Onset and Remission of Psychosis in Parkinson's Disease: Pharmacologic and Motoric Markers

Abstract

Background Psychosis is among the most disabling complications of Parkinson’s disease (PD). The chronicity of PD psychosis remains understudied and the relative importance of dopaminergic therapy versus the disease process itself in engendering psychosis remains unclear. Objectives To examine pharmacologic and motoric correlates of PD psychosis onset and remission in a longitudinally monitored PD cohort. Methods We analyzed data from 165 participants enrolled in a longitudinal PD study through the Morris K. Udall Parkinson’s Disease Research Center of Excellence at Johns Hopkins University. Evaluations included formal psychiatric assessment and were conducted at two-year intervals. Regression with generalized estimated equations (GEE) was used to produce unadjusted and adjusted estimates for time-varying longitudinal associations between psychosis and putative risk factors. Results Sixty-two participants (37.6%) were diagnosed with psychosis during at least one evaluation. Of forty-nine participants with psychosis followed over multiple evaluations, 13 (26.5%) demonstrated remission despite significant Hoehn & Yahr stage increase (p=0.009); two of these cases later relapsed. Multivariable regression with GEE identified dementia diagnosis, akinesia-rigidity, anticholinergic usage, and levodopa-carbidopa dose to be significantly associated with psychosis, while disease duration was not. A sub-analysis of 30 incident psychosis cases suggested that dopamine agonist dose was lowered after psychosis onset with a compensatory increase in levodopa-carbidopa dosage. Conclusions Our findings suggest that in the context of standard therapy, PD-related psychotic disorder can remit at a frequency of approximately 27%. Additionally, akinetic-rigid motor impairment was more strongly associated with psychosis than disease duration, independent of cognitive impairment and medications.

Visual Hallucinations and the Role of Medications in Parkinson’s Disease: Triggers, Pathophysiology, and Management

“…PD-associated psychosis is defined as at least one of the following: illusions, false sense of presence, hallucinations, or delusions; meeting the United Kingdom Brain Bank criteria for PD; symptom occurrence after the onset of PD; recurrent or continuous symptoms for at least 1 month; and exclusion of other causes (4). Visual hallucinations are the most common symptom of PD psychosis (5) and occur in up to 70% of patients with advanced PD (6). They generally evolve throughout the course of the disease, with periods of remission and relapse (5).…”

“…Visual hallucinations are the most common symptom of PD psychosis (5) and occur in up to 70% of patients with advanced PD (6). They generally evolve throughout the course of the disease, with periods of remission and relapse (5). Most significantly, the presence of psychosis in PD is associated with higher mortality, caregiver distress, and nursing home placement (4,7).…”