Objective: We studied the phenotypic characteristics of psychosis in PD patients, their associated risk factors and assessed their long term outcome.

Background: Psychosis in PD is common and an important contributor of disease morbidity and mortality. PD psychosis studies are mostly cross sectional and have focused on visual hallucinations. There are no longitudinal studies from India addressing the phenotypic spectrum and long term outcome of PD psychosis.

Methods: The study involved 50 PD patients with and 50 without psychosis. At baseline following parameters were analysed: age, age at onset, duration of PD, UPDRS motor score, MMSE, Hamilton depression rating score (HDRS), University of Miami PD Hallucinations Questionnaire (UM-PDHQ), Brief Psychiatric Rating Scale (BPRS), gait freezing, sleep and visual abnormalities and medication history. The phenotypic spectrum of psychosis was described. The prevalence of psychosis, dementia and death in these two groups were noted at the end of five years and the baseline factors predicting these outcomes were analysed.

Results: PD psychosis patients were older (68.1±6.8vs 60.04±11.5 years), had increased disease duration (10.2±4.7 vs 6.7±4.3years), severe disease (UPDRS-46.06 +14.91vs 35.22 +15.92), low MMSE (25.36±5.04 vs 27.78±2.96), high HDRS (14.68±7.19 vs 9.9±5.95) and BPRS (42.1±12.01 vs32.22±11.98) scores, more sleep disturbances (50% vs 34%), gait freezing (18% vs6%) and visual abnormalities (12% vs4%). Levodopa daily (747.1±496 vs 507.1±314.9) and levodopa equivalent doses (934.6±538.22 vs 677.84±381.83) were also higher in PD psychosis group. The phenomenology comprised of visual (84%), minor (49%), auditory (55%), tactile (24%), olfactory (16%) hallucinations and delusions (32%). Autoscopic (n: 2) and gustatory (n: 1) hallucinations were also noted. At the end of five years, psychosis persisted in 46%and resolved in 38%, dementia (38% vs 4%) and mortality (38%vs 14%) were high in PD psychosis group compared to controls. New onset psychosis was seen in 10% of PD controls.

Conclusions: Old age, increased disease duration, severe disease, dementia, depression and levodopa intake were the risk factors for psychosis in the present study. A wide range of psychotic symptoms were encountered in addition to the formed visual hallucinations. The mortality in PD psychosis was high. Interestingly the prevalence of psychosis was low in control PD patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/phenotypic-spectrum-and-longitudinal-outcome-of-parkinsons-disease-patients-with-psychosis/