Parkinson’s Minute: Psychosis


(music) – Another hugely important
topic today on ParkinsonTV, psychosis in Parkinson disease. And not the easiest one. Not the easiest one because it’s complex and it’s debilitating. We talked about the various presentations. We separated hallucinations, where some form of insight is retained, from an outright psychosis, where things are totally
real for patients. We talked about the fact
that it is always critical to review the medication and
to remove culprit medication. This can be Parkinson’s medication, but often times it can
be other medication. We talked about the importance
of doing a general work up looking for maybe a bladder infection, a metabolic disorder, any
other blood chemistry disorders which is treatable. And if that’s all not the case, then it could be the
Parkinson disease itself, which we know can cause
hallucinations or psychosis. In that case, the reflex should
probably not be to reduce the dopaminergic medication
because it may worsen the Parkinson’s symptoms,
but rather to resort to symptomatic treatments
to make things better. If it’s mild, if it’s hallucinations, could be a cholinesterase inhibitor. If it’s a more severe psychosis, then antipsychotics can be
a serious consideration. You always need to find the right dose for the right person
and the right symptom. And in doing so, even the
psychosis can be improved with the right management.

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