title: Diagnostic criteria for psychosis in Parkinson's disease: report of an NINDS, NIMH work group.
abstract: There are no standardized diagnostic criteria for psychosis associated with Parkinson's disease (PDPsy). As part of an NIH sponsored workshop, we reviewed the existing literature on PDPsy to provide criteria that distinguish PDPsy from other causes of psychosis. Based on these data, we propose provisional criteria for PDPsy in the style of the Diagnostic and Statistical Manual of Mental Disorders IV-TR. PDPsy has a well-characterized temporal and clinical profile of hallucinations and delusions, which is different than the pattern seen in other psychotic disorders such as substance induced psychosis or schizophrenia. PDPsy is associated with a poor prognosis of chronic psychosis, nursing home placement, and death. Medications used to treat Parkinson's disease (PD) contribute to PDPsy but may not be sufficient or necessary contributors to PDPsy. PDPsy is associated with Lewy bodies pathology, imbalances of monoaminergic neurotransmitters, and visuospatial processing deficits. These findings suggest that PDPsy may result from progression of the disease process underlying PD, rather than a comorbid psychiatric disorder or drug intoxication. PDPsy is not adequately described by existing criteria for psychotic disorders. We established provisional diagnostic criteria that define a constellation of clinical features not shared by other psychotic syndromes. The criteria are inclusive and contain descriptions of the full range of characteristic symptoms, chronology of onset, duration of symptoms, exclusionary diagnoses, and associated features such as dementia. These criteria require validation and may be refined, but form a starting point for studies of the epidemiology and pathophysiology of PDPsy, and are a potential indication for therapy development.
authors.affiliation: Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14620, USA. bernard.ravina@ctcc.rochester.edu
authors.forename: Bernard
authors.initials: B
authors.lastname: Ravina
authors.forename: Karen
authors.initials: K
authors.lastname: Marder
authors.forename: Hubert H
authors.initials: HH
authors.lastname: Fernandez
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Friedman
authors.forename: William
authors.initials: W
authors.lastname: McDonald
authors.forename: Diane
authors.initials: D
authors.lastname: Murphy
authors.forename: Dag
authors.initials: D
authors.lastname: Aarsland
authors.forename: Debra
authors.initials: D
authors.lastname: Babcock
authors.forename: Jefferey
authors.initials: J
authors.lastname: Cummings
authors.forename: Jean
authors.initials: J
authors.lastname: Endicott
authors.forename: Stewart
authors.initials: S
authors.lastname: Factor
authors.forename: Wendy
authors.initials: W
authors.lastname: Galpern
authors.forename: Andrew
authors.initials: A
authors.lastname: Lees
authors.forename: Laura
authors.initials: L
authors.lastname: Marsh
authors.forename: Mark
authors.initials: M
authors.lastname: Stacy
authors.forename: Katrina
authors.initials: K
authors.lastname: Gwinn-Hardy
authors.forename: Valerie
authors.initials: V
authors.lastname: Voon
authors.forename: Christopher
authors.initials: C
authors.lastname: Goetz
mesh_terms: D032921:Consensus; D003937:Diagnosis, Differential; D004493:Education; D006801:Humans; D009315:National Institute of Mental Health (U.S.); D010300:Parkinson Disease / Q000453:epidemiology*; D015995:Prevalence; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D011643:Publishing / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D014481:United States