Open Access

Karsten Witt, Johannes Levin, Thilo van Eimeren, Alkomiet Hasan, Georg Ebersbach, Mathias Bähr, Jos Becktepe, Daniela Berg, Kathrin Brockmann, Carsten Buhmann, Andrés Ceballos-Baumann, Joseph Claßen, Cornelius Deuschl, Günther Deuschl, Richard Dodel, Georg Ebersbach, Carsten Eggers, Thilo van Eimeren, Alessandra Fanciulli, Bruno Fimm, Ann-Kristin Folkerts, Madeleine Gausepohl, Alkomiet Hasan, Wiebke Hermann, Rüdiger Hilker-Roggendