Diagnostic criteria for psychosis in Parkinson's disease: Report of an NINDS, NIMH work group

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 pro- pose provisional criteria for PDPsy in the style of the Diagnos- tic and Statistical Manual of Mental Disorders IV-TR. PDPsy has a well-characterized temporal and clinical profile of hallu- cinations and delusions, which is different than the pattern seen in other psychotic disorders such as substance induced psycho- sis 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 visuospa- tial 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 intoxica- tion. PDPsy is not adequately described by existing criteria for psychotic disorders. We established provisional diagnostic cri- teria that define a constellation of clinical features not shared by other psychotic syndromes. The criteria are inclusive and con- This article is part of the journal's CME program. The CME form can be found on page 1214 and is available online at http://www.