What You Need to Know About Psychosis in Parkinson’s Disease

 By Margarita Tartakovsky, M.S.

Psychosis doesn’t just affect individuals with psychiatric disorders such as schizophrenia. It also affects other illnesses, including Parkinson’s disease (PD), a degenerative disorder that disturbs movement and balance.

Over five million people worldwide have PD, struggling with symptoms such as shaking, stiffness, slowness of movement and instability.

“Psychosis in Parkinson’s disease is very common,” according to Michael S. Okun, M.D., national medical director at the National Parkinson Foundation and author of the Amazon no. 1 bestseller Parkinson’s Treatment: 10 Secrets to a Happier Life.

In fact, psychosis may affect 1 in 5 Parkinson’s patients, he said. And as many as 2 out of 3 patients may experience minor symptoms, “such as non-bothersome illusions.” (An example is “seeing something in the corner of your eye that may not be there, [such as] a bug in the sink for an instant.”)

“Patients primarily experience visual hallucinations,” said James Beck, Ph.D, the director of research programs at Parkinson’s Disease Foundation. A smaller number of patients – 10 to 20 percent – experience auditory hallucinations, he said.

Some patients also may experience delusions, or fixed false beliefs. According to Dr. Okun in his piece on managing psychosis in PD:

“Delusions are usually of a common theme, typically of spousal infidelity. Other themes are often paranoid in nature (such as thinking that people are out to steal from one’s belongings, or to harm or place poison on their food, or substitute their Parkinson medications, etc.) Because they are paranoid in nature, they can be more threatening and more immediate action is often necessary, compared to visual hallucinations (Zahodne and Fernandez 2008a; Zahodne and Fernandez 2008b; Fernandez 2008; Fernandez et al. 2008; Friedman and Fernandez 2000). It is not uncommon that patients actually call 9-1-1 or the police to report a burglary or a plot to hurt them.”

In the early stages of psychosis, patients tend to have insight into their symptoms, Beck said. In other words, they realize that what they’re seeing (or hearing) isn’t actually there. But this may worsen over time. According to Okun in the same piece:

“At later stages [of psychosis], patients may be confused and have impaired reality testing; that is, they are unable to distinguish personal, subjective experiences from the reality of the external world. Psychosis in Parkinson’s disease patients frequently occurs initially in the evening, then later on spills into the rest of the day.”

Psychosis typically doesn’t develop until several years after a person has been diagnosed with PD, Beck said.

(If hallucinations are present from the start, then it may be another condition. For instance, Lewy body dementia “might cause psychosis and can be misdiagnosed as Parkinson’s disease.”)

These symptoms can be incredibly disturbing for both patients and caregivers, Beck said. They also make caregiving more challenging and overwhelming. Some research has found that hallucinations were the strongest predictor for institutionalization.

What Triggers Psychosis in Parkinson’s Disease

“There are many potential triggers for hallucinations or other psychotic phenomena and these include medications, infections and sleep deprivation,” Okun said. Particularly in the elderly population, stress, dehydration and urinary tract infections can spark hallucinations, Beck said.

Medications that treat Parkinson’s disease increase levels of dopamine in the brain. This is important, because the disorder involves the malfunction and loss of neurons that produce dopamine. Dopamine relays messages to the substantia nigra and other parts of the brain, which control movement and coordination.

But dopamine also plays a pivotal role in hallucinations, Beck said. In other words, by boosting dopamine levels, these medications improve motor symptoms, and may produce psychosis.

Parkinson’s disease itself may lead to hallucinations. As the disease progresses, it can impair cognition and visual processing, leading to dementia, Beck said.

Treating Psychosis in Parkinson’s Disease

“Psychosis does not always require treatment, particularly if hallucinations are non-bothersome,” Okun said. If it does require treatment, doctors try to pinpoint what’s causing the hallucinations. For instance, if it’s an infection, they may prescribe antibiotics. If it’s a sleep disorder, they may prescribe a sleeping aid.

To reduce hallucinations directly, atypical antipsychotics, such as clozapine (Clozaril) and quetiapine (Seroquel), may be used, Okun said.

