Psychosis Assessment in Early-Stage Parkinson’s Disease: Comparing Parkinson’s Psychosis Questionnaire with the Brief Psychiatric Rating Scale in a Portuguese Sample

I Cargaleiro,J Alves Da Silva,B Neto,M Gonçalves-Pereira,P Bugalho,M Serra

doi:10.1155/2012/469126

Abstract

Psychotic symptoms in Parkinson's disease (PD) are frequent, disabling, and an important prognostic factor. Thus, screening instruments for detecting psychosis in PD are needed. For this purpose, we applied the Parkinson's Psychosis Questionnaire (PPQ), a short structured questionnaire, which requires no specific training, along with the Brief Psychiatric Rating Scale, expanded version (BPRS-E), for rating general psychopathology, including psychotic symptoms. We evaluated, in a cross-sectional study, a Portuguese sample of 36 early-stage PD patients (mean age of 73 years; mean duration of illness of 3.2 years). The PPQ total score correlated with the BPRS-E total score (0.359; P = 0.032) and with the BPRS-E-positive symptoms score (0.469; P = 0.004). The prevalence of psychosis (41.7%) was higher than expected. Sampling bias and detection of minor psychotic phenomena may have contributed to this result. These findings suggest that the PPQ should be further evaluated as a feasible assessment for psychotic symptoms in PD.

Highlights

In the context of Parkinson’s disease (PD), the term psychosis usually referred to a mental state characterized by hallucinations and/or delusions, occurring with a clear sensorium and a chronic course
There was no evidence of correlation between levodopa equivalent dosages (LED) and the other BPRS-E factor scores, or between LED and the Total BPRS-E score
Minor psychotic phenomena were responsible for the definition of approximately one quarter of cases. This could help to explain the high prevalence of psychotic symptoms found in our sample of patients with early stage PD

Summary

Introduction

In the context of Parkinson’s disease (PD), the term psychosis usually referred to a mental state characterized by hallucinations and/or delusions, occurring with a clear sensorium and a chronic course. Definitions have changed and the typical hallucinatory syndrome in PD encompasses other related phenomena, such as minor phenomena, like illusions, sense of presence, and passage hallucinations [1]. Among the nonmotor features of Parkinson’s disease (PD), psychotic symptoms are frequent, ranging from 20 to 30% of patients [2]. Over the course of PD, psychotic symptoms, once present, tend to be persistent and progressive [3]. The impact of psychosis is substantial in that it is associated with dementia, depression, earlier mortality, greater caregiver strain, and nursing home placement. Psychosis has important treatment implications, as it limits the therapy of motor symptoms [4]

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Conclusion