine or quetiapine being much more effective and with fewer side effects.
In recent years, a medication has been developed for the treatment of psychotic symptoms in people with Parkinson’s disease, which has been approved by the FDA (American Food and Drug Administration). This drug reduces the psychotic symptoms associated with this disease without worsening the motor symptoms. Known as pimavanserin, this medication influences psychotic symptoms without directly blocking the flow of dopamine. However, this medication is very recently created, so time will tell how effective and safe it can be.
