The psychosis spectrum in Parkinson disease
Open accessAbstract
In 2007, the clinical and research profile of illusions, hallucinations, delusions and related symptoms in Parkinson disease (PD) was raised with the publication of a consensus definition of PD psychosis. Symptoms that were previously deemed benign and clinically insignificant were incorporated into a continuum of severity, leading to the rapid expansion of literature focusing on clinical aspects, mechanisms and treatment. Here, we review this literature and the evolving view of PD psychosis. Key topics include the prospective risk of dementia in individuals with PD psychosis, and the causal and modifying effects of PD medication. We discuss recent developments, including recognition of an increase in the prevalence of psychosis with disease duration, addition of new visual symptoms to the psychosis continuum, and identification of frontal executive, visual perceptual and memory dysfunction at different disease stages. In addition, we highlight novel risk factors - for example, autonomic dysfunction - that have emerged from prospective studies, structural MRI evidence of frontal, parietal, occipital and hippocampal involvement, and approval of pimavanserin for the treatment of PD psychosis. The accumulating evidence raises novel questions and directions for future research to explore the clinical management and biomarker potential of PD psychosis.
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People with PD can experience a wide range of psychological difficulties, including anxiety, depression, apathy, impulse control disorders, and more rarely psychosis.
“people with PD can experience a wide range of psychological difficulties, including anxiety, depression, apathy, impulse control disorders, and more rarely psychosis (ffytche et al., 2017; Simpson, McMillan, & Reeve, 2013).”
From Psychological interventions for people with Parkinson's disease in the early 2020s: Where do we stand? (2021) · cites this paper as ffytche et al., 2017
The Frequency and clinical consequences section confirms that people with PD can experience psychosis, but describes psychosis-spectrum symptoms as common rather than rare. The paper mentions depression and anxiety as factors associated with hallucinations, but the passages found do not establish the claimed list of difficulties or compare their frequencies with psychosis. Page numbers were unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPD-VH decline cognitively more rapidly and show possible subclinical cognitive variations early on in their VH.
“This is consistent with reports of PD-VH declining cognitively more rapidly2 and showing possible subclinical cognitive variations early on in their VH4.”
From Deviations in effective connectivity explain different hallucination subtypes in Parkinson's disease psychosis (2026) · cites this paper as [2]
Psychotic problems in PD can fluctuate over the course of the condition but generally tend to increase over time.
“Although these can fluctuate over the course of the condition, they generally tend to increase over time (ffytche et al., 2017).”
From Psychological interventions for people with Parkinson's disease in the early 2020s: Where do we stand? (2021) · cites this paper as ffytche et al., 2017
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Risk factors for minor hallucinations in Parkinson's disease
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Koros, C., Stefanis, L., & Scarmeas, N. (2021) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2021.120015 · Cited by 23 · see citing works
Functional neurological disorder and somatic symptom disorder in Parkinson's disease
ONOFRJ, M. C., Russo, M., Carrarini, C., Pizzi, S. D., Thomas, A., Bonanni, L., Espay, A. J., & Sensi, S. L. (2021) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2021.120017 · Cited by 23 · see citing works
Brainstem Pathologies Correlate With Depression and Psychosis in Parkinson's Disease
Fischer, N. M., Hinkle, J. T., Perepezko, K. M., Bakker, C. C., Morris, M., Broen, M. P. G., Butala, A., Dawson, T. M., Leentjens, A. F. G., Mari, Z. K., et al. (2021) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2020.12.009 · Cited by 23 · see citing works
Smeland, O. B., Kutrolli, G., Bahrami, S., Fominykh, V., Parker, N., Hindley, G., Rødevand, L. N., Jaholkowski, P. P., Tesfaye, M., Parekh, P., et al. (2023) · medRxiv · doi:10.1101/2023.07.21.23292993 · Cited by 23 · see citing works
Batzu, L., Podlewska, A. M., Gibson, L. L., Chaudhuri, К. R., & Aarsland, D. (2024) · International review of neurobiology · doi:10.1016/bs.irn.2023.11.001 · Cited by 22 · see citing works
Self-citationDopamine manipulations modulate paranoid social inferences in healthy people
Barnby, J. M., Bell, V., Deeley, Q., & Mehta, M. A. (2020) · Translational Psychiatry · doi:10.1038/s41398-020-00912-4 · Cited by 22 · see citing works
Predictors of onset of psychosis in patients with Parkinson's disease: Who gets it early?
