Parkinson’s Disease and Hallucinations

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Most people know Parkinson’s disease can cause motor (movement) problems, especially tremors. But the disease also has what doctors call non-motor symptoms. These may include hallucinations and delusions.

When you hallucinate, you see, hear, or feel things that aren’t really there. When you have delusions, you believe things that aren’t true.

Hallucinations and delusions are two main symptoms of Parkinson’s disease-associated psychosis. Several treatments can make these symptoms easier on you, your loved ones, and your care team.

Hallucinations

Hallucinations in Parkinson’s disease can affect any of your five senses: sight, hearing, taste, touch, and smell. Visual hallucinations are the most common. You may think a deceased loved one is in the room with you, or that a pet you don’t own is on the couch.

When you first start to have hallucinations, you may know that what you see isn’t real. Doctors call this retaining insight, and it can help you manage the changes. Over time, you may lose some or all of that insight.

Other key facts about hallucinations:

  • They’re often a side effect of medication.
  • They’re more common in people who have problems with thinking or memory.
  • They’re more likely to happen when light is low or it’s hard to see.

 

Delusions

Delusions in Parkinson’s psychosis involve more than untrue beliefs. They can also make you upset, more likely to argue, and more likely to get physical with others.

You can have a delusion about anything, but these are typical themes in Parkinson’s psychosis:

  • Jealousy. You believe your partner is unfaithful. You act paranoid, upset, suspicious, or aggressive.
  • Persecution. You believe you’re being attacked, harassed, or plotted against. You act paranoid, suspicious, upset, aggressive, defiant, or socially withdrawn.
  • Body/health obsession. You believe some part of your health isn’t normal. You act anxious, upset, obsessed with your symptoms, and have frequent doctor visits.

 

Risk Factors

Up to 50% of people with Parkinson’s disease get psychosis. Things that can make that more likely include:

  • Long-term use of drugs to manage motor symptoms, like tremor
  • Changes in sleep
  • Genes 
  • Dementia or memory problems
  • Depression
  • Impaired vision
  • Older age
  • Advanced disease

 

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Ruling Out Other Causes

There’s a chance your hallucinations are temporary. This could be the case if you take medications that can trigger them, like:

  • Muscle relaxants
  • Pain medications
  • Benzodiazepines (valium, lorazepam, clonazepam)

Your doctor will also want to rule out other reversible causes, including:

  • Infections
  • Electrolyte imbalances
  • Sleep disorders 

 

Section Header Managing Psychosis With Medication

Don’t keep hallucinations or delusions a secret from your doctor. Medications -- or changes to the medications you take -- can help manage Parkinson’s psychosis.

Streamlining your meds. The first thing your doctor may want to do is stop or lower your Parkinson’s medication dose. They may boost dopamine levels in your brain. That improves motor symptoms but can also cause changes in your emotions or the way you act.

Antipsychotics. These medications balance your brain chemicals. Only a few are considered safe for people with Parkinson’s disease. These include quetiapine (Seroquel) and clozapine (Clozaril).

Pimavanserin (Nuplazid). Another antipsychotic, this first-in-class drug was approved by the FDA in 2016 to treat hallucinations and delusions in Parkinson’s disease linked with psychosis.

If you see a doctor who isn’t part of your usual care team -- say, in the emergency room or an urgent care setting -- tell them you have Parkinson’s disease and what medications you take for it.

Tips for Caregivers

If you’re a family member or caregiver of someone with Parkinson’s psychosis, these steps can help you manage the symptoms:

  • Make sure to have good lighting in your home.
  • Keep your loved one’s brain engaged in the evening, when symptoms tend to occur.
  • Don’t try to argue or reason through an episode.
  • Get outside help if the situation becomes difficult to manage or poses a safety risk.

 

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on May 08, 2020

Sources

SOURCES:

Parkinson’s Foundation: “Hallucinations/Delusions,” “Non-Movement Symptoms,” “What Is Parkinson’s?”

Pharmacy and Therapeutics: “Pimavanserin (Nuplazid).”  

University of Florida Health: “Parkinson’s Treatment Tips on Psychosis and Hallucinations.”

 
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