Advertisement

Hallucinations and the spectrum of psychosis in Parkinson's disease

Published:January 05, 2017DOI:https://doi.org/10.1016/j.jns.2017.01.014

      Highlights

      • The phenomenology of psychosis in Parkinson’s disease and diffuse Lewy body dementia are unique to the disease state
      • Minor hallucinations can occur early in the course of the disease sometimes predating the onset of motor symptoms.
      • Visual hallucinations are the most common sensory modality of hallucinations in Parkinson’s disease psychosis.
      • Auditory, olfactory, tactile and gustatory hallucinations can occur and tend to coincide
      • Treatment is with reduction of dopaminergic medications and possibly addition of an antipsychotic agent or pimavanserin.

      Abstract

      Hallucinations and psychosis can be a part of Parkinson's disease and are considered to be a nonmotor symptom or a neuropsychiatric complication of the disease. Hallucinations of different modalities and delusions can occur beyond the common visual hallucinations. The various types of hallucinations and psychotic symptoms comprising the spectrum of Parkinson's disease psychosis is the subject of this review article.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Chang A.
        • Fox S.H.
        Psychosis in Parkinson's disease: epidemiology, pathophysiology and management.
        Drugs. 2016; 76: 1093-1118
        • Ravina B.
        • Marder K.
        • Fernandez H.H.
        • Friedman J.H.
        • McDonald W.
        • Murphy D.
        • et al.
        Diagnostic criteria for psychosis in Parkinson's disease: report of an NINDS, NIMH work group.
        Mov. Disord. 2007; 22: 1061-1068
        • Pagonabarra J.
        • Martinez-Horta S.
        • Bobadilla R.F.D.
        • Perez J.
        • Robosa-Nogue R.
        • Marin J.
        • et al.
        Minor hallucinations occur in drug-naïve Parkinson's disease patients, even from the premotor phase.
        Mov. Disord. 2016; 31: 45-52
        • Fenelon G.
        • Mahieux F.
        • Huon R.
        • Ziegler M.
        Hallucinations in Parkinson's disease. Prevalence, phenomenology and risk factors.
        Brain. 2000; 123: 733-745
        • Fenelon G.
        • Soulas T.
        • Zenashi F.
        • de Langavant F.C.
        The changing face of Parkinson's disease associated psychosis: a cross-sectional study based on the new NINDS-NIMH criteria.
        Mov. Disord. 2010; 25: 763-766
        • Williams D.R.
        • Warren J.D.
        • Lees A.J.
        Using the presence of visual hallucinations to differentiate Parkinson's disease from atypical parkinsonism.
        J. Neurol. Neurosurg. Psychiatry. 2008; 79: 652-655
        • Pacchetti C.
        • Manni R.
        • Zangaglia R.
        • Mancine F.
        • Marchioni E.
        • Tassorelli C.
        • et al.
        Relationship between hallucinations, delusions and rapid eye movement sleep behavior disorder in Parkinson's disease.
        Mov. Disord. 2005; 20: 1439-1448
        • Fenelon G.
        • Alves G.
        Epidemiology of psychosis in Parkinson's disease.
        J. Neurol. Sci. 2010; 289: 12-17
        • Chou K.L.
        • Messing S.
        • Oakes D.
        • Feldman P.D.
        • Breier A.
        • et al.
        Drug-induced psychosis in Parkinson disease. Phenomenology and correlations among psychosis rating instruments.
        Clin. Neuropharmacol. 2005; : 215-219
        • Fenelon G.
        • Soulas T.
        • Langavant L.C.D.
        • Trinkler I.
        • Bachoud-Levy A.C.
        Feeling of presence in Parkinson's disease.
        J. Neurol. Neurosurg. Psychiatry. 2011; 82: 1219-1224
        • Pagonabarraga J.
        • Soriano-Mas C.
        • Llebaria G.
        • Lopez-Sola M.
