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Prevalence of Psychotic Symptoms in a Community-Based Parkinson Disease Sample

https://doi.org/10.1097/JGP.0b013e31821f1b41Get rights and content

Objectives

To determine the prevalence of psychotic phenomena, including minor symptoms, in a Parkinson disease (PD) sample and compare the clinical correlates associated with the various psychotic phenomena. To evaluate the extent to which cases met National Institute of Neurological Diseases and Stroke (NINDS)/National Institute of Mental Health (NIMH)–proposed criteria for PD-associated psychosis.

Methods

A total of 250 patients with idiopathic PD and Mini Mental State Exam scores greater than 23 from three community-based movement disorder clinics underwent comprehensive research diagnostic evaluations by a geriatric psychiatrist as part of a study on mood disorders in PD. Psychotic symptoms were categorized using a checklist, which included a breakdown of hallucinations, delusions, and minor symptoms. Clinical characteristics of groups with minor and other psychotic symptoms were compared. The NINDS/NIMH criteria for PD-psychosis were retrospectively applied.

Results

Of the total sample, 26% of patients were found to have any current psychotic symptoms, with 47.7% of those having isolated minor symptoms, and 52.3% having hallucinations and/or delusions. Compared to those with no current psychiatric symptoms, minor symptoms were associated with more depressive symptoms and worse quality of life, and 90.8% of those with psychotic symptoms fulfilled the NINDS/NIMH proposed criteria.

Conclusions

Psychotic symptoms are common in PD patients, with minor psychotic phenomena present in nearly half of affected patients in a community-based sample. Psychotic symptoms, including minor phenomena, were clinically significant. The NINDS/NIMH PD-psychosis criteria captured the clinical characteristics of psychosis as it relates to PD. Longitudinal studies are needed to determine whether minor psychotic symptoms represent a precursor to hallucinations and delusions, and to further validate diagnostic criteria.

Section snippets

Subjects

Subjects were a convenience sample recruited from a pool of 747 patients with idiopathic PD from three community-based movement disorder neurology practices. Patients were mailed letters by their neurologist asking them to participate in a study evaluating the psychometric performance of depression rating scales in patients with PD (the Methods of Optimal Depression Detection in PD [MOOD-PD] study). A total of 287 patients enrolled and completed initial screening. Eighteen subjects were

RESULTS

The demographic and clinical features for the 250 subjects completing the diagnostic evaluation are shown in Table 1. The sample had two-thirds male subjects and almost all individuals were living in their own home. Based on study criteria, no subject had a MMSE score less than 24.

Sixty-five subjects (26%) had current psychotic symptoms (PSY). The prevalence of specific psychotic symptoms is shown in Table 2. Twelve PSY subjects (18.5%) were taking antipsychotic medications, resulting in

DISCUSSION

The present study reported the prevalence of all forms of psychotic phenomena, including minor phenomena, in a community-based, convenience sample of outpatients with idiopathic PD and MMSE more than 23. It also examined the validity of the NINDS/NIMH criteria for PD-psychosis against consensus diagnoses made by an expert panel. In this sample, the prevalence of any current psychotic symptom was 26% when based on consensus diagnoses from an expert panel, and 23.6% when based on the proposed

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    A poster corresponding to this paper was presented at the 2010 Annual Meeting of the American Association for Geriatric Psychiatry, Savannah, GA, March 5–8, 2010.

    Supported by grants from the NIH [RO1-MH069666 (MOOD-PD Study), P50-NS-038377 (the Morris K. Udall Parkinson's Disease Research Center of Excellence at Johns Hopkins) and #T32-AG-027668], the Department of Veterans Affairs, the Donna Jeanne Gault Baumann Fund, and the Weldon Hall Trust.

    Disclosure of competing interests: Dr. Margolis: Consultant to Astrazeneca ($3000); Dr. Marsh: Grant/Research funding from Boeringer-Ingelheim ($155,480, 4/07–8/09), Forest Research Institute ($154,029, 8/04–12/09), Eli Lilly ($93,727, 11/04–10/08), Michael J. Fox Foundation ($32,352, 1/09–12/09), and NIH ($2,394,225, 7/04–present).

    The views expressed in this article do not necessarily represent the views of the Food and Drug Administration or the United States.

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    Copyright © 2012 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.