Steps to treating Parkinson's disease psychosis

Parkinson’s disease (PD) psychosis is a condition that affects some people who have Parkinson’s disease, a type of neurodegenerative disorder.

Neurodegenerative disorders are conditions that cause damage to the nervous system, typically the central nervous system, which is made up of the brain and spinal cord.

Parkinson’s disease causes damage to nerve cells (neurons) in the parts of the brain that control movement. The primary symptoms of Parkinson’s disease are motor symptoms—involuntary movements, rigidity (muscle stiffness), slowed movement, and problems with balance and posture. Symptoms are typically mild at first but worsen over time.

How does Parkinson’s disease cause PD psychosis?

The exact mechanisms of PD psychosis are not fully understood. The condition is believed to be caused by the physical and chemical changes that occur in the brain as a result of Parkinson’s disease. These changes include fluctuating or abnormal levels of neurotransmitters, chemicals that enable neurons to communicate with one another.

Dopamine is one of the major neurotransmitters, and also the neurotransmitter that is most impacted by Parkinson’s disease. Parkinson’s disease destroys dopamine-producing neurons, disrupting the brain’s ability to send and receive signals to other parts of the body.

It is believed that these physical and chemical changes that occur in the brain are what cause hallucinations and other psychosis symptoms for people who have Parkinson’s disease.

Additionally, treatment for Parkinson’s disease typically involves medications that mimic or boost the function of dopamine (and sometimes other neurotransmitters). These medications have been known to exacerbate psychosis symptoms in some cases, though PD psychosis can occur in people who have not taken these types of medications.

What is the treatment for PD psychosis?

PD psychosis affects different people in different ways. Likewise, different people will have different requirements when it comes to treating PD psychosis. While treatment will vary from one person to the next, treating PD psychosis typically follows several steps.

Evaluation

The first step in treating PD psychosis is an evaluation and assessment. The goal of this step is to identify what is causing and contributing to symptoms, determine the severity of the symptoms, and determine if treatment is needed. Secondary causes of psychosis—such as infections, injuries, or other conditions—will either be ruled out or treated. If PD psychosis symptoms are mild and not disruptive or distressing, a healthcare team may recommend no treatment other than monitoring.

Adjustment

Mentioned above, the medications used to treat Parkinson’s disease can sometimes exacerbate psychosis symptoms. In cases where psychosis symptoms require treatment, the first approach is typically an adjustment to medications. This can include adjusting the dosages of certain medications or switching to different medications. Your healthcare providers will want to find the dosage or combination of therapies that provide the most benefit to treating Parkinson’s disease but also cause the least amount of side effects.

Please note that any changes to medications should only be made under the guidance of a healthcare provider—do not stop taking a medication, change the dosage, or add new medications unless you are directed to by your healthcare provider. Medication withdrawal can worsen Parkinson’s disease symptoms and cause serious side effects, especially if done incorrectly.

Neuroleptic medications

When adjustments to medications are not enough to manage psychosis symptoms, a healthcare provider can prescribe a neuroleptic medication. Also called antipsychotic medications, neuroleptic medications are used to treat psychosis. As with any drug therapy, treatment with a neuroleptic medication comes with a risk of side effects. This step in treatment is also about finding the approach that provides the most benefit with the lowest risk of side effects.

While it can help to know the basic approaches to treating PD psychosis, the condition affects everyone differently. Your healthcare provider will be your best source of information and can guide you through treatment.