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8 Facts You Should Know About Parkinson’s Disease and Psychosis

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Celebrities like Muhammad Ali and Michael J. Fox have helped thrust Parkinson’s disease into the media spotlight, educating people about its associations with tremors, slurred speech, and deteriorating motor function. Lesser known, however, is the link between Parkinson’s and psychosis, a nonmotor symptom that can cause people with the progressive movement disorder to experience hallucinations, delusions, and more.

“Psychosis is quite common,” says Irene Litvan, MD, the director of the Movement Disorder Center at the University of California at San Diego’s department of neurosciences. While there’s no way to predict precisely who’s at risk for Parkinson’s-related psychosis, a person’s age and the duration and severity of the disease all play a role.

“Psychosis can be viewed as part of the disease as it advances — and may be associated with dementia — or it can be a result of medication,” says Dr. Litvan. “Dementia is five times more frequent in people with Parkinson’s disease than it is in the general population, but it’s also much more common among people who’ve had the disease for 16 years [versus] 2 years.” Here are eight additional facts you should know about Parkinson’s and psychosis.

1. Hallucinations differ from delusions.

“Hallucinations are misperceptions, while delusions are beliefs,” Litvan says. According to the National Parkinson Foundation, when someone sees, hears, or feels something that isn’t there, that person is experiencing a hallucination. It’s important to note that, unlike dreams or nightmares, hallucinations occur when a person is awake. Delusions, on the other hand, are irrational views that aren’t based in reality — for example, accusations of marital infidelity, or a fear of being poisoned by medication or food. Delusions are not deliberate and can’t be controlled, and they’re very real to the person with Parkinson’s.

2. People with Parkinson’s disease most commonly experience visual hallucinations.

Of all the senses — visual (sight), auditory (hearing), olfactory (smell), tactile (touch), and gustatory (taste) — hallucinations involving sight are the most common. “It’s the sense that something is nearby, you look, and it’s not there,” Litvan says. “Visual hallucinations can be minor and benign — like mistaking a tree for a person or sensing that an animal just crossed your path — or they can be more imposing.”

3. The most common delusions are related to jealousy.

While hallucinations are misperceptions and generally involve seeing things that aren’t there, delusions are beliefs. Jealousy ranks high among these psychotic beliefs, but it’s not the only emotion involved in delusions. “Patients may have the feeling that someone is stealing from them,” Litvan says. “They may have the feeling that they want to go home when they’re already in their house, or they may not recognize their spouse as their spouse, which is terrible for the family.” Delusions can vary in type and severity as well. “I had a patient, a former physician, who called 911 after having the delusion that he was shot in the thorax,” she says. It’s important to note, however, that delusions are much less common than hallucinations, she says.

4. Dementia is manifested differently in Parkinson’s disease than in Alzheimer’s.

With Alzheimer’s disease, dementia is typically characterized by a person’s asking questions (often the same ones) over and over. With Parkinson’s, dementia is often tied to cognitive abilities and task-related duties. “It starts with difficulties with things called executives, like planning and scheduling,” Litvan says. While minor missteps can be frustrating and signal minor cognitive impairment, a person doesn’t have full dementia until the condition becomes severe and affects his or her quality of life. “When people have significant difficulty with abstract concepts,” says Litvan, “and imagining future events without the events being laid out concretely — for example, a CEO who can’t plan a day or a trip — it’s a sign of dementia.”

5. Dementia is not always obvious in people with Parkinson’s disease.

In everyday conversation, it might not be apparent that someone has Parkinson’s-related dementia. When you talk to such a person, Litvan says, as long as you stay on tangible topics, you might not notice anything wrong. She adds, “It may manifest in someone who can no longer make decisions or show up on time, but if certain questions are avoided in conversation, that person might seem completely fine.”

6. Most people with Parkinson’s don’t admit psychosis symptoms to a doctor.

Relatively harmless hallucinations — like seeing children playing in a sandbox in the backyard — are often not reported by people with Parkinson’s to their doctors. “But even minor ones should be reported,” Litvan says. According to the American Parkinson Disease Association, only 10 to 20 percent of patients currently report symptoms of psychosis to their doctors. “Reporting psychosis is extremely important because if it’s related to medication, that can be adjusted,” Litvan says. Psychosis can also be related to new conditions, such as infections or metabolic problems, including dehydration, that need to be treated.

7. We need to take away the stigma.

It’s important to reassure people that they’re not crazy because they experience hallucinations or delusions. “That’s a major fear that we would all have — you start to see things that are not there, get scared, and don’t want to admit it,” Litvan says. “Patients need to know that what they’re experiencing is not at all related to schizophrenia, and that it could even be treatable with medication changes.” But doctors can’t treat what they don’t know about: “It’s important for physicians to ask questions,” says Litvan, “and for family members and patients to report [new symptoms].” In Litvan’s practice, doctors give patients a questionnaire and explain hallucinations and delusions; normalizing the symptoms addresses the fear and makes psychosis easier to treat.

Psychosis can take its toll on family members too. “Physicians tend to focus on the patient, but thoughts of stealing, infidelity, and being held against your will can be damaging to relationships” — which may already be taxed because of the work of caring for someone with advanced Parkinson’s disease, says Janis Miyasaki, MD, a member of the Movement Disorders Program at the University of Alberta, Kaye Edmonton Clinic and University Hospital. “We all need to be mindful of the hurt and burden these thoughts can cause spouses and families.”

8. New medications are available.

Fortunately, new, more effective treatments are available for Parkinson’s disease. “Before, we had nothing other than one good antipsychotic that had a lot of side effects,” Litvan says. “The major [side effect] was a significant decrease in white blood cell count, so [blood tests] would have to be done every two weeks — which was a burden for both patients and doctors.” While there’s no cure for psychosis, new medications with fewer side effects make managing the condition easier.






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Date: 10.12.2018, 12:15 / Views: 45341