Psychosis in Parkinson’s disease: how to treat it?

Mental illnesses, especially those of a neurodegenerative nature, affect the brain functions of patients in such a way that they continue to amaze the medical and scientific community. This is the case with psychosis caused by Parkinson’s disease.

Although this is not the most common, sometimes the dementia that can accompany Parkinson’s disease becomes psychosis, Causing all kinds of symptoms of this. In this article, we will talk about these symptoms and the possible treatments that are available to combat them.

    When Parkinson’s disease precedes psychosis

    Typically, Parkinson’s disease it is considered a neurodegenerative disease which is distinguished by causing a whole series of movement alterations. The most characteristic symptoms are those which affect motor function and are manifested by very characteristic tremors, difficulty walking and difficulty starting movement.

    However, in addition to motor symptoms, this disease is also characterized by symptoms related to cognition and mood. It is therefore not uncommon for psychotic symptoms associated with Parkinson’s disease to appear in some cases.

    In some patients with Parkinson’s disease, a progressive dementia known as Lewy body dementia develops. These bodies are made up of abnormal clumps in the brain of a protein known as synuclein. Although this element is commonly found in the substantia nigra region, dispersal of Lewy bodies outside of it has been associated with non-motor symptoms and the development of progressive dementia.

    It is estimated that between 20% and 30% of Parkinson’s disease patients who develop dementia may have psychotic symptoms. However, there are also recorded cases of psychosis in the absence of dementia. Finally, as Parkinson’s disease worsens, the severity of psychotic symptoms worsens.

    Usually, psychotic symptoms usually appear after years of illness, especially when it is in its most severe stages. However, it is possible for these to appear at any time, even shortly after starting treatment for Parkinson’s disease.

      What are these psychotic symptoms associated with Parkinson’s disease?

      Traditionally, psychosis has been defined as a mental or psychiatric disorder in which the patient experiences some type of delirium and / or hallucinations of any kind. Outraged, when this symptomatology appears during Parkinson’s diseaseThe person may also show states of confusion.

      This psychotic symptomatology is preceded by a series of altered and changed sleep patterns, Such as REM sleep behavior disorder, which is distinguished by a parasomnia in which there is a lack of muscle atony in the REM phase. It is also accompanied by strong and sudden movements and the experience of violent dreams.

      Next, we explain how psychotic symptoms appear in patients with Alzheimer’s disease.

      1. Hallucinations

      Hallucinations are one of the most characteristic symptoms of psychotic states. these they cause the person to perceive stimuli that are not really here. In the specific case of Parkinson’s disease, these hallucinations can be visual, auditory or even tactile.

      At the onset of hallucinations, they can become very terrifying for the patient, and are usually related to the perception of dead people or extremely strange things. Unfortunately, the severity of these tends to increase with the development of the disease, Causing real states of anxiety and panic in the patient.

        2. Delirium

        In Parkinson’s disease patients with psychotic symptoms, delusions or delusions they are usually paranoid in nature. The content of these is usually related to the idea that they are watching you, chasing you, or that one or more people are trying to harm you.

        3. Confusion states

        In states of confusion or confusional symptoms, the patient experiences alterations in his state of consciousness. One of the signs that the patient begins to exhibit psychotic symptoms is that they tend to feel fluctuations between alert and waking states, concentration problems and a kind of disconnection from everything around it.

        This type of disorganized thinking tends to favor the paranoid ideas mentioned above. In addition, if this occurs in elderly patients or in whom there is a comorbidity with other diseases, it can reach states of severe delirium.

        Is there a treatment?

        Before undertaking any type of intervention to relieve the psychotic symptoms of Parkinson’s disease, it is necessary to define precisely what are the causes at the origin of these symptoms. These are usually caused by the antiparkinson drug itself.; however, they can also be the result of an infection that triggers delirium or the dementia itself that accompanies Parkinson’s disease.

        Once the origin is determined, they can begin to take the first treatment steps. Because the drug itself is responsible for the onset of delusions and hallucinations, the first steps to take are to adjust the dose of this. However, it is a really complicated process; because if the drug is reduced too much, the motor symptoms of Parkinson’s disease can increase considerably. But if no changes are made, the psychotic symptomatology will increase.

        If reduction of psychotic symptoms fails with adjustment of Parkinson’s medication, the doctor may decide to resort to antipsychotics. However, this choice is not without risk either.

        Medicines used to treat psychotic symptoms are usually effective because they block dopamine receptors in the limbic areas of the brain. However, they can also block dopamine in areas of the brain that manage motor functions, such as the striate body, which will cause abnormal movements to appear closer to Parkinson’s disease.

        However, if these psychotic symptoms are severe enough to require the use of medication, the use of typical antipsychotics such as haloperidol is not recommended, as atypical antipsychotics such as clozapine are much more effective and have fewer side effects. . Quetiapine.

        In recent years, a drug has been developed for the treatment of psychotic symptoms in people with Parkinson’s disease which has been approved by the American Food and Drug Administration (FDA). This medication decreases the psychotic symptoms associated with this disease without worsening the motor symptoms. Known as pimavanserinThis drug influences psychotic symptoms without directly blocking the flow of dopamine. However, this drug is very new, so time will tell how effective and how safe it can become.

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