To date clozapine is the only medication shown to be effective in double-blind studies, Beck said. (This 2011 paper reviews the research for clozapine along other medications.) “Though given at very low doses for Parkinson’s, clozapine may cause a dangerous drop in white blood cell count. Therefore, patients must undergo regular blood monitoring.”

First-generation or typical antipsychotic drugs, such as haloperidol, are not prescribed for psychosis in PD. In fact, this is actually dangerous, because these drugs lower dopamine and can induce a “neuroleptic crisis,” Beck said.

He also mentioned a new drug called pimavanserin, developed specifically for psychosis in Parkinson’s disease. (It hasn’t received FDA approval yet.) Instead of modulating dopamine, Beck said, this drug targets serotonin. Some research has suggested that activating particular serotonin receptors can lead to visual hallucinations. “Shutting down the activity of this receptor and neurons associated with it may alleviate hallucinations [without] impacting motor performance.”

Psychosis is a serious problem for many patients with Parkinson’s disease. Beck stressed the importance of telling your doctor right away if you’re struggling with hallucinations or other psychotic symptoms. “Early intervention [or] treatment can make a difference, improving quality of life for both the person with PD and their caregiver.” He also encouraged readers to work with a movement disorders specialist, who will have expertise in both motor and non-motor symptoms.

Additional Information

▪   Both the Parkinson’s Disease Foundation (800-457-6676) and the National Parkinson Foundation (800-473-4636) have helplines for more information.

▪   Parkinson’s Disease Foundation includes over 30 seminars you can watch with PD experts on research, treatment, non-motor symptoms and more.

▪   National Parkinson Foundation features a helpful outline of psychosis in PD.

▪   The Michael J. Fox Foundation offers a wealth of information, including articles on diagnosis, treatment and the latest science.

    Last reviewed: By John M. Grohol, Psy.D. on 4 Aug 2015

    Published on PsychCentral.com. All rights reserved.

http://psychcentral.com/lib/what-you-need-to-know-about-psychosis-in-parkinsons-disease/ 

Size Matters When It Comes to Cells' Vulnerability to Parkinson's

Brian Burt/Flicker

Neurons involved in Parkinson’s disease are especially susceptible to burnout because of their complex branching

By Diana Kwon | August 27, 2015

Each year doctors diagnose approximately 60,000 Americans with Parkinson’s disease, an incurable neurodegenerative condition for which the number-one risk factor is age. Worldwide an estimated seven to 10 million people currently live with the malady. As U.S. and global populations grow older, it is becoming increasingly urgent to understand its causes.

So far, researchers know that Parkinson’s involves cell death in a few restricted areas of the brain including the substantia nigra (SNc), one of two big cell clusters in the midbrain that house a large population of dopamine neurons. These cells release dopamine and are involved in a variety of functions including reward processing and voluntary movement. Their death leads to the motor control and balance issues that are core symptoms of the disease.

New research shows that these brain cells, most at risk in Parkinson’s disease, require unusually high amounts of energy to carry out their tasks because of their highly branched structures. Like a massive car with an overheating engine, these neurons are susceptible to burnout and early death. This discovery emerged from a comparison of energy use in nigral dopamine neurons and in similar neurons found in the nearby ventral tegmental area (VTA), also in the midbrain. “We were trying to understand why dopamine neurons of the substantia nigra die in Parkinson’s disease patients while there are so many other brain cells that have no problem at all,” says Louis-Eric Trudeau, a neuroscientist at the University of Montreal and senior author of the study published in the August 27 Current Biology.

Although located nearly side by side, neurons in the SNc expended much larger amounts of energy than those in the VTA, and their mitochondria, the structures that create energy in cells, continuously worked at maximum capacity. On further examination, the researchers found that the huge demand of these energy-guzzling cells stemmed from the fact that they are about twice the size of their neighbors in the VTA. SNc neurons also have many more axonal extensions. Like a tree with many branches, the larger neurons require more energy to survive and carry out their functions.

When the experimenters reduced this branching by adding semaphorin, an axonal guidance protein that inhibits neural growth, it reduced mitochondrial activity, energy expenditure and vulnerability in these neurons. Unfortunately, such an approach would compromise surviving neurons, which need to increase their branching, especially in aging brains, to take over and replenish dopamine stores.