        • Pujol J.
        • Kulisevsky J.
        Neural correlates of minor hallucinations in non-demented patients with Parkinson's disease.
        Parkinsonism Relat. Disord. 2014; 20: 290-296
        • Williams D.R.
        • Lees A.J.
        Visual hallucinations in the diagnosis of idiopathic Parkinson's disease: a retrospective autopsy study.
        Lancet Neurol. 2005; 4: 605-610
        • Sacks O.
        Hallucinations.
        Random House Inc., New York2012
        • Mack J.
        • Rabins P.
        • Anderson K.
        • Goldstein S.
        • Grill S.
        • et al.
        Prevalence of psychotic symptoms in a community-based Parkinson disease sample.
        Am. J. Geriatr. Psychiatry. 2012; 20: 123-132
        • Svetel M.
        • Smiljkovic T.
        • Pekmezovic T.
        • Kostic V.
        Hallucinations in Parkinson's disease: cross-sectional study.
        Acta Neurol. Belg. 2012; 112: 33-37
        • Klein C.
        • Kompf D.
        • Pulkowski U.
        • Moser A.
        • Vieregge P.
        A study of visual hallucinations in patients with Parkinson's disease.
        J. Neurol. 1997; 244: 371-377
        • Holroyd S.
        • Currie L.
        • Wooten G.F.
        Prospective study of hallucinations and delusions in Parkinson's disease.
        J. Neurol. Neurosurg. Psychiatry. 2001; 70: 734-738
        • Sanchez-Ramos J.R.
        • Ortoll R.
        • Paulson G.W.
        Visual hallucinations associated with Parkinson disease.
        Arch. Neurol. 1996; 53: 1265-1268
        • Inoue M.
        • Ueno S.
        Background scenery visual hallucinations in a depressed patient with Parkinson's disease.
        Mov. Disord. 2010; 25: 786-787
        • Vaou O.
        • Saint-Hilare M.
        • Friedman J.
        Visual hallucinations in photographs in Parkinson's disease.
        BMJ Case Rep. 2013; 22: 2013
        • Manford M.
        • Andermann F.
        Complex visual hallucinations. Clinical and neurobiological insights.
        Brain. 1998; 121: 1819-1840
        • Moskovitz C.
        • Moses H.
        • Klawans H.L.
        Levodopa-induced psychosis: a kindling phenomenon.
        Am. J. Psychiatry. 1978; 135: 669-675
        • Harding A.J.
        • Broe G.A.
        • Halliday G.M.
        Visual hallucinations in Lewy body disease relate to Lewy bodies in the temporal lobe.
        Brain. 2002; 125: 391-403
        • Onofrj M.
        • Thomas A.
        • D'Andreamatteo G.
        • Iacono D.
        • Luciano A.L.
        • Di Rollo A.
        • et al.
        Incidence of RBD and hallucinations in patients affected by Parkinson's disease: 8-year follow-up.
        Neurol. Sci. 2002; 23: S91-S94
        • Inzelberg R.
        • Kippervasser S.
        • Korczn A.D.
        Auditory hallucinations in Parkinson's disease.
        J. Neurol. Neurosurg. Psychiatry. 1998; 64: 533-535
        • Factor S.A.
        • Molho E.S.
        Threatening auditory hallucinations and Cotard syndrome in Parkinson's disease.
        Clin. Neuropharmacol. 2004; 27: 205-207
        • Nagata T.
        • Shinagawa S.
        • Tagai K.
        • Nakayama K.
        A case in which mirtazapine reduced auditory hallucinations in a patient with Parkinson's disease.
        Int. Psychogeriatr. 2013; 25: 1199-1201
        • Mittal M.
        • Giron L.T.
        Elvis is back: musical hallucinations in a Parkinson's disease patient.
        South. Med. J. 2010; 103: 837-840
        • Ergun U.
        • Bozbas A.
        • Akin U.
        • Inan L.
        Musical hallucinations and Parkinson's disease.
        Neurologist. 2009; 15: 1150-1152
        • Clark J.
        Case history of a patient with musical hallucinations and Parkinson's disease.
        Int. J. Geriatr. Psychiatry. 1998; 13: 886-887
        • Gondim F.D.A.A.
        • Costa H.A.
        • Taunay T.C.D.
        • de Oliveira G.R.
        • Ferriera J.M.
        • Rola F.H.
        Transient amantadine-induced musical hallucinations in a patient with Parkinson's disease.
        Mov. Disord. 2010; 25: 1505-1526
        • Kataoka H.
        • Ueno S.
        Auditory musical hallucinations associated with extended release pramipexole in an elderly patient with Parkinson's disease.
        Medicine (Baltimore). 2014; 93 (10.1097): e 251
        • Wand A.
        Transient citalopram-induced auditory hallucinations in a patient with Parkinson's disease and depression.
        Aust NZ J. Psychiatry. 2012; 46: 178
        • Bannier S.
        • Berdague J.L.
        • Rieu I.
        • de Chazeron I.
        • Marques A.
        • Derost P.
        • et al.
        Prevalence and phenomenology of olfactory hallucinations in Parkinson's disease.
        J. Neurol. Neurosurg. Psychiatry. 2012; 83: 1019-1021
        • Landis B.N.
        • Burkhard P.R.
        Phantosmias and Parkinson disease.
        Arch. Neurol. 2008; 65: 1237-1239
        • Singh S.
        • Schwankaus J.
        Olfactory disturbance in Parkinson's disease.
        Arch. Neurol. 2009; 66: 805-806
        • McAuley J.H.
        • Gregory S.
        Prevalence and clinical course of olfactory hallucinations in idiopathic Parkinson's disease.
        J. Parkinsons Dis. 2012; 2: 199-205
        • Tousi B.
        • Frankel M.
        Olfactory and visual hallucinations in Parkinson's disease.
        Parkinsonism Relat. Disord. 2004; 10: 253-254
        • Fenelon G.
        • Thobois S.
        • Bonnet A.M.
        • Broussolte E.
        • Tison F.
        Tactile hallucinations in Parkinson's disease.
        J. Neurol. Dec 2002; 249: 1699-1703
        • Kataoka H.
        • Sawa N.
        • Sugie K.
        • Ueno S.
        Can dopamine agonists trigger tactile hallucinations in patients with Parkinson's disease?.
        J. Neurol. Sci. 2014; 347: 361-363
        • Jimenez-Jimenez F.J.
        • Ortparga M.
        • Gasalla T.
        • Tallon-Barranco A.
        • Cabrera-Valdera F.
        Cenesthetic hallucinations in a patient with Parkinson's disease.
        J. Neurol. Neurosurg. Psychiatry. 1997; 63: 120
        • Kiziltan G.
        • Ozekmekci S.
        • Ertan S.
        • Ertan T.
        • Erginoz E.
        Relationship between age and subtypes of psychotic symptoms in Parkinson's disease.
        J. Neurol. 2007; 254: 448-452
        • Solla P.
        • Cannas A.
        • Orofino G.
        • Marrosu F.
        Fluctuating Cotard syndrome in a patient with advanced Parkinson disease.
        Neurologist. 2015; 19: 70-72
        • Moro A.
        • Munhoz R.P.
        • Moscovich M.
        • Arruda W.U.
        • Teiv H.A.G.
        Delusional misidentification syndrome and other unusual delusions in advanced Parkinson's disease.
        Parkinsonism Relat. Disord. 2013; 19: 751-754
        • Cannas A.
        • Solla P.
        • Floris G.
        • Tacconi P.
        • Marrosu F.
        • Marrosu M.G.
        Othello syndrome in Parkinson disease patients without dementia.
        Neurologist. 2009; 15: 34-36
        • McNamara P.
        • Durso R.
        Reversible pathologic jealousy (Othello syndrome) associated with amantadine.
        J. Geriatr. Psychiatry Neurol. 1991; 4: 157-159
        • Hermanowicz N.
        A blind man with Parkinson's disease, visual hallucinations and Capgras syndrome.
        J. Neuropsychiatr. Clin. Neurosci. 2002; 14: 462-463
        • Marsh L.
        • Williams J.R.
        • Rocco M.
        • Grill S.
        • Munro C.
        • Dawson T.M.
        Psychiatric comorbidities in patients with Parkinson disease and psychosis.
        Neurology. 2004; 63: 293-300
        • Miwa H.P.
        • Mizuno Y.
        Capgras syndrome in Parkinson's disease.
        J. Neurol. 2001; 248: 804-805
        • Cercy S.P.
        • Marasia J.C.
        Combined delusional misidentification syndrome in a patient with Parkinson's disease.
        J. Neuropsychiatr. Clin. Neurosci. 2012; 24: E3-E4
        • Islam L.
        • Piacentini S.
        • Soliveri P.
        • Scarone S.
        • Gambini O.
        Capgras delusion for animal and inanimate objects in Parkinson's disease: a case report.
        BMC Psychiatry. 2015; 15: 73
        • Apaydini H.
        • Benbir G.
        Capgras syndrome during the course of Parkinson's disease dementia.
        J. Neuropsychiatr. Clin. Neurosci. 2014; 26E46
        • Stewart J.T.
        Fregoli syndrome associated with levodopa treatment.
        Mov. Disord. 2008; 23: 308-309
        • Kyrtaos C.R.
        • Stahl M.C.
        • Esliyer P.
        • Subramanian T.
        • Lucassen E.B.
        Capgras syndrome in a patient with Parkinson's disease after bilateral subthalamic nucleus deep brain stimulation: a case report.
        Case Rep. Neurol. 2015; 7: 27-53
        • Cannas A.
        • Spissu A.
        • Floris G.L.
        • Saddi M.V.
        • Cossu G.
        • Melis M.
        • et al.
        Chronic delusional hallucinatory psychosis in early onset Parkinson's disease: drug-induced complication or sign of an idiopathic psychiatric illness?.
        Neurol. Sci. 2001; 22: 53-54
        • Papapetropoulos S.
        • Katzen H.
        • Schrag A.
        • Singer C.
        • Scanlon B.K.
        • Nation D.
        • et al.
        A questionnaire-based (UM_PDHQ) study of hallucinations in Parkinson's disease.
        BMC Neurol. 2008; 8: 21https://doi.org/10.1186/1471-2377-8-21
        • Aarsland D.
        • Larsen J.P.
        • Cummings J.L.
        • Laake K.
        Prevalence and clinical correlates of psychotic symptoms in Parkinson disease.
        Arch. Neurol. 1999; 56: 595-601
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders.
        fifth ed. 2013
        • Gordon P.C.
        • Kauark R.B.G.
        • Costa C.D.M.
        • de Oliveira A.O.
        • Godinho F.L.F.
        • Rocha M.S.G.
        Clinical implications of the National Institute of Neurological Disorders and Stroke criteria for diagnosing psychosis in Parkinson's disease.
        J. Neuropsychiatr. Clin. Neurosci. 2016; 28: 26-31
        • Goetz C.G.
        • Ouyang B.
        • Negron A.
        • Stebbins G.T.
        Hallucinations and sleep disorders in Parkinson's disease: ten-year prospective longitudinal study.
        Neurology. 2010; 57: 2078-2082
        • Goetz C.G.
        • Fan W.
        • Leurgans S.
        • Bernard B.
        • Stebbins G.T.
        The malignant course of “benign hallucinations” in Parkinson disease.
        Arch. Neurol. 2006; 63: 713-716
        • Goetz C.G.
