Treatment for Parkinson's Disease Psychosis

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Parkinson’s disease is one of the most common neurodegenerative diseases worldwide. This condition occurs when nerve cells in the brain, known as neurons, break down over time and eventually die. As a result, your brain is unable to function normally.

As many as 50% of people who’ve lived with Parkinson’s disease for a decade or more develop psychosis, a disorder where your thoughts and emotions become disconnected with reality. The prospect of developing psychosis is frightening for many, but there are ways to manage this complication. However, if you develop any symptoms of psychosis, it’s important to speak to your doctor as soon as possible. A quick diagnosis can help get you the treatment you need, and the sooner this symptom is treated, the better.

What is Parkinson’s disease psychosis?

Parkinson’s disease complications like psychosis generally occur as the condition progresses over time. While the exact cause of Parkinson’s disease psychosis is not known, doctors speculate it may result as a side effect from dopaminergic therapy, also called dopamine therapy. Dopamine therapy, which boosts levels of the neurotransmitter dopamine, is a mainstay of Parkinson’s disease treatment—to date, no other therapy manages Parkinson’s disease as effectively as these medications.

But even though dopamine therapy is essential for managing symptoms of Parkinson’s disease, excessive levels of this neurotransmitter may also cause chemical and physical changes in your brain. For some, but not all, these changes lead to problems like psychosis. However, psychosis may also result as a natural outcome of the disease, since brain cells are eventually broken down.

Parkinson’s disease psychosis usually causes two main issues:

  • Delusions: These are false beliefs not based in reality.

  • Hallucinations: If you have hallucinations, you may see, hear, smell, or sense things that aren’t there.

People living with Parkinson’s disease psychosis may describe this complication as seeing things that aren’t there, being paranoid, having flashbacks or nightmares, or losing touch with reality.

It’s important to keep in mind that not everyone diagnosed with Parkinson’s disease will develop psychosis. Your risk factors for this specific complication may be increased if you:

  • Are elderly

  • Have lived with Parkinson’s disease for many years

  • Have a sleep disorder, hearing issues, or vision problems

  • Have other neurocognitive problems, like dementia

  • Use certain medications, like dopamine therapy, aspirin, or ibuprofen

How is Parkinson’s disease psychosis treated?

Any symptoms of Parkinson’s disease psychosis should be reported to your doctor immediately so that treatment to manage these symptoms can begin promptly. Your doctor will likely diagnose psychosis after discussing your medical history, performing a physical exam, and ruling out any other problems that may result in psychosis.

Your doctor may first recommend decreasing the dose of your dopamine therapy medication, especially if you only have mild symptoms. However, this approach may not work for everyone, and your medication dose should not be decreased without your doctor’s approval.

Further treatment for Parkinson’s disease psychosis typically includes the use of specific medications to reduce symptom severity and prevent delusions or hallucinations from occurring. Medications like clozapine (Clozaril, FazaClo) and pimavanserin (Nuplazid) help bring chemicals in your brain back into balance, including dopamine. When dopamine levels are balanced, your behavior, mood, and thinking ability all improve.

Some studies suggest that more intensive treatments, such as electroconvulsive therapy, may prove beneficial for managing Parkinson’s disease psychosis. Other nonmedical measures, such as keeping a light on at night, may help reduce specific symptoms you may have, such as visual hallucinations.

As Parkinson’s disease research continues, doctors hope to discover better treatments and preventative strategies for Parkinson’s disease psychosis. It’s normal to be scared by the prospect of developing this complication. But not everyone with Parkinson’s disease develops psychosis, and for many people, symptoms like delusions or hallucinations are manageable with treatment.

Let your doctor know if you think you may have hallucinations or delusions. Your doctor will help you determine which treatment options may work best for you. Working together with your doctor gives you the best chance at successfully managing Parkinson’s disease psychosis.


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