Nosology and Phenomenology of Psychosis in Movement Disorders

Abstract

Background Psychotic symptoms such as delusions and hallucinations are part of the clinical picture of several conditions presenting movement disorders. Phenomenology and epidemiology of psychosis in Parkinson's disease have received wide attention; however, the presence of psychosis in other movement disorders is, comparatively, less‐well‐known.

Objectives To review psychotic symptoms present in different movement disorders.

Methods A comprehensive and structured literature search was performed to identify and analyze data on patients with movement disorders and comorbid psychosis.

Results In monogenic parkinsonisms, such as PARK‐GBA, PARK‐LRRK2, and PARK‐SNCA, visual hallucinations related to dopamine replacement therapy are frequent as well as are delusions in PARK‐LRRK2, and PARK‐SNCA, but not in PARK‐GBA. Different types of delusions and hallucinations are found in Huntington disease and other choreic disorders. In Tourette syndrome, paranoid delusions, visual, olfactory and auditory hallucinations have been described, which usually develop after an average of 10 years of disease. Delusions in ataxias are more frequent in ATX‐TBP, ATX‐ATN1, ATX‐ATXN3, while it is rare in Friedreich's ataxia. Psychosis is also a prominent and frequent clinical feature in Fahr's disease, Wilson's disease, Neurodegeneration with brain iron accumulation, and some lysosomal storage disorders, while it is uncommon in atypical parkinsonisms and dystonia. Psychosis usually occurs at late disease stages, but may appear as onset symptoms of the disease, especially in Wilson's disease, Huntington disease, Late‐onset Tays Sachs and Niemann‐Pick.

Conclusion Psychosis is a frequent comorbidity in most hyperkinetic and hypokinetic movement disorders. Appropriate recognition is relevant both in the early and late disease stages.