Hallucinations may occur in people who are treated with PD drugs. They are usually visual and are often accompanied by delusions. The combination is called a psychosis. It may be difficult or even impossible for you to convince your spouse that there isn't anyone there or that you aren't going to harm him or her. Such symptoms cause distress to families and are the most frequently given reason for placing a patient in a nursing home.
Psychosis may occur without dementia as in LSD, amphetamine, or cocaine psychosis, and dementia may occur without psychosis as in LBD or Alzheimer's disease; however, in the presence of dementia, psychosis is more likely to appear. Symptoms of psychosis include hallucinations, seeing things that don't exist; delusions, a belief in something with no basis in reality; and paranoia, a belief that people are seeking to harm you. Obsessions with specific topics such as germs, sex, or death and dying, and compulsions such as gambling, eating, talking, and sex, are more common than reported.
When treated with PD drugs, PD patients, whether their dementia is recognized or unrecognized, can develop a psychosis that "unmasks" an underlying dementia. The type and severity of the psychosis will depend on the underlying dementia and the type and amount of the drugs. Anticholinergic drugs, such as Artane, Cogentin, Kemadrin and Symmetrel, are used in PD to control tremor; other anticholinergic drugs, Ditropan and Detrol, control bladder irritability; and still others, such as Elavil and Sinequan, are used to
Psychosis a mental disorder in which delusions and hallucinations are combined; the person is convinced that unreal things or people truly exist.
Hallucinations a delusion in which a person sees or hears things or people that don't exist.
Delusions a belief in something with no basis in reality.
Paranoia a belief that people are seeking to harm you.
treat depression or insomnia. Such drugs are more likely to cause psychosis than dopamine drugs. Among the dopamine drugs, the agonists Mirapex, Requip, and Permax are more likely to cause psychosis than Sinemet.
Psychosis may appear in people with PD who are not on anticholinergic drugs, agonists, or Sinemet. Although a psychosis may uncover an underlying dementia, it does not necessarily mean that a person has a dementia or will develop a dementia. A psychosis is reversible if the cause is found, but a dementia is not reversible.
The psychosis in PD resembles the psychosis in young people without dementia who overdose on drugs such as amphetamine, methamphetamine, cocaine, and ecstasy. It also resembles, in part, the psychosis of schizophrenia. The situations in PD in which psychosis may appear, other than after the addition of a new drug, are as follows:
• Intensive care unit psychosis. This occurs when a person with PD in an intensive care unit—with bells ringing, beepers beeping, lights flashing, and strangers coming and going—is sleep deprived and develops a psychosis. An underlying dementia may or may not exist.
• Postoperative psychosis. In this instance, a person with PD develops a psychosis after surgery and anesthesia, depending on the type and duration of the surgery and anesthesia, the severity of blood loss, and the type and amount of fluids given. An underlying dementia may or may not exist.
• Sundown psychosis. Here, a person with PD develops a psychosis at night when in strange surroundings. An underlying dementia usually exists.
• The "DTs." Psychosis sometimes occurs when a person is inadvertently and abruptly withdrawn from alcohol.
Other causes of psychosis can include:
• Infections (usually of the lung and bladder). These may or may not be associated with fever.
• Lung disease. Difficulty breathing may result in lack of brain oxygen, retention of carbon dioxide, and changes in acid-base balance.
• Strokes (especially if they occur in specific regions).
• Thyroid disease (especially an overactive thyroid).
In PD, dementia symptoms result from a loss of dopamine, norepinephrine, serotonin, and acetylcholine cells in different brain regions. The type and severity of the symptom will depend on the type, the severity, and the location of the cell loss. In PD psychosis, symptoms result from excess dopamine and perhaps norepineph-rine and serotonin in different brain regions. The type and severity of the symptoms also will depend on the duration and the amount of treatment with PD drugs. Not all PD patients have all symptoms. Sometimes, even though the differences outlined appear clear cut, they're not, as described here:
• In dementia, you lack awareness. You do not realize or recognize that anything is wrong. In psychosis, you are super or hyperaware of your surroundings.
• In dementia, you lack alertness. You sleep all day. In psychosis, you're awake all night, and you may or may not sleep during the day.
• In dementia, you have difficulty with memory. You can't remember the day, the date, the year, or where you are, and you get lost in a new place. In psychosis, your memory may be intact, but you may be so anxious and so distracted that you can't remember.
• In dementia, you have difficulty paying attention. You can't remember how to spell a word such as W-O-R-L-D backward. In psychosis, you can't pay attention long enough to spell W-O-R-L-D backward.
• In dementia, you have difficulty with calculations. You may be unable to balance your checkbook or make change. In psychosis, you may be unable to pay attention long enough to balance your checkbook or make change.
• In dementia, you have difficulty using and understanding words. You forget what certain words mean, and you can't think of the name of an object. In psychosis, you're too distracted to think.
• In dementia, you have difficulty following directions or instructions, as hard as you may try. You may be unable to organize, plan, or think of new ideas. In psychosis, you can't sit still long enough to do anything.
• In dementia, you may be apathetic and may take no interest in people or in your surroundings. You may appear depressed, but you're not. Usually you're not sad, and you don't feel guilty. In psychosis, your moods are inappropriate; for example, you're happy when others are sad. You change rapidly and go from being down to up to down for no apparent reasons. You're very anxious and panic easily.
• In dementia, you may have obsessions and compulsions. You may have "passive" compulsions, humming or repeating stereotyped phrases. In psychosis, you may have "positive" but destructive obsessions and compulsions. You may be obsessed with germs to the exclusion of all activities, or you may have a compulsion to gamble, eat, collect trash, or engage in aberrant sexual behavior.
• In dementia, you are not able to read this. In psychosis, you are able to read this, but you would not.
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