Lenka, A., George, L., Arumugham, S. S., Hegde, S., Reddy, V., Kamble, N. L., Yadav, R., & Pal, P. K. (2017) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2017.09.015 · Cited by 22 · see citing works
Suicide in Parkinson’s Disease: A Systematic Review
Berardelli, I., Belvisi, D., Nardella, A., Falcone, G., Lamis, D. A., Fabbrini, G., Berardelli, A., Girardi, P., & Pompili, M. (2019) · CNS & Neurological Disorders - Drug Targets · doi:10.2174/1871527318666190703093345 · Cited by 22 · see citing works
Illusions, hallucinations, and visual snow
Fraser, C. L., & Lueck, C. J. (2021) · Handbook of clinical neurology · doi:10.1016/b978-0-12-821377-3.00014-3 · Cited by 22 · see citing works
Negative mood invites psychotic false perception in dementia
Watanabe, H., Nishio, Y., Mamiya, Y., Narita, W., Iizuka, O., Baba, T., Takeda, A., Shimomura, T., & Mori, E. (2018) · PLoS ONE · doi:10.1371/journal.pone.0197968 · Cited by 21 · see citing works
Treating hallucinations in Parkinson’s disease
Powell, A., Matar, E., & Lewis, S. J. G. (2020) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2021.1851198 · Cited by 21 · see citing works
Diplopia in Parkinson’s disease: visual illusion or oculomotor impairment?
Visser, F., Vlaar, A. M. M., Borm, C. D. J. M., Apostolov, V., Lee, Y. X., Notting, I. C., Weinstein, H. C., & Berendse, H. W. (2019) · Journal of Neurology · doi:10.1007/s00415-019-09430-w · Cited by 21 · see citing works
Drug and Disease Effects in Parkinson's Psychosis: Revisiting the Role of Dopamine
Dave, S., Weintraub, D., Aarsland, D., & Ffytche, D. H. (2019) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.12851 · Cited by 21 · see citing works
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Network Connectivity Determines Cortical Thinning In Early Parkinson’s Disease ProgressionPreprint
Yau, Y., Zeighami, Y., Baker, T. E., Larcher, K., Vainik, U., Dadar, M., Fonov, V., Hagmann, P., Griffa, A., Mišić, B., et al. (2017) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/147611 · Cited by 23 · see citing works
Lewy Body Dementias: A Coin with Two Sides?
Milán-Tomás, Á., Fernández‐Matarrubia, M., & Rodríguez‐Oroz, M. (2021) · Behavioral Sciences · doi:10.3390/bs11070094 · Cited by 20 · see citing works
- Authors
- ffytche, D. H., Creese, B., Politis, M., Chaudhuri, K. R., Weintraub, D., Ballard, C., & Aarsland, D.
- Affiliations
- King's College London (GB)
- Corresponding author
- ffytche, Dominic H.
- Venue
- Nature Reviews Neurology
- Published
- 2017-01-20
- Volume
- 13
- Issue
- 2
- Pages
- 81-95
- ISSN
- 1759-4758 (ISSN-L)
- 1759-4766
- PMC
- PMC5656278
- OpenAlex
- W2579373654
- Cited by
- 355
- References
- 188
- Citations by year
- 2026: 26 · 2025: 40 · 2024: 36 · 2023: 33 · 2022: 39 · 2021: 51 · 2020: 42 · 2019: 30 · 2018: 35 · 2017: 23
- FWCI
- 4.74
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature Reviews Neurology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Open Research Exeter (University of Exeter) (acceptedVersion)
- Figshare (submittedVersion)
- Funders
- National Institute for Health and Care Research (RP-PG-0610-10100)
- H. Lundbeck A/S
- National Institute of Neurological Disorders and Stroke (P50NS053488)
- Topics
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Life Sciences › Neuroscience › Cognitive Neuroscience › Hallucinations in medical conditions
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- psychosis continuum, hallucinations, delusions, visual hallucinations, dementia risk, antiparkinsonian drugs, autonomic dysfunction, frontal executive dysfunction, memory impairment, pimavanserin, structural MRI, biomarkers, disease duration
- MeSH terms
- Humans, Parkinson Disease, Psychotic Disorders
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