The symptoms experienced by people with Parkinson disease (PD) are extensive, and it can be daunting even for an experienced clinician to sort through the diverse symptoms that patients present with. In addition to problems with mobility patients often experience fatigue, weight loss, sleep disorders, bladder and bowel dysfunction, mood disturbance, cognitive decline, and psychosis.
During these visits, providers must prioritize and be especially attentive to those symptoms that have the potential to be particularly disruptive to the patients and their caregivers. Although the list of problems associated with PD is long, only a small number may be especially and acutely derailing. Although this includes falls and associated injuries, infections, stool impaction and bowel obstruction, in this article, I focus on psychosis.
Hallucinations and delusions
Psychosis symptoms in PD consist of hallucinations and delusions. The hallucinations are most commonly visual but may involve any of the senses. When hallucinations are initially present, they typically manifest as a sense that someone is standing beside or behind them, or that someone or something has passed through the periphery of their vision. Patients may also have visual illusions, seeing an object differently than what it truly is. A roadside fire hydrant might appear to be a child, or a potted plant appears to be an animal.
Although initially infrequent and nonthreatening, over time the hallucinations generally occur more often, are more complex, involve other senses and become distressing. Patients with PD psychosis symptoms may buy food and set their table for hallucinated guests; refuse to enter their bedrooms or their bathrooms because of their perception that strangers are lurking there; flee their homes to escape, call the police, or arm themselves because the hallucinated intruders are perceived as intending to harm them.
PD psychosis delusions often have content that is paranoid or consists of spousal infidelity. Theft of money or possessions, poisoning by food or medications, including by spouses, family members, or caregivers, are recurrent themes of delusions. Spousal infidelity with hired caregivers, friends and neighbors is a common delusion.
The psychosis symptoms can turn a difficult situation of coping with PD into an untenable one. They worsen quality of life for patients and caregivers, they are a common reason that PD patients present to emergency departments and are admitted to a hospital, and they are the leading reason that PD patients leave their homes for continued care in a skilled nursing facility.
Dr Hermanowicz reports that he is on the Speakers Bureau and a Consultant for Acadia.
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