Psychosis can be a scary word. Understanding what it means in Parkinson's disease (PD) and how an individual may experience symptoms can reduce the fear and stigma surrounding this medical term. Hallucinations and delusions can be a common occurrence in PD. Talking openly about these symptoms can help your healthcare team discover the best treatment strategies. Learn about the different ways people experience these symptoms and how to address them.

Bringing clarity to psychosis

If you live with Parkinson's, some of your most challenging symptoms may seem invisible to others. Known as non-motor symptoms, they can affect mood, sleep, thinking, and more. It is easier to talk about some than others.

Not all people with PD will have hallucinations or delusions, but up to 50% of people with Parkinson's may experience symptoms throughout the disease. Studies show that up to 90% of individuals do not proactively talk to their doctor about it, which means the true number may be higher.

It is important for you to know that you are not alone. If you feel, hear, or perceive things that aren't really there, you may feel self-conscious, embarrassed, or even afraid to share your experiences. These feelings can lead to isolation and avoidance of care. Although it may take courage to talk about your experience, trust that your doctor, neurologist, or movement disorder specialist is familiar with these symptoms.

In Parkinson's, your doctor may use the term psychosis to describe anything from visual hallucinations caused by slight errors in perception to complex, detailed delusions: seeing things that aren't there or believing things that aren't true. These brain tricks may seem like small inconveniences, but they often have a big impact on you and your loved ones. These symptoms may be due to Parkinson's brain changes, medication, dementia, or delirium; that is, sudden hallucinations or delusions that may indicate a medication or health problem.

If left untreated, hallucinations and delusions can reduce the quality of life for people with Parkinson's and their caregivers. They can cause lack of sleep, increase stress, and create risks of falls or other safety problems. Symptoms can also increase the risk of hospitalization, costs of care, and the need for long-term care.

Other medical conditions that can cause psychosis are:

(1)Bipolar disorder

(2)Brain tumor

(3)Depression

(4)Dementia

(5)Lupus

(6)Lung malignant neoplasm

(7)Multiple sclerosis

(8)Schizophrenia

(9)Corticosteroid treatment in autoimmune disorders

(10)Stroke

Gradual changes in perception

The symptoms of Parkinson's disease psychosis vary in severity. In the early stages of PD, you may be aware that what you are experiencing does not really exist. You may lose that insight as Parkinson's progresses. This happens slowly and gradually over time.

Symptoms of psychosis may include:

1.Illusions or misperceptions: Misperceiving what is there: for example, a coat and hat on a coat rack may look like an individual or a shadow may look like a mouse.

2.False sense of presence: The feeling that someone is looking over your shoulder, in the room, or lying next to you in bed, but when you look, no one is there.

3.False sensation that something is moving nearby: The awareness that something fleetingly passes or moves in the periphery or feeling that something is sliding on the floor or that someone is walking down the hallway.

4.Hallucinations and delusions: Seeing or believing things that are not true, which can cause a series of feelings ranging from calm or anxiety to agitation or fear.

Types of hallucinations

Some hallucinations recur frequently, while others only happen once. Hallucinations are more common in individuals with cognitive, sleep or depression problems. Although increased medication can sometimes put people at risk for hallucinations, most people with Parkinson's will experience hallucinations within 10 years of diagnosis.

Hallucinations are less likely to occur when the individual is engaged in an activity. They are more likely to occur when you have vision problems, when you are alone, or at night. Understanding how people with Parkinson's may experience these symptoms can help reduce stigma.

Types of hallucinations include:

(1)Visual: See people or animals alive or deceased.

(2)Auditory: Hearing things like voices or music.

(3)Olfactory: Smelling things that aren't there, like burning chemicals or gasoline.

(4) Tactile: Sensation of having something on or under the skin, which may cause scratching.

Visual hallucinations can seem like you are having a vivid dream, despite knowing you are awake: seeing distorted animals and individuals, with strange colors, bugs, figures hovering on the ground. People have reported seeing fairies or colonies of tiny people. Some individuals are entertained by the sight, while others are frightened by them.

The most common visual hallucinations in people with PD may include:

1.See someone sitting at home, possibly in the living room or at the dining room table. It can range from a friendly presence like a visitor to the distressing feeling of an intruder.

2.Some veterans with PD have reported seeing elaborate and detailed military training camps overseas, with a drill sergeant and service members.

3.City and urban dwellers may see wild animals out of place, such as deer or skunks.

Auditory hallucinations can cause distraction or lack of sleep. People may think that neighbors are working in the yard or having a party in the middle of the night. Sounds may appear to be coming from the attic, basement, or walls.

Understanding delusions

Delusions can distress the person with Parkinson's and their loved ones, sometimes causing isolation, shame, fear, suspicion or jealousy or leading to anger or violence toward a caregiver. Delusions can lead to safety or legal problems. Caregivers, who may recognize symptoms of psychosis before the person with PD, should share them with their loved one's doctor.

Although delusions are not based in reality, they often seem real to the person experiencing them. They usually have common themes such as:

(1)Persecution: Believing that someone is trying to deceive or harm you. You may suspect that a trusted person wants to steal from you or that your family is plotting against you. Some individuals suspect that their caregiver is trying to poison them and are wary of medication or food.

(2) Jealousy: Believing that a spouse or partner is being unfaithful. Othello syndrome is the false certainty and concern about the couple's imaginary infidelity.

(3)Reference: Feeling that a song or television program is addressing you. You may feel like it's something you need to do.

Other ways can be:

(1) Fregoli's delusion: Believing that different individuals are actually a single individual who changes appearance or disguises himself.

(2)Cotard Syndrome: Thinking that you are dead, decomposing, that you do not really exist or that you are missing blood or some internal organ.

(3)Capgras Syndrome: Believing that an identical imposter has replaced a friend, spouse, family member or pet.

Delirium

Seek medical attention if you experience a sudden change, as these are not typical of Parkinson's. When hallucinations or delusions begin within hours or days, it may be due to a change, stop, increase, or decrease in a medication or may be a sign of another medical problem, such as:

1.urinary tract infection or pneumonia

2.dehydration

3.suspension of substances

4.high or low blood sugar levels

5.low blood pressure

6.surgery or hospitalization

7.organic insufficiency

Control the impact

There are several ways to help a loved one experiencing PD psychosis. Find the methods that work best for you. These techniques can help manage the impact:

(1)A stable, calm, and familiar environment is essential for someone experiencing psychosis.

(2)Keep a routine.

(3)Try to keep a well-lit and tidy home: this can minimize visual misperception, hallucinations and injuries.

(4)Use a night light in the bedroom. Unfamiliar surroundings can make symptoms worse.

(5) Reassure the person with PD that they are safe, that they are loved, and that the symptoms are not their fault. This can reduce the fear and shame caused by hallucinations and delusions.

(6)During an episode, do not argue or rationalize. Leave the room if necessary.

(7)Guide your loved one with calendars, photos or messages on post-its.

(6)Remove objects that may pose a safety problem, such as rugs. Explore our home safety page for more information.

Focusing on good sleep habits, getting enough exercise, and pursuing stress management strategies are vital for those experiencing hallucinations and delusions and their caregivers. Caregivers also need adequate rest and breaks to avoid the risk of burnout.

Your doctor can recommend safe management strategies or adjust your medication. Many antipsychotic medications used to treat psychosis should not be used in PD, as they can act on dopamine receptors and worsen Parkinson's symptoms.