A clinical profile of patients with Parkinson′s disease and psychosis

Abstract

Aims:The aim of the study was to study the clinical profile of the patients with Parkinson's disease (PD) and psychosis.Settings and Design:This was a prospective, cross sectional, hospital-based study done at the Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India from September 2009 to January 2011. All patients with PD, diagnosed by United Kingdom PD Society Brain Bank criteria, having with features of psychosis as diagnosed by the neuropsychiatric inventory (NPI) were included. Patients without a caregiver who could validate the patient's symptoms were excluded.Results:A total of 40 patients (5 women, 35 men) with PD with psychosis (mean age: 54.2 ± 11.5 years, mean duration of illness: 6.5 ± 4.5 years, and mean duration of psychosis: 4.3 ± 4.3 years) were included in the study. The Global NPI score was 19.1 ± 11.5. Majority of the patients had pure hallucinations (85%), while the rest had either pure delusions (7.5%) or a combination of delusions and hallucinations (7.5%). In those with hallucinations, visual hallucinations were the commonest (60%) (pure only in 22.5%), followed by auditory (45%), minor hallucinations (45%), and tactile (20%). Only one person reported having olfactory hallucinations (2.5%). Loss of insight was most often observed during the visual hallucinations (52%), followed by tactile (44.4%), auditory (38.9 %), and minor hallucinations (33.3%).Conclusions:In patients with PD and psychosis, pure hallucinations are common and visual hallucinations are the commonest among the hallucinations. A large proportion of patients have minor hallucinations, which need to be recognized early for effective and early management. The limitations of the study were small sample size, use of a single scale to assess psychosis and subjective assessment of insight.

Auditory and visual hallucination prevalence in Parkinson's disease and dementia with Lewy bodies: a systematic review and meta-analysis

“…Three studies reported the proportion of AH that were verbal: Amar et al . (2014) found 11/18 (61.1%) of patents had verbal AH in PD; Fénelon et al . (2000) reported a similar proportion in PD – 13/21 (61.9%); while Suárez-González et al .…”

“…Fifteen studies (Fernandez et al ., 1992; Graham et al ., 1997; Fénelon et al ., 2000; Holroyd et al ., 2001; Gupta et al ., 2004; de Maindreville et al ., 2005; Pacchetti et al ., 2005; Papapetropoulos et al ., 2008; Williams et al ., 2008; Fénelon et al ., 2010; Mack et al ., 2012; Svetel et al ., 2012; Amar et al ., 2014; de Chazeron et al ., 2015; Llorca et al ., 2016) diagnosed PD according to a version of the United Kingdom Parkinson's Disease Society Brain Bank Criteria (Gibb and Lees, 1988). Five other studies used different diagnostic criteria, including definite or probable PD based on Larsen et al .…”

“…Most common were verbal AH, perceived as originating outside the head, which differentiates verbal AH in PD or DLB from those found in schizophrenia. Interestingly, of the three studies to report relative rates of different types of AHs, two found that verbal hallucinations formed the majority in PD (Fénelon et al ., 2000; Amar et al ., 2014) while Suárez-González et al . (2014) reported that these were a minority in DLB.…”

“…Previous reports vary widely in reported prevalence of AH in PD from 2% (Leu-Semenescu et al ., 2011) to 45% (Amar et al ., 2014; Llorca et al ., 2016). Prevalence rates also range widely in DLB, from 18% (Suárez-González et al ., 2014) to 43% (Piggott et al ., 2007).…”

Research in Parkinson′s disease in India: A review

“…Pure hallucinations were commonest in these patients (85%) and a combination of delusions and hallucinations was found in 7.5%. [ 71 ] Of these visual hallucinations were predominant, amounting to 60%.…”