Addressing psychosis in Parkinson disease

Issue: BCMJ, Vol. 59, No. 6, July, August 2017, page(s) 324-325 Pulsimeter

The World Parkinson’s Program has assembled some considerations for caregivers of Parkinson disease patients relating to hallucinations and psychosis. 

Hallucinations and psychosis may occur in about 20% of patients with Parkinson disease. Drug-induced psychosis in Parkinson disease is more common in the elderly and at times may be triggered by medications used for treatment of the disease (e.g., amantadine, selegiline, and dopamine agonists). Confusion and hallucinations can be debilitating, and a physician may choose to modify a current drug therapy for Parkinson disease to minimize these symptoms. Hallucinations become more frequent when one is in an unfamiliar setting.

The visual hallucinations in Parkinson disease may be detailed and well formed but nonfrightening in most cases. Auditory hallucinations are rare, but if they occur they are accompanied with visual hallucinations. Patients with severe dementia might develop periods of confusion, especially at sunset. The following tips may help in coping with the visual hallucinations:

Adequate nutrition and fluid intake.
Ruling out the precipitating factors such as infections, dehydration, and vision or hearing impairment.
Improving nighttime sleep.
Turning on the lights at night in order to reduce shadows.
Switching off the television when violent scenes are on.
Explaining what is happening to the patient, but neither arguing with the patient that hallucinations are not real nor reinforcing them.
Repeatedly reassuring the patient.

Caregivers should be aware that a hallucination may seem very real to the patient. If the patient is beyond reason, but calm and nonthreatening, nothing may be needed. However, if the patient is agitated and becomes violent, it is best to call for assistance to help avert serious injury.

The World Parkinson’s Program is a Canadian-based nonprofit global organization with a mission to improve the lives of those affected with Parkinson disease through education, supportive services, and advocacy for patients and caregivers. For more information about the organization, visit