SThe hypothesis that extensive axonal branching contributes to the vulnerability of dopamine neurons implicated in Parkinson’s has been suggested in the past, but this is the first study that puts these claims to the test—in the lab at least. It remains to be seen if the findings also can be obtained in living animals, says André Parent, a professor at Laval University who studies neurodegenerative diseases and was not involved in the study.

All of us lose dopamine neurons as we age. This is not a problem for most people because as neurons are lost, other surviving ones take over. In some individuals, however, a “critical threshold” of neural loss is reached and the remaining cells are no longer able to compensate. “Parkinson’s is a multiple-hit disease,” Trudeau says. “To develop the disease, you need a few things: the aging process and a mutation or exposure to environmental toxins. Perhaps all of us have neurons that are at risk that will eventually die in older age. But we don’t have that second ‘hit’ that will increase the stress on these cells, leading to the development of the disease.” The large dopamine cells in the substantia nigra need extra energy to run, and this chronically elevated stress makes them more vulnerable to gene mutations, environmental effects and aging, all of which might be why they are some of the first to die off.

Trudeau and his team are now looking to use the findings from this discovery to improve rodent models of Parkinson’s disease so that they are better able to mimic what happens in the primate brain. Because such brains are bigger, dopamine neurons have more territory to cover, likely requiring them to make more connections and expend more energy. Currently, scientists are not even sure that rats or mice develop Parkinson’s at all, and it might be because their cells are too small. Future studies will hopefully reveal exactly how much size matters in brain.

http://health.einnews.com/article/283432200/6UH0iR_7H0fZ4RVn

Lawson and STEMCELL Technologies Announce Partnership for Commercialization of Tools for Parkinson’s Disease Research

August 26, 2015 8:00 AM

GlobeNewswire

Parkinson’s Disease is the second most common neurodegenerative disorder, after Alzheimer’s disease, affecting about seven to ten million people around the world. It is characterized by progressive neurological impairment that produces tremor, slowness of movement, impaired balance, muscle rigidity, cognitive decline and other medical disturbances. The symptoms are caused by the death of cells in the nervous system, including those that generate dopamine, which is a chemical neurotransmitter that sends signals between nerve cells. Although specific gene mutations have been identified in a minority of patients, there is no known cause in most individuals. There is currently no cure for Parkinson’s Disease.

A team led by Dr. Matthew Hebb, a neurosurgeon-researcher at Lawson and Western University’s Department of Clinical Neurological Sciences has been developing innovative strategies to study Parkinson’s Disease. “The partnership with STEMCELL Technologies greatly expands the expertise focused on moving this technology forward and providing critical access to researchers worldwide.” says Dr. Hebb.

Commenting on the agreement:

“We are delighted for the opportunity to bring these important products to the research community and we are excited to be the exclusive supplier.”

- Dr. Allen Eaves, CEO and President of STEMCELL Technologies

“Lawson’s partnership with STEMCELL Technologies is critically important to provide global access to these novel research tools that are anticipated to enable unique insights into the disease process.”

- Kirk Brown, Manager, Business Development, Lawson

“Lawson is very pleased to partner with STEMCELL Technologies to make these products available to all researchers, with the immediate goal of moving Parkinson’s Disease research forward and the ultimate goal that it will lead to better treatment options for patients.”

- Dr. David Hill, Scientific Director, Lawson

About Lawson

As the research institute of London Health Sciences Centre and St. Joseph's Health Care London, and working in partnership with Western University, Lawson Health Research Institute is committed to furthering scientific knowledge to advance health care around the world. Commercialization at Lawson is facilitated by WORLDiscoveries®, a joint venture of Lawson, Western, and Robart’s Research Institute. As the business development arm of London, Ontario’s extensive research network, it is a bridge between local invention and global industry.

About STEMCELL Technologies

As Scientists Helping Scientists, STEMCELL Technologies Inc. is committed to providing high-quality cell culture media, cell isolation products and accessory reagents for life science research. Driven by science and a passion for quality, STEMCELL Technologies provides over 2000 products to more than 70 countries worldwide. STEMCELL Technologies’ specialty cell culture reagents, instruments and tools are designed to support science along the basic to translational research continuum. To learn more, visit www.stemcell.com.

