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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 (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
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“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]
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“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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Neuropsychiatric disorders in Parkinson’s disease
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Pennington, C. M., Duncan, G. W., & Ritchie, C. W. (2020) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5415 · Cited by 27
Risk factors for minor hallucinations in Parkinson's disease
Omoto, S., Murakami, H., Shiraishi, T., Bono, K., Umehara, T., & Iguchi, Y. (2020) · Acta Neurologica Scandinavica · doi:10.1111/ane.13380 · Cited by 23
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Self-citationDopamine manipulations modulate paranoid social inferences in healthy people
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Metadata
- 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 › Clinical 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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