Othello syndrome describes a form of psychosis in which one has delusional thoughts about their partner having an affair or similar relationship that does not exist. They may misinterpret ‘clues’ to support this delusion.
Delusions and hallucinations can be seen with certain psychiatric disorders and in the setting of Parkinson’s disease with the following conditions:
-High dose dopamine medicines especially dopamine agonists, amantadine and selegiline
-Other medicines that can cause confusion such as anticholinergics, muscle relaxants and pain medicines (narcotics)
-Illicit (street) drugs)Cognitive problems suggestive of dementia
-Coexisting medical conditions such as thyroid disease, vitamin deficiency (B12),infection or dehydration
-Reducing medicines when possible
-Occupational therapy evaluation to analyze how someone is taking medicines and help family administer medicines in the event the person with PD is taking more than prescribed
-Antipsychotic medicines- namely clozaril or quetiapine
-Cognitive enhancing medicines such as rivastigmine
-Counseling and psychiatric evaluation to evaluate for other conditions
-There is little evidence to date about the effect of a new antipsychotic.
-A combined neurology and psychiatry evaluation may be needed for this difficult problem.
See related article on hallucinations
Hallucinations are a side effect associated with dopaminergic medicines used to treat Parkinson’s disease motor symptoms. Hallucinations are an altered perception of how our brain interprets information it receives about our environment, surroundings, senses and/or body sensations. Hallucinations can be visual, auditory or tactile. The most common type of hallucinations in PD are visual in nature. They may range from the experience of a simple illusion such as ‘seeing’ a spot on the wall turn into a well formed object such as a spider or they me be more complex and actual visions that do not exist. Sights of people and animals are common hallucinations. A person can have insight into and reason through the fact that a hallucination is not indeed real. In more advance cases, insight is lost and hallucinations are interpreted as real without the ability to reason that they are not grounded in reality.
The risk of experiencing hallucinations if you have Parkinson’s disease increases with the following:
- High levels of dopaminergic medicines. Specific medicines such as dopaminergic agonists, anticholinergic medicines and amantadine are associated with a higher risk of this problem.
- Additive effect of other brain active medicines such as sedatives, sleeping aids, muscle relaxants, narcotic pain medicines and some bladder medicines.
- Cognitive problems, confusion and dementia increases risk of hallucinations associated with Parkinson’s medicines.
- Visual problems such as cataracts, glaucoma and reduced night vision can increase the risk of developing hallucinations especially at night. (Hallucinations are not directly caused by eye problems but reflect how the brain interprets sensory information. However, poor vision does exacerbate this problem in susceptible individuals.)
- Stress can increase the risk – whether emotional, physical or the stress on your body from a medical condition or surgery.
- Change or reduction in Parkinson’s medicines and other brain active medicines described above.
- Antipsychotic medicines. Only two antipsychotic medicines are recommended for PD-clozapine and quetiapine. Other antipsychotics can worsen movement problems due their dopamine blocking activity.
- Cognitive enhancing medicines such as Aricept or Exelon if dementia is a problem
- Medical evaluation to insure other medical conditions are not contributing to the problem. Examples include cardiopulmonary disease, thyroid problems, vitamin B12 deficiency, infection, dehydration and kidney disease.
- Lifestyle changes with a focus on stress management and improved sleep.
A positive attitude and gratitude for that which adds meaning and value to life can help you deal with life’s set backs, frustrations and improve health related problems. Gratitude can even be found during and even increase in the setting of difficult times. Gratitude enhances positive thinking which can help us deal with health related problems. Gratitude can help us better manage stress which not only worsens how we feel with PD but is linked to health problems such as depression, anxiety, heart disease and cancer.
What is the take home message? Use these techniques to take a moment and reflect on what you are grateful for to improve your sense of well-being, mood, PD symptoms and perhaps general health.
- Tell yourself something you are grateful for, thankful of, or appreciative of each day.
- Take this exercise on step further by writing your thoughts of gratitude down in a book or journal.
- Share your thoughts of gratitude with you partner or someone special in your life.
- Take a moment out of each week to read your thoughts of gratefulness.
Depression is a symptom of Parkinson’s disease. Find out more:
- Present in up to 50% of people with Parkinson’s
- Can co-exist with anxiety, apathy or cognitive problems
- Can begin before movement problems
- Can be generalized, or a symptom associated with off periods
- Impacts life quality as much or sometimes more than movement problems.
- Is high in caregivers if not recognized and treated
- Responds to exercise, socialization, diet, stress management, and medicines
Find out more about depression in the July-August Wellness Center update.
What is the association between Parkinson’s and depression?
Many people with Parkinson’s experience depression, in fact, up to 50% of people with Parkinson’s.The cause of depression in Parkinson’s is thought to occur from biochemical changes (serotonin, dopamine, and norepinephrine) in brain regions that influence mood. Depression can also be caused by other circumstances and frustrations such as a reaction or response to your Parkinson’s diagnosis, life worries, social isolation, loneliness, or secondary to chronic frustrations when symptoms cause problems with everyday tasks. Depression can be present at all times, as a reaction to having a bad day or when Parkinson’s medications start to wear off just before the next dose of medicine is due. Other facts about depression
- Can be present all the time or as a wearing off symptom
- Can be present with anxiety
- Can be associated with apathy or loss of motivation
- Conversely apathy can be present without depression
- Can worsen sleep, pain, coping, fatigue
- Impacts relationships, lifestyle choices so important to living better
- Is treatable- diet, exercise, relaxation techniques, stress reduction and gratitude all can help
- New antidepressants called selective serotonin reuptake inhibitors and norepinephrine-serotonin reuptake inhibitors improve symptoms
See Wellness Center for more about depression
Reduce stress and improve symptoms.
Does stress cause Parkinson’s? My tremor is only noticeable when I am under stress.
Although stress may not cause Parkinson’s, it certainly can affect how you feel with the disease, cope and adjust to symptoms and your own tendency to take charge of your condition.
Stress can worsen symptoms, especially tremor and freezing. Steps to reduce stress can improve these symptoms. Mindfulness therapies such as yoga, guided imagery, meditation and hypnosis can help. Learn more…