Parkinson’s Disease and Psychosis: Hallucinations, Delusions

Parkinson's disease psychosis occurs in around 50% of PD patients. In Parkinson's disease, hallucinations and confusion are relatively common, often occurring as side-effects of Parkinson's medications. These symptoms can also be indicative of Parkinson's disease psychosis, however, so it's important to consult your doctor if you think you might be delusional or psychotic. In the meantime, here is everything you need to know about Parkinson's disease psychosis, including symptoms and treatment.

What Is Parkinson’s Disease Psychosis?

Parkinson’s disease psychosis is a neuropsychiatric condition that occurs in over half of all people with Parkinson's disease. Although it is relatively common, few people speak up about their experiences of psychosis, whether or not they have a neurological condition like PD.

According to recent studies, only 10% of people with Parkinson’s disease psychosis report their symptoms to their physicians. However, the symptoms of Parkinson's disease psychosis can put you and other people at risk, so it's important to speak up, even if the symptoms are mild. Remember: your symptoms may be a result of your medication; they don't indicate that anything is wrong with you or that you are mentally unwell ("How Parkinson’s Disease Affects Your Mental Health").

Parkinson’s Disease: Symptoms of Psychosis

Common symptoms of psychosis in Parkinson’s disease include:

• Visual hallucinations: Seeing things or people that aren't there
• Auditory hallucinations: Hearing voices and other noises that no one else can hear. Parkinson’s disease and auditory hallucinations are more common in people over the age of 65
• Tactile hallucinations: Touching or feeling something that isn’t really there
• Olfactory hallucinations: Imagining strong smells
• Confusion: Not being sure what’s real and what isn’t. In Parkinson’s disease, hallucinations and confusion can occur as a result of certain PD drugs, so your doctor may wish to change your medication if you report these symptoms
• Paranoia: Believing that people aren't who they say they are, or that your loved ones or doctors are trying to hurt you. You may also feel an intense suspicion of abandonment or extreme jealousy of others who are well
• Delusions: Irrational or illogical beliefs not based in reality 
• Agitation: A state of high anxiety or extreme restlessness
• Argumentative and aggressive behavior: Lashing out at others or refusing help

Confusion and delusional thinking are common in PD psychosis, so you may not be able to identify psychotic symptoms in yourself. Usually, Parkinson's disease psychosis is noticed by loved ones or care staff. However, if you think you're displaying some of the signs, report them to your doctor immediately. Psychotic episodes can be incredibly frightening and upsetting, but there's no need to suffer in silence.

What Causes Parkinson’s Disease Psychosis?

Hallucinations and psychosis in Parkinson's disease may occur as a result of chemical and physical changes in the brain. Drugs used to treat Parkinson's disease can also cause psychotic symptoms, so your doctor should monitor you closely when you start taking a new medication.

Although Parkinson's disease psychosis is scary and upsetting, there are various ways to treat the symptoms. Your doctor may wish to withdraw your medication to see if it is causing your psychosis, or you might be prescribed an antipsychotic. Antipsychotic medications commonly used for people with Parkinson's disease psychosis include clozapine, quetiapine, and ziprasidone.

If your psychosis does not go away with a change of medication, your doctor may run tests to rule out intercurrent physical illness, electrolyte imbalance and systemic infection. They may also suggest specific lifestyle changes, such as improving your sleep health, avoiding sensory overload and seeking full-time care, if that’s something you don’t already have.

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