Support Statement

Supported by an educational grant from Acadia Pharmaceuticals Inc. 

Learning Objective

After completing this educational activity, you should be able to: 

• Identify appropriate best practices for the diagnosis of Parkinson’s disease psychosis 

Release, Review, and Expiration Dates

This CME activity was published in April 2023 and is eligible for AMA PRA Category 1 Credit™ through April 30, 2024.

Statement of Need and Purpose

Parkinson's disease affects up to 10 million people worldwide and is diagnosed by the presence of motor symptoms including bradykinesia in combination with rigidity or resting tremor. Motor symptoms remain the key diagnostic criteria for identifying Parkinson's disease. However, nonmotor symptoms, including psychiatric dysfunction, are also included in the diagnostic criteria, and most patients with Parkinson's disease experience at least one neuropsychiatric complication, with over half of patients developing psychotic symptoms. Parkinson's disease psychosis (PDP) is a nonmotor symptom characterized by hallucinations, illusions, a false sense of presence, and delusions, and increases morbidity and mortality associated with Parkinson’s disease while also negatively impacting patient and caregiver quality of life. 

Clinicians should assess for symptoms associated with PDP at diagnosis and throughout the disease, and patients should be educated early in the course of Parkinson’s disease about nonmotor symptoms such as PDP so they may report them to allow for early interventions. Provisional diagnostic criteria have been proposed by the National Institutes of Neurological Disorders and Stroke and the National Institute of Mental Health, and diagnosis of PDP requires the presence of symptoms characteristic of psychosis which are recurrent or continuous for at least one month, a primary diagnosis of Parkinson's disease, and the exclusion of other causes of psychosis. These criteria and the use of standardized screening tools, such as the NMSQuest self-completing instrument, can aid in identifying neuropsychiatric symptoms associated with PDP and may be especially impactful for patients and caregivers who may not realize symptoms of psychosis can be related to Parkinson's disease. 

PDP should be managed with education, support, and behavioral strategies. Reducing or removing medications that may worsen psychosis, starting with non-Parkinson’s disease medications, and avoiding antipsychotics which can worsen motor symptoms are strategies for addressing PDP. Three antipsychotics, clozapine, quetiapine, and pimavanserin, may be used without worsening motor symptoms. Behavioral strategies such as developing coping mechanisms and providing psychoeducation, caregiver support, and adjustments to the home may also offer benefits in reducing psychosis symptoms. Because PDP may be associated with medications used to treat other symptoms or may be caused by pre-existing psychiatric illness or Parkinson's disease itself, multidisciplinary collaboration is crucial. Coordinated multidisciplinary centers with specialized inpatient and outpatient services for Parkinson's disease may meet the needs of patients with PDP by incorporating specialists from neurology, neuropsychiatry, neuropsychology, and functional neurosurgery as well as nurse coordinators and allied health professionals and can optimize care for these patients and their caregivers.   

Unlabeled and Investigational Usage

The faculty of this educational activity may include discussions of products or devices that are not currently labeled for use by the FDA. Faculty members have been advised to disclose to the audience any reference to an unlabeled or investigational use.

No endorsement of unapproved products or uses is made or implied by coverage of these products or uses.

Please refer to the official prescribing information for each product for discussion of approved indicators, contraindications and warnings.

Review Process

The faculty members agreed to provide a balanced and evidence-based presentation and discussed the topics and CME objectives during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by the Chair and a peer reviewer who is without conflict of interest.

The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporter.

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