Contact:

For more information, please contact:                                                                 

Lawson - Laura Goncalves

Communications & External Relations

T: 519-685-8500 ext. 64059

C: 226-448-1525

laura.goncalves@lawsonresearch.com

https://twitter.com/lawsonresearch

STEMCELL – LubaMetlitskaia, MSc.

Director, Licensing and Business Development

e-mail: bdv@stemcell.com

visit us at: www.stemcell.com

Haldol (Haloperidol) is one drug that should be avoided by people who have Parkinson’s disease.

On Haldol (Haloperidol)… Again. Posted: 27 Aug 2015 07:32 AM PDT

For some time, it has been known that Haldol (Haloperidol) is one drug that should be avoided by people who have Parkinson’s disease.  It amazes me that conferences I have attended, webinars I have seen, things I have read by specialized doctors in the PD community all reiterate the claim: stay away from this and other like drugs.

However, when you talk to many PD patients, they have no idea that there is any concern over certain drugs being administered to PD patients.  Why? Because in most cases, they administered while you are in the hospital for some other reason other than PD related and the medical staff is unaware of the dangers, as well.

Most nurses AND doctors are not educated in the field of Parkinson’s disease and so administering drugs to calm a patient is seemingly protocol – NOT.

Over Thanksgiving, my mother n-law was telling about her time in the hospital a few years back and a doctor on duty ordered an MRI for her. She fought with the orderly over going to have it done as she lay in her hospital bed. She told the orderly, after insisting she wasn’t stepping foot in that room, that she had a pace maker.  The doctor later came to her and apologized for that ‘minor’ overlook.  What if she hadn’t been coherent? What if…

The point: you have to be proactive with your care and treatment. You have to know more about you than those caring for you or a life-threatening mistake could occur (see my previously published article of a PD patient and their experience with Haldol as told by his son in-law).

So, if you have PD,  here are the drugs you need to make  a note of to AVOID: Haloperidol (marketed as Haldol, Haldol Decanoate, and Haldol Lactate). This is an antii-psychotic drug, often prescribed to people with schizophrenia. Other like drugs include risperidone (Risperdal), aripiprazole (Abilify) and olanzapine (Zyprexa). These drugs will play havoc on your brain or much worse. One conference speaker (doctor – movement disorder specialist) went so far as to say they will KILL a person with PD.

There are, however, two drugs (antipsychotic) that can be used  without  a problem to the PD patient: quetiapine (Seroquel) and clozapine (Clozapine).

Well, I have done my Haldol rant for the year, but I’ll be back just in case you forget.

The post On Haldol (Haloperidol)… Again. appeared first on Parkinson's Journey.

Copied from website Parkinson's Journey

A diet low in animal fat and rich in N-hexacosanol and fisetin is effective in reducing symptoms of Parkinson's disease.

J Med Food. 2012 Aug;15

This study describes how foods rich in fisetin and hexacosanol added to a strict diet reversed most symptoms of Parkinson's disease (PD) in one patient.

 This is a case report involving outpatient care. The subject was a dietitian diagnosed with idiopathic PD in 2000 at the age of 53 years old, with a history of exposure to neurotoxins and no family history of PD. A basic diet started in 2000 consisted of predominantly fruits, vegetables, 100% whole grains, extra virgin olive oil, nuts, seeds, nonfat milk products, tea, coffee, spices, small amounts of dark chocolate, and less than 25 g of animal fat daily. The basic diet alone failed to prevent decline due to PD. In 2009, the basic diet was enhanced with a good dietary source of both fisetin and hexacosanol. Six months after the patient started the enhanced diet rich in fisetin and hexacosanol, a clinically significant improvement in symptoms was noted; the patient's attending neurologist reported that the clinical presentation of cogwheel rigidity, micrographia, bradykinesia, dystonia, constricted arm swing with gait, hypomimia, and retropulsion appeared to be resolved. 

The only worsening of symptoms occurred when the diet was not followed precisely. Little improvement in tremor or seborrhea was observed. The clinical improvement has persisted to date. To the best of our knowledge, this is the first case where adjunctive diet therapy resulted in a significant reduction of symptoms of PD without changing the type or increasing the amount of medications.

PMID: 22846082 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/22846082