        • Stebbins G.T.
        • Ouyang B.
        Visual plus nonvisual hallucinations in Parkinson's disease: development and evolution over 10 years.
        Mov. Disord. 2011; 26: 2196-2200
        • Goetz C.G.
        • Wuu J.
        • Curgian L.
        • Leurgans S.
        Age-related influences on the clinical characteristics of new-onset hallucinations in Parkinson's disease patient.
        Mov. Disord. 2006; 21: 267-270
        • De Maindreville A.D.
        • Fenelon G.
        • Mahieux F.
        Hallucinations in Parkinson's disease: a follow-up study.
        Mov. Disord. 2005; 20: 212-216
        • Forsaa E.B.
        • Larsen J.P.
        • Wentzel-Larsen T.
        • Goetz C.G.
        • Stebbins G.T.
        • Aarsland D.
        • et al.
        A 12-year population-based study of psychosis in Parkinson's disease.
        Arch. Neurol. 2010; 67: 996-1001
        • Gibson G.
        • Motram P.G.
        • Brown D.J.
        • Hindle J.V.
        • Landau S.
        • Samuel M.
        • et al.
        Frequency, prevalence, incidence and risk factors associated with visual hallucinations in a sample of patients with Parkinson's disease: a longitudinal 4-year study.
        Int. J. Geriatr. Psychiatry. 2013; 28: 626-631
        • Dotchin C.L.
        • Jusabani A.
        • Walker R.W.
        Non-motor symptoms in a prevalent population with Parkinson's disease in Tanzania.
        Parkinsonism Relat. Disord. 2009; 15: 457-460
        • Goetz C.G.
        • Pappert E.J.
        • Blasucci L.M.
        • Stebbins G.T.
        • Ling Z.D.
        • Nora M.V.
        • et al.
        Intravenous levodopa in hallucinating Parkinson's disease patients: high-dose challenge does not precipitate hallucinations.
        Neurology. 1998; 50: 515-517
        • Fenelon G.
        • Goetz C.G.
        • Karenberg A.
        Hallucinations in Parkinson's disease in the prelevodopa era.
        Neurology. 2006; 66: 93-98
        • Goetz C.G.
        • Fan W.
        • Leurgans S.
        Antipsychotic medication treatment for mild hallucinations in Parkinson's disease: positive impact on long-term worsening.
        Mov. Disord. 2008; 23: 1541-1545
        • Ojo O.O.
        • Fernandez H.H.
        The current understanding of psychosis in Parkinson's disease.
        Curr. Psychiatry Rep. 2016; 18: 97
        • Voon V.
        • Lang A.E.
        Antidepressants in the treatment of psychosis with comorbid depression in Parkinson's disease.
        Clin. Neuropharmacol. 2004; 27: 90-92
        • Tagai K.
        • Nagata T.
        • Shinagawa S.
        • Tsuno N.
        • Ozone M.
        • et al.
        Mirtazapine improves visual hallucinations in Parkinson's disease: a case report.
        Psychogeriatrics. 2013; 13: 103-107
        • Godschalk-Dekker J.A.
        • Siegers H.P.
        Reduction of parkinsonism and psychosis with mirtazapine: a case report.
        Pharmacopsychiatry. 2014; 47: 81-83
        • Nishioka K.
        • Tanaka R.
        • Sumura H.
        • Hirano K.
        • Hatano T.
        • et al.
        Quantitative evaluation of electroconvulsive therapy for Parkinson's disease with refractory psychiatric symptoms.
        J. Neural Transm. (Viena). 2014; 121: 1405-1410
        • Taylor J.
        • Anderson W.S.
        • Brandt J.
        • Mari Z.
        • Pontone G.M.
        Neuropsychiatric complications of Parkinson disease treatments: importance of multidisciplinary care.
        Am. J. Geriatr. Psychiatry. 2016; 24: 1171-1180