Parkinson disease psychosis: from phenomenology to neurobiological mechanisms
Abstract
Parkinson disease (PD) psychosis (PDP) is a spectrum of illusions, hallucinations and delusions that are associated with PD throughout its disease course. Psychotic phenomena can manifest from the earliest stages of PD and might follow a continuum from minor hallucinations to structured hallucinations and delusions. Initially, PDP was considered to be a complication associated with dopaminergic drug use. However, subsequent research has provided evidence that PDP arises from the progression of brain alterations caused by PD itself, coupled with the use of dopaminergic drugs. The combined dysfunction of attentional control systems, sensory processing, limbic structures, the default mode network and thalamocortical connections provides a conceptual framework to explain how new incoming stimuli are incorrectly categorized, and how aberrant hierarchical predictive processing can produce false percepts that intrude into the stream of consciousness. The past decade has seen the publication of new data on the phenomenology and neurobiological basis of PDP from the initial stages of the disease, as well as the neurotransmitter systems involved in PDP initiation and progression. In this Review, we discuss the latest clinical, neuroimaging and neurochemical evidence that could aid early identification of psychotic phenomena in PD and inform the discovery of new therapeutic targets and strategies.
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Human and animal stimuli are often the content of VH in these patients.
“human and animal stimuli are often the content of VH in these patients32,50”
From Deviations in effective connectivity explain different hallucination subtypes in Parkinson's disease psychosis (2026) · cites this paper as [32]
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Prevalence and Risk Factors for Minor Hallucinations in Patients with Parkinson’s Disease
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Dependence of connectivity on geometric distance in brain networks
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Catd: unified representation learning for eeg-to-fmri cross-modal generation
Yao, W., Lyu, Z., Mahmud, M., Zhong, N., Lei, B., & Wang, S. (2025) · IEEE Transactions on Medical Imaging · doi:10.1109/tmi.2025.3550206 · Cited by 24 · see citing works
Stampacchia, S., Bernasconi, F., Van De Ville, D., Amico, E., Pagonabarraga, J., Kulisevsky, J., & Blanke, O. (2025) · doi:10.1101/2025.04.17.649310 · Cited by 5 · see citing works
Self-citationVignando, M., Ffytche, D., Mazibuko, N., Palma, G., Bhat, A., Montagnese, M., Dave, S., Tai, Y. F., Batzu, L., Leta, V., et al. (2026) · Nature Mental Health · doi:10.1038/s44220-026-00669-7
“Inter-estingly, human and animal stimuli are often the content of VH in these patients 32,50 .”
- Authors
- Pagonabarraga, J., Bejr-Kasem, H., Martinez-Horta, S., & Kulisevsky, J.
- Affiliations
- Universitat Autònoma de Barcelona (ES)
- Corresponding author
- Pagonabarraga, Javier
- Venue
- Nature Reviews Neurology
- Published
- 2024-01-15
- Volume
- 20
- Issue
- 3
- Pages
- 135-150
- ISSN
- 1759-4758 (ISSN-L)
- 1759-4766
- OpenAlex
- W4390879322
- Cited by
- 69
- References
- 213
- Citations by year
- 2026: 21 · 2025: 41 · 2024: 7
- FWCI
- 4.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Nature Reviews Neurology (publishedVersion)
- PubMed (publishedVersion)
- 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
- hallucinations, delusions, illusion, dopaminergic therapy, attentional control, sensory processing, limbic system, default mode network, thalamocortical connections, predictive processing, neurotransmitter systems, early detection, therapeutic target
- MeSH terms
- Brain, Hallucinations, Humans, Parkinson Disease, Psychotic Disorders
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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