Psychosis in Parkinson's disease: how is it treated?

Mental illnesses, especially those of a neurodegenerative nature, affect people brain functions of patients in ways that continue to amaze the medical community and scientific. This is the case of the psychosis produced by Parkinson's disease.

Although it is not the most common, on some occasions the dementia that can accompany Parkinson's disease develops into a psychosis, causing all kinds of symptoms of this. In this article we will talk about these symptoms and the possible treatments that exist to combat them.

• Related article: "Parkinson's: causes, symptoms, treatment and prevention"

When Parkinson's precedes psychosis

As a rule, Parkinson's disease It is considered a neurodegenerative condition that is distinguished by causing a whole series of movement disorders. The most characteristic symptoms of this are those that affect motor function and manifest through very characteristic tremors, difficulties with walking and problems to initiate the motion.

However, in addition to motor symptoms, this disease is also characterized by symptoms related to cognition and mood. So 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. 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 the Lewy bodies outside of this has been associated with non-motor symptoms and the development of dementia progressive.

It is estimated that between 20 and 30% of Parkinson's patients who develop dementia may present psychotic symptoms. Nevertheless, there are also reported cases of psychosis in the absence of dementia. Finally, as Parkinson's disease worsens, so does the severity of the psychotic symptoms.

Usually, psychotic symptoms usually appear after years of the disease, especially when it is in its most serious stages. However, there is a possibility that these appear at any time, even shortly after starting treatment for Parkinson's.

• You may be interested in: "What is psychosis? Causes, symptoms and treatment"

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 kind of delusions and/or hallucinations of any kind. Besides, when this symptomatology appears within the evolution of Parkinson's disease, the person can 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 REM sleep. Likewise, it is also accompanied by strong and sudden movements and by the experimentation of violent dreams.

Next, we go on to 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 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, these can become very terrifying for the patient, since they are usually related to the perception of people already deceased 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.

• Related article: "The 15 types of hallucinations (and their possible causes)"

2. delusions

In Parkinson's patients with psychotic symptoms, delusions or delusional ideas are often paranoid in nature. The content of these is usually related to the idea that you are being watched, persecuted or that one or more people are trying to do you harm of any kind.

3. states of confusion

In states of confusion or confusional symptoms, the patient experiences alterations in his state of consciousness. One of the signs that the patient is beginning to manifest psychotic symptoms is that he tends to experience fluctuations between alertness and wakefulness, concentration problems and a kind of disconnection from everything that surrounds him.

This type of disorganized thinking tends to favor the aforementioned paranoid ideas. In addition, if this happens in elderly patients or in those with comorbidity with other diseases, it can reach states of severe 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 defined specifically. Usually, these are caused by the antiparkinsonian medication itself.; however, they can also be the consequence of an infection that triggers the delirium or the dementia that accompanies Parkinson's disease.

Once the origin has been determined, the first treatment measures can begin to be adopted. Since 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, the psychotic symptomatology will increase.

In the case of not being able to reduce the psychotic symptoms with an adjustment in the medication for Parkinson's, the doctor may decide to resort to antipsychotic medication. However, this choice is not without risk 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 give way to the appearance of more abnormal movements similar to those of the Parkinson.

Even so, if these psychotic symptoms are severe enough to require the use of medication, the use of typical antipsychotics such as haloperidol, being much more effective and with fewer side effects the atypical antipsychotics such as clozapine wave quetiapine.

In recent years, a drug has been developed for the treatment of psychotic symptoms in people with Parkinson's disease which has been approved by the FDA (American Agency of Administration of Food and Medicines). This drug reduces the psychotic symptoms associated with this disease without worsening motor symptoms. Known as pimavanserin, this drug influences psychotic symptoms without directly blocking the flow of dopamine. However, this medicine is of very recent creation, so time will tell how effective and safe it can be.