Most often involving seeing things that are not there
Psychosis and hallucinations are usually related to Parkinson’s disease itself or may be an unwanted effect of a patient’s medications.
Key points
- Psychosis, which includes hallucinations and delusions, is a common non-movement symptom in Parkinson's disease. It is also a symptom of other neurodegenerative conditions, such as Lewy body dementia. Noticing when these features occur and reporting them, helps your care team manage your condition effectively.
- In Parkinson's disease, hallucinations are often related to changes in brain chemistry from the disease itself, combined with the effects of dopamine-based medications used to treat movement symptoms.
- Practical guidance for patients and families is to note when hallucinations occur, what they involve and whether insight is retained (ie whether the person knows it isn't real), which can help you feel more in control and reassured. You should also report this to your care team rather than dismissing it.
- Your GP or specialist can guide you through checking for reversible triggers (such as infection or dehydration) and adjusting Parkinson's medication, which is often the first step in management.
- Some Parkinson's medications can worsen hallucinations and psychosis, so discussing any new or changing symptoms with your care team is essential for safe management rather than managing them in isolation.
Next steps:
Symptoms of psychosis and hallucinations can consist of:
- having false beliefs, such as feeling followed, watched or deceived (delusions)
- less commonly, hearing, feeling or smelling things that others don't experience
- seeing people, animals or objects that aren't there, often in vivid detail (visual hallucinations)
- retaining awareness, in many cases, that the hallucination isn't real (insight)
- experiencing symptoms that may occur more often in low light, in the evening or when alone.
Psychosis and hallucinations are not unique to Parkinson's disease, and several factors can trigger or worsen them:
- dehydration or other acute medical illness
- infection, such as a urinary tract infection, which is a common and reversible trigger
- Lewy body dementia
- Parkinson's medications, particularly dopamine agonists or anticholinergic treatments
- sleep deprivation or significant sleep disruption
- other causes of dementia or delirium.
When to consider specialist review
So you feel supported and guided through managing these symptoms, speak with your GP or neurologist if hallucinations are:
- associated with loss of insight
- increasing in frequency or distress
- new
- not improving with simple measures.
When to seek urgent help
Seek urgent medical attention for a sudden onset or rapid worsening of delusions or hallucinations, especially alongside confusion, fever or a recent fall, to ensure you feel reassured that help is available for serious issues rather than assuming it's 'just the Parkinson's'.
Call Emergency 000 if any behaviour is concerning or a risk to your, or the patient's safety. These changes need prompt assessment rather than waiting for a routine review.