Management of psychiatric symptoms of Parkinson's disease

Depression and hallucination are the two main psychiatric symptoms in parkinsonian patients. Depressive features in Parkinson patients are very close to those of endogenous depression, except for a relative lack of anxiety, irritability, suicidal ideations, delusions and circadian rhythm. Pharmacotherapy with antidepressants is most reliable in the treatment of parkinsonian depressives, although levodopa or other antiparkinsonian drugs may relieve a depression. Hallucinatory complications of long-term antiparkinsonian treatment appear in two types of symptoms: (1) hallucinosis type-vivid visual hallucination and illusion with clear consciousness and well-preserved orientation, and (2) delirium type-less vivid visual hallucination and illusion with disturbed orientation and confusion. Antipsychotic drugs and 'drug holiday' are recommended for the management of hallucinations as side effects of antiparkinsonian drugs.