Objective: To compare prevalence of psychosis in Parkinson’s disease (PD) using the NINDS-NIMH and standard criteria (hallucinations and / or delusions).

Background: The prevalence of Psychosis in Parkinson’s disease (PD) varies between 10-60% across studies due to variability in diagnostic criteria used. Some studies have included vivid dreams, sense of presence, illusions as psychotic symptoms along with delusions and hallucinations. Interestingly the new diagnostic criteria for PD associated Psychosis proposed by the National Institute of Neurological Disorder and Stroke- National Institute of Mental Health (NINDS – NIMH) includes “minor psychotic symptoms” (sense of presence and illusions) along with the “major psychotic symptoms”.

Methods: 200 consecutive consenting patients with PD, fulfilling UK Brain Bank Criteria attending a Neuro-speciality hospital in Eastern India were evaluated with the Unified Parkinson’s disease Rating Scale (UPDRS), Modified Hoehn and Yahr staging, Schwab and England Activities of Daily Living Scale, the Mini International Neuropsychiatric Inventory (M.I.N.I), the National Institute of Neurological Disorder and Stroke- National Institute of Mental Health (NINDS – NIMH) criteria, Mini Mental State Examination (MMSE) and Patient Health Questionnaire 9 (PHQ9).

Results: Psychosis was reported in 26.5% (N=53) and 34% (N= 68) patients using standard criteria and NINDS-NIMH criteria respectively. 31.5% (N=63) patients had no psychiatric illness. 7.5% (N=15) patients with psychosis had “minor psychotic symptoms” only. Patients with minor psychotic symptoms reported significantly higher treatment complications (dyskinesia and clinical fluctuations) as compared to patients with no psychiatric illness. When compared to patients with major psychotic symptoms they were on significantly lower levodopa equivalent doses and less likely to have anorexia, sleep disturbances and depressive symptoms.

Conclusions: The study highlights the need to identify patients with PD having minor psychotic symptoms as they possibly form a distinct subgroup.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/parkinsons-disease-associated-psychosis-prevalence-and-risk-factors/