Parkinson’s Disease Psychosis

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Diagnostic criteria for psychosis in Parkinson’s disease: Report of an NINDS, NIMH work group

By Bernard Ravina MD, MSCE,*, Karen Marder MD, MPH, Hubert H. Fernandez MD, Joseph H. Friedman MD, William McDonald MD, Diane Murphy PhD, Dag Aarsland MD, Debra Babcock MD, PhD, Jefferey Cummings MD, Jean Endicott PhD, Stewart Factor MD, Wendy Galpern MD, PhD, Andrew Lees MD, Laura Marsh MD, Mark Stacy MD, Katrina Gwinn-Hardy MD, Valerie Voon MD and Christopher Goetz MD

There are no standardized diagnostic criteria for psychosis associated with Parkinson’s disease (PDPsy). As part of an NIH sponsored workshop, we reviewed the existing literature on PDPsy to provide criteria that distinguish PDPsy from other causes of psychosis. Based on these data, we propose provisional criteria for PDPsy in the style of the Diagnostic and Statistical Manual of Mental Disorders IV-TR. PDPsy has a well-characterized temporal and clinical profile of hallucinations and delusions, which is different than the pattern seen in other psychotic disorders such as substance induced psychosis or schizophrenia. PDPsy is associated with a poor prognosis of chronic psychosis, nursing home placement, and death. Medications used to treat Parkinson’s disease (PD) contribute to PDPsy but may not be sufficient or necessary contributors to PDPsy. PDPsy is associated with Lewy bodies pathology, imbalances of monoaminergic neurotransmitters, and visuospatial processing deficits. These findings suggest that PDPsy may result from progression of the disease process underlying PD, rather than a comorbid psychiatric disorder or drug intoxication. PDPsy is not adequately described by existing criteria for psychotic disorders. We established provisional diagnostic criteria that define a constellation of clinical features not shared by other psychotic syndromes. The criteria are inclusive and contain descriptions of the full range of characteristic symptoms, chronology of onset, duration of symptoms, exclusionary diagnoses, and associated features such as dementia. These criteria require validation and may be refined, but form a starting point for studies of the epidemiology and pathophysiology of PDPsy, and are a potential indication for therapy development.

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