Hallucinations, Delusions and Impulse Control Disorders in Parkinson Disease

Karlo J Lizarraga; Susan H Fox; Antonio P Strafella; Anthony E Lang

doi:10.1016/j.cger.2019.09.004

Hallucinations, Delusions and Impulse Control Disorders in Parkinson Disease

Clin Geriatr Med. 2020 Feb;36(1):105-118. doi: 10.1016/j.cger.2019.09.004. Epub 2019 Sep 6.

Authors

Karlo J Lizarraga¹, Susan H Fox², Antonio P Strafella², Anthony E Lang²

Affiliations

¹ The Edmond J. Safra Program in Parkinson Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Division of Neurology, Department of Medicine, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, Toronto, Ontario, Canada; Motor Physiology and Neuromodulation Program, Division of Movement Disorders, Department of Neurology, University of Rochester, Rochester, New York, United States; Center for Health + Technology (CHeT), University of Rochester, Rochester, New York, United States. Electronic address: [email protected].
² The Edmond J. Safra Program in Parkinson Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Division of Neurology, Department of Medicine, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, Toronto, Ontario, Canada.

PMID: 31733691
DOI: 10.1016/j.cger.2019.09.004

Abstract

Psychotic and compulsive symptoms in Parkinson disease are highly prevalent and associated with poor outcomes and greater caregiver burden. When acute, delirium should be ruled out or treated accordingly. When chronic, comorbid systemic illnesses, dementia, and psychiatric disorders should be considered. Reduction and discontinuation of anticholinergics, amantadine, dopamine agonists, and levodopa as tolerated, as well as adjunctive clozapine or quetiapine are frequently effective to manage Parkinson disease psychosis. Pimavanserin appears effective but is not widely available, and more experience is needed. Dopamine agonist discontinuation is usually successful for impulse control disorders, but requires frequent monitoring, documentation, and caregiver involvement.

Keywords: Compulsions; Delirium; Delusions; Dopamine dysregulation syndrome; Hallucinations; Impulse control disorders; Parkinson disease; Psychosis.

Publication types

Review

MeSH terms

Aged
Diagnosis, Differential
Disruptive, Impulse Control, and Conduct Disorders* / etiology
Disruptive, Impulse Control, and Conduct Disorders* / therapy
Humans
Parkinson Disease* / complications
Parkinson Disease* / psychology
Parkinson Disease* / therapy
Patient Care Management / methods*
Perceptual Disorders* / etiology
Perceptual Disorders* / therapy
Psychotic Disorders* / etiology
Psychotic Disorders* / therapy