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UntitledInformation Sheet Hallucinations and
What are hallucinations?
When a person hallucinates they may see, hear, feel, It seems that the hallucinations are caused partly by smell or taste something that, in reality, does not exist.
Parkinson's itself and partly by the medication that is prescribed to treat it. While just about any of the drugs While most people with Parkinson's disease do not can be to blame, hallucinations are more likely to affect get hallucinations, some people may experience people who take dopamine agonist and anticholinergic hallucinations and these are usually visual. While the drugs, particularly if they are in the older age group. hallucinations may comprise quite complex scenes, Further information about these drugs is available in they typically involve the person seeing small animals, the Parkinson's Disease Society (PDS) booklet The Drug insects or other people in the room with them. These Treatment of Parkinson's Disease. images do not usually speak or make sounds and they can either disappear quickly or last for some time. Sometimes, hallucinations occur when an adjustment has Occasionally, the hallucinations are auditory (where the been made to the dose of a particular anti-Parkinson's person hears a voice or sound without seeing anything), drug or when a new drug is added to a combination or tactile (the person feels something touching them), that the person is already taking. On other occasions, but for people with Parkinson's, these are less common it seems that the hallucinations occur spontaneously, than visual hallucinations.
without any immediate cause.
Sometimes, people with Parkinson's experience It is important to remember that most people who have delusions of presence; when they feel that an animal Parkinson's take their medication successfully, without or object is present just next to them but they do not experiencing hallucinations. You should not, therefore, actually see it.
be put off taking the drugs that are prescribed for you. If you are worried or have questions about the medication Most people with Parkinson's fi nd that the hallucinations you are taking, you should discuss these with your GP, they experience are not threatening or distressing. In many specialist doctor or Parkinson's Disease Nurse Specialist. cases, the person with Parkinson's is actually aware that You can also call the Society's freephone Helpline the images or sounds are not real, and are able to cope (0808 800 0303) to talk to a nurse adviser.
with them. In fact, some people even look upon the person or object that they see as a companion. In other instances, the hallucinations can be very frightening, Sometimes, hallucinations are not simply due to particularly if the person with Parkinson's believes that Parkinson's or its drug treatment, but are precipitated the image they see or sound they hear is real and do not by some other cause. For example, an acute illness realise that they are, in fact, hallucinating. In such cases, such as a bladder or chest infection can cause people coping with hallucinations can be diffi cult.
to hallucinate, as can some medications that are prescribed to treat other conditions. Hallucinations can What causes hallucinations?
also be a feature of dementia.
The hallucinations associated with Parkinson's can affect both younger and older people, but they are more common in the older age group, and particularly in Occasionally, visual hallucinations may be due to those who have had Parkinson's for a long time.
severely impaired vision. See the PDS information sheet Parkinson's and Eyes for more information.
Contact the Parkinson's Disease Society
s Disease Society fr
eephone helpline for advice and information on
freephone helpline for advice and information on 0808 800 0303
How are hallucinations treated?
Treatment with special drugs
If you are experiencing hallucinations, it is important that The type of drug that is often prescribed to treat you visit your doctor so that the cause can be identifi ed hallucinations is called a neuroleptic or antipsychotic and any appropriate treatment given.
drug. Unfortunately, most of these drugs can make the symptoms of Parkinson's worse. There are two types Treat any underlying illness
– the older, conventional ones and newer, atypical drugs.
If there is some other underlying cause, such as a Older, more conventional neuroleptics, such as bladder infection, the doctor will treat this and the haloperidol (trade name Haldol) and chlorpromazine hallucinations should then disappear.
(Largactil), always markedly worsen parkinsonism. Thioridazine (Melleril) and sulpiride (Dolmatil) cause Adjustment of anti-Parkinson's medication
moderate worsening. The newer, atypical neuroleptics If the hallucinations are associated with Parkinson's are so called because they are less likely to cause side but are not troublesome, the doctor may decide to effects than standard antipsychotic drugs.
delay giving treatment and just monitor the situation. If, however, the hallucinations are causing distress to However, at least two of these drugs, risperidone the person with Parkinson's, the doctor may suggest (Risperdal) and olanzapine (Zyprexa), should be used that some treatment is necessary.
with caution to treat dementia in people at risk of stroke (the risk increases with age, hypertension, diabetes, The fi rst line of treatment is usually to adjust the anti- atrial fi brillation, smoking and high cholesterol), because Parkinson's medication. This will involve a reduction in of an increased risk of stroke and other cerebrovascular the dose, or the gradual withdrawal, of particular drugs. problems. It is unclear whether there is an increased The doctor will usually withdraw anticholinergic drugs, risk of stroke with quetiapine (Seroquel) and clozapine particularly in older people, and other drugs may also be (Clozaril). Quetiapine (Seroquel) seems much less reduced. Such measures can often eliminate or reduce prone to worsen Parkinson's symptoms and is often the hallucinations, and any improvement is usually noticed used to treat hallucinations, especially when they are within a few weeks, or sometimes even within a few days.
accompanied by troublesome delusions. Clozapine Unfortunately, making adjustments to the anti- (Clozaril) also usually does not worsen Parkinson's Parkinson's drugs does not always eliminate the symptoms, but can be associated with serious bone hallucinations. In addition, you may fi nd that a reduction marrow toxicity. It is, therefore, only used in special in the dose, or the withdrawal, of some drugs can circumstances, and with close monitoring through mean that the symptoms of Parkinson's are not as well regular blood tests.
controlled as they were before. In these cases, the The potential risks of any drug treatment will need to doctor will usually try to achieve a balance by reducing be balanced against the diffi culties that might ensue if the hallucinations to an acceptable level while, at the nothing is done.
same time, trying to maintain a good level of control over the Parkinson's symptoms. This compromise Cognitive impairment and Parkinson's
is usually acceptable if the hallucinations are not Hallucinations may arise, either on or off anti-Parkinson's distressing and the Parkinson's symptom control is drug treatment, in people with Parkinson's who relatively good. If a satisfactory balance between already have some degree of cognitive impairment (for hallucinations and symptoms cannot be achieved, the example, poor recent memory), often associated with doctor may consider prescribing a special drug to help fl uctuating alertness and arousal (sometimes falling overcome the problem.
asleep after taking their tablets). In this situation, drugs Contact the Parkinson's Disease Society freephone helpline for advice and information on 0808 800 0303
called cholinesterase inhibitors such as donepezil important to encourage the person with Parkinson's to hydrochloride (Aricept), rivastigmine (Exelon) and discuss the hallucinations with their doctor because it is galantamine (Reminyl) may improve both cognitive and likely that something can be done to help.
behavioural problems and often also hallucinations. These drugs can sometimes worsen Parkinson's tremor. Where can I obtain further information?
Increasingly, Parkinson's specialists are more likely to If you or the person you are caring for is experiencing consider rivastigmine as the drug of choice for treating hallucinations, the best person to advise you is your GP hallucinations, especially if there is co-existent dementia.
or consultant. It is important that you visit the doctor so that the cause of the hallucinations can be identifi ed Caring for someone who experiences
and any appropriate treatment given.
If you have access to a Parkinson's Disease Nurse Hallucinations can be very diffi cult for a carer to cope Specialist, it is likely that they will be able to provide with. It is not always easy to know how to react and you with further advice about coping with hallucinations. what to say to someone who is hallucinating. The PDS is also here to help you. If you have any While the hallucinations can be quite distressing for the questions or require further information, please contact carer, it is important to try to stay calm. Do not agree us. Our Helpline number is 0808 800 0303, available that there is something in the room when there is not Monday–Friday, 9.30am–9pm, Saturday, 9.30am–5.30pm and try not to let an argument develop about whether (except bank holidays).
the image or sound is real. Instead, offer reassurance, particularly if the hallucinations are causing distress to The PDS would like to thank Dr Duncan Forsyth, Dr Ronald Pearce and Dr Hugh Rickards for their help It is sometimes helpful to explain that you cannot see with updating this information sheet.
what they are seeing or hear what they are hearing, but you understand that the images and sounds are very real to them. It can also be effective to distract the person in order to take their mind off what they are seeing. The image may then disappear. Of course, it is Parkinson's Disease Society
215 Vauxhall Bridge Road, London SW1V 1EJ, UK Tel: 020 7931 8080 Fax: 020 7233 9908
Helpline: 0808 800 0303
Parkinson's Disease Society of the United Kingdom (2008) Charity registered in England and Wales No. 258197 and in Scotland No. SCO37554.
A company limited by guarantee. Registered No. 948776 (London) Registered offi ce: 215 Vauxhall Bridge Road, London SW1V 1EJ Revised March 2008 To obtain any PDS resource, please go online to www.parkinsons.org.uk or contact Sharward Services Ltd, the appointed PDS Distribution House, at Westerfi eld Business Centre, Main Road, Westerfi eld, Ipswich, Suffolk IP6 9AB, tel: 01473 212115, fax: 01473 212114, email: [email protected] Contact the Parkinson's Disease Society freephone helpline for advice and information on 0808 800 0303
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