psychosis in PD

 Q: 72 year old male with past medical history of Parkinson's Disease (PD) is admitted to ICU with severe psychosis and tendency of hurting himself or others. What are the usual characteristics of severe psychosis in PD?

Answer: Visual hallucinations is the most common psychotic symptom in PD. Unfortunately, it is mostly due to Anti PD drugs. An interesting feature is that patients are mostly cognizant of the fact that their hallucinations are not real. Also, underlying Lewy body disease needs to be ruled out. The second symptom is delusion. Majorly described delusions are spousal infidelity, people stealing money, intruders living in the house, or nurses planning harmful plots.

#psychiatry

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References:

1. Aarsland D, Brønnick K, Ehrt U, et al. Neuropsychiatric symptoms in patients with Parkinson's disease and dementia: frequency, profile and associated care giver stress. J Neurol Neurosurg Psychiatry 2007; 78:36. 

2. Goetz CG, Wuu J, Curgian LM, Leurgans S. Hallucinations and sleep disorders in PD: six-year prospective longitudinal study. Neurology 2005; 64:81. 

3. Fénelon G, Mahieux F, Huon R, Ziégler M. Hallucinations in Parkinson's disease: prevalence, phenomenology and risk factors. Brain 2000; 123 ( Pt 4):733. 

4. Sanchez-Ramos JR, Ortoll R, Paulson GW. Visual hallucinations associated with Parkinson disease. Arch Neurol 1996; 53:1265.