Prevalence and management of psychosis in an outpatient population with Parkinson's disease: A real-life descriptive study.

BACKGROUND

Previous studies reporting prevalence of psychosis were predominantly cross-sectional, with a limited focus on the full spectrum of features seen in psychosis associated with Parkinson's disease (PDPsy).

OBJECTIVES

To assess the prevalence of PDPsy, explore the association of PDPsy with demographic, drug-related, and disease-related characteristics and describe the management of PDPsy in an outpatient population with PD.

METHODS

We analysed the psychosis prevalence and clinical correlates in PD patients seen for an outpatient visit at the Parkinson Expert Centre of Rouen. PD patients were evaluated with detailed clinical history taken by an investigator trained in PD (DM). Psychosis was diagnosed according to NINDS diagnostic criteria. PDPsy characteristics were collected using a standardized questionnaire composed of ten qualitative items on hallucinations, minor phenomena, and delusions. All PD patients considered to have a previous or ongoing PDPsy underwent an interview to assess the age at onset, exacerbating and relieving factors, the management and outcomes.

RESULTS

From June to December 2021, 315 outpatients with PD were included in the study, 42% had previous or ongoing psychosis, mostly visual hallucinations. PD patients with PDPsy were older, with a more advanced form of the disease and were treated with a higher dose of anti-Parkinson drugs. Psychotic symptoms can be adequately managed with nonpharmacoligical approaches, while in other patients, reduction or withdrawal of drugs, or introduction of clozapine was necessary.

CONCLUSIONS

Untreated PDPsy is associated with impaired quality of life, and significant distress to caregivers and patients. Early detection of psychotic symptoms may yield prognostic and therapeutic benefits.