Psychosis in Parkinson’s disease (hallucinations and delusions) is common, under-recognized, and tied to worse disability, hospitalizations, caregiver distress, and mortality. An expert multidisciplinary panel reviewed existing guidelines and tools and concluded that current research scales are too long or nonspecific for routine care, creating a need for a brief, standardized approach. They developed a two-step screening pathway: a pre-visit patient/caregiver screener with two plain-language questions (“Do you sense things others don’t?” and “Do you believe things others don’t think are true?”). This was followed by a clinician assessment that asks whether these symptoms disrupt activities or cause distress.
For management, the panel recommends first checking and treating reversible contributors (eg, infections, sleep or mood disorders), reviewing medications, and tapering non-essential psychosis-provoking drugs before adjusting dopaminergic therapy. Non-pharmacologic strategies (behavioral interventions, optimizing sleep/light, caregiver education) should start early. If symptoms persist, pimavanserin is the preferred first-line antipsychotic. The panel emphasizes that broader validation of this concise tool is needed, but it offers practical, clinician-friendly guidance to improve timely detection and treatment of Parkinson’s disease psychosis.
Reference: Pahwa R, Isaacson SH, Small GW, et al. Screening, Diagnosis, and Management of Parkinson’s Disease Psychosis: Recommendations From an Expert Panel. Neurol Ther. 2022;11(4):1571-1582. doi: 10.1007/s40120-022-00388-y. Epub 2022 Jul 29. Erratum in: Neurol Ther. 2023;12(5):1803. doi: 10.1007/s40120-023-00507-3.
