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Are hallucinations and delusions in Parkinson's disease due to medications or an intrinsic part of the disease?
This is what we tried to answer by going back in time to case notes prior to the use of dopaminergic therapies.
Let's explain...
tandfonline.com/doi/full/10.10…
This is what we tried to answer by going back in time to case notes prior to the use of dopaminergic therapies.
Let's explain...
tandfonline.com/doi/full/10.10…
Firstly, what do you think? What causes the psychosis in PD?
The problem with answering this Q is that pretty much everyone in industrialised countries who has PD beyond the very early stages is now on medications.
To solve this, we used the amazing case notes housed by @neurolib at Queen Square, London.
To solve this, we used the amazing case notes housed by @neurolib at Queen Square, London.
One of the fantastic @MentalhealthMSc students in @UCLPsychiatry, @ChengyuZhang23, spent weeks reading through case notes from between 1924 and 1946, long before levodopa was being used.
He found 115 patients with a mean duration of PD of 5 years.
He found 115 patients with a mean duration of PD of 5 years.
Any idea what he found? Out of 115 PD patients, how many reported hallucinations and/or delusions?
The correct answer is...
ZERO.
Not a single patient with frank psychosis.
(One had an illusion, but they were taking an anticholinergic medication.)
ZERO.
Not a single patient with frank psychosis.
(One had an illusion, but they were taking an anticholinergic medication.)
So does this mean that psychosis in PD is 100% due to medications?
Well, it's not that conclusive. The main weakness of our study is that we often couldn't be sure that patients didn't have symptoms - they might not have been asked.
Well, it's not that conclusive. The main weakness of our study is that we often couldn't be sure that patients didn't have symptoms - they might not have been asked.
However, lots of patients were reported as having other neuropsych symptoms like depression or cognitive impairment, so it's not that early 20th century neurologists were interested only in abnormal movements.
My takeaways:
💠We can't rule out that medication-naive PD patients experience psychotic symptoms (and there is some other work suggesting they do)
💠BUT at a relatively early stage in the disease, they didn't seem to be that bothered by them (or I think it would have come up)
💠We can't rule out that medication-naive PD patients experience psychotic symptoms (and there is some other work suggesting they do)
💠BUT at a relatively early stage in the disease, they didn't seem to be that bothered by them (or I think it would have come up)
Well done to @ChengyuZhang23 on finishing this and thanks to @Suzanne__Reeves, @Harry_Costello, @ProfTonyDavid and @neurolib for their help!
Article published #OpenAccess in @CogNPsychiatry: tandfonline.com/doi/full/10.10….
Article published #OpenAccess in @CogNPsychiatry: tandfonline.com/doi/full/10.10….
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