Parkinson’s disease psychosis: Understanding Hallucinations and Delusions

Parkinson’s disease psychosis can occur in more than half of all patients over the lifetime course of living with Parkinson’s disease. But many patients and families are surprised when non-motor symptoms, including hallucinations, often visual, or paranoid delusions occur. Loved ones and those charged with caring for the Parkinson’s disease patient need to be on the lookout for hallucinations or delusions because they can be managed under the care of a physician. Parkinson’s disease psychosis: Understanding Hallucinations and Delusions
Seeing What Isn’t There
With Parkinson’s disease psychosis, visual hallucinations are the most common. For example, many patients reporting seeing a fleeting image out of the corner of the eye that is not there, or they may see groups of people or animals. The hallucinations may look very real or appear black and white, fuzzy, or even cartoon-like. The person experiencing psychosis may speak to them or even approach them, but then find they suddenly disappear.
As hallucinations occur more frequently, what once might have been disregarded or even entertaining can quickly turn disturbing and bothersome, and the patients’ behavior may change.
Diane S., whose husband has Parkinson’s disease psychosis shares that, “He started seeing black cats all over the house that were not really there or he reported seeing groups of people in the living room, particularly at night. A man he dubbed “Big Boy” slept in our bed. What was scary is that my husband would try to confront “Big Boy” physically.”
Delusions and their Impact
With Parkinson’s disease psychosis, delusions are usually paranoid in nature. For example, a patient might think that someone (often a spouse) is stealing their belongings or trying to access his bank account illegally. Or, a husband may be irrationally convinced that his wife is cheating on him after 45 years of marriage.
Diane says, “I try to have a sense of humor about Jay’s beliefs, but sometimes it can be hard to handle. In order to look after Jay, I’ve dramatically reduced the time I spend maintaining my therapy practice and I spend much less time on activities I enjoy like gardening, yoga, and playing the cello.”
Tell Your Doctor
If your loved one living with Parkinson’s disease is experiencing hallucinations or delusions, it’s important to share those symptoms with their doctor. Parkinson’s disease psychosis remains underreported, possibly because patients and families are embarrassed or don’t realize the symptoms are associated with Parkinson’s. An open dialogue about all symptoms will help the doctor develop a management strategy for the patient.
For more information about caring for someone with advanced Parkinson’s disease, visit the CareMAP online resource, created by the National Parkinson Foundation at caremap.parkinson.org.
By: Dr. David Kreitzman, M.D., Director, Parkinson’s Disease & Movement Disorders Center of Long Island Director, Parkinson’s Disease Specialty Care Center, St. Charles Hospital