Screening, Diagnosis, and Management of Parkinson's Disease Psychosis: Recommendations From an Expert Panel.

Symptoms relating to psychosis are debilitating, progressive, and often emerge in patients with Parkinson's disease. Symptoms of Parkinson's disease psychosis include illusions, a false sense of presence, and hallucinations or delusions or both. While there are established consensus criteria for the diagnosis of Parkinson's disease psychosis, there is currently a lack of simple and standardized criteria for the screening of Parkinson's disease psychosis. This can make it challenging to identify patients who may benefit from treatment for Parkinson's disease psychosis symptoms. A group of clinical experts met to discuss guidance for the screening, clinical diagnosis, and management of Parkinson's disease psychosis. The group identified a paucity of screening tools, weaknesses in existing criteria for diagnosing Parkinson's disease psychosis, and variability in treatment recommendations. The group proposed a screening tool that includes two parts: (1) a simple pre-visit screening to be completed by the patient and caregiver before an appointment, and (2) a clinician portion to be discussed with the patient and caregiver during the appointment. If a patient has hallucinations and/or delusions that require treatment, the proposed guidance includes potential interventions or medications, which were established by review of evidence-based literature and the US Food and Drug Administration guidelines. This provides a quick and relatively simple clinical tool for a patient and caregiver to report symptoms of Parkinson's disease psychosis, and for the clinician to formulate an accurate diagnosis and a decision tree to consider treatment options.