Psychosis and Parkinson’s Disease

Christina L. Vaughan*, Jennifer G. Goldman

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapter


The clinical spectrum of Parkinson’s disease (PD) psychosis ranges from mild illusions to formed hallucinations or even frank delusions. Hallucinations occur in about one-third of PD patients treated with chronic dopaminergic therapy and are most often visual. Delusions are less common but typically consist of well-systematized, thematic ideas such as paranoia or infidelity. PD psychosis may be due to extrinsic (i.e., pharmacological treatment) and/or intrinsic (i.e., disease-related) factors. Risk factors for the development of psychosis include older age; advanced disease; akinetic-rigid motor phenotype; concomitant cognitive impairment, depression, or sleep disturbances; and multiple medical problems. When psychosis in PD develops acutely, becomes troublesome or frightening, or poses a safety risk, medical attention is necessary. Medical management of acute psychosis typically includes the following: identifying and addressing specific precipitants (e.g., infection, medications), reducing or discontinuing medications for PD and other conditions that may aggravate psychosis, and introducing antipsychotic medications. Since antipsychotics with dopamine-blocking properties may worsen parkinsonism, medications with greater serotonergic properties such as clozapine, pimavanserin, and quetiapine are favored, with pimavanserin having FDA approval in the United States. Effective and well-studied treatments that improve PD psychosis without worsening motor function or posing serious risks are still needed.

Original languageEnglish (US)
Title of host publicationCurrent Clinical Neurology
PublisherHumana Press Inc.
Number of pages20
StatePublished - 2022

Publication series

NameCurrent Clinical Neurology
ISSN (Print)1559-0585
ISSN (Electronic)2524-4043


  • Antipsychotic
  • Dementia with Lewy bodies
  • Dopaminergic medication
  • Misidentification syndrome
  • Visual hallucination

ASJC Scopus subject areas

  • Clinical Neurology


Dive into the research topics of 'Psychosis and Parkinson’s Disease'. Together they form a unique fingerprint.

Cite this