Screening, Diagnosis, and Management of Parkinson's Disease Psychosis: Recommendations From an Expert Panel

Introduction Hallucinations and delusions present with psychosis are debilitating non-motor symptoms of Parkinson's disease, with a prevalence of up to 50-70% at some point during the course of the disease. Often patients and caregivers do not report the presence of hallucinations or delusions unless specifically questioned. A panel of experts in neurology and geriatric psychiatry convened to develop a simple screening tool and guidance on diagnosis and treatment of Parkinson's disease psychosis (PDP). Methods The working group reviewed literature for existing PDP guidelines on diagnosis and management and identified gaps in recommendations. The group discussed and developed a screening tool and treatment guidance that addressed the gaps in existing methodology based on their clinical experience. Results The proposed screening tool consists of two parts: (1) a brief pre-visit screening portion to be completed by the patient and caregiver, and (2) a clinician portion to be completed via clinical interview of the patient and caregiver. If psychotic symptoms are present, an appropriate treatment plan is developed for PDP based on evaluation. Conclusions This simple screening tool and treatment guidance offers a practical clinical approach for clinicians in the diagnosis and management of PDP. Plain Language Summary Symptoms relating to psychosis are debilitating, progressive, and often emerge in patients with Parkinson's disease. Symptoms of Parkinson's disease psychosis include illusions, a false sense of presence, and hallucinations or delusions or both. While there are established consensus criteria for the diagnosis of Parkinson's disease psychosis, there is currently a lack of simple and standardized criteria for the screening of Parkinson's disease psychosis. This can make it challenging to identify patients who may benefit from treatment for Parkinson's disease psychosis symptoms. A group of clinical experts met to discuss guidance for the screening, clinical diagnosis, and management of Parkinson's disease psychosis. The group identified a paucity of screening tools, weaknesses in existing criteria for diagnosing Parkinson's disease psychosis, and variability in treatment recommendations. The group proposed a screening tool that includes two parts: (1) a simple pre-visit screening to be completed by the patient and caregiver before an appointment, and (2) a clinician portion to be discussed with the patient and caregiver during the appointment. If a patient has hallucinations and/or delusions that require treatment, the proposed guidance includes potential interventions or medications, which were established by review of evidence-based literature and the US Food and Drug Administration guidelines. This provides a quick and relatively simple clinical tool for a patient and caregiver to report symptoms of Parkinson's disease psychosis, and for the clinician to formulate an accurate diagnosis and a decision tree to consider treatment options.

Automated summary

Hallucinations and delusions are debilitating non-motor symptoms in Parkinson's disease, but often go unreported. A panel of experts developed a simple screening tool and treatment guidance to assist in the diagnosis and management of Parkinson's disease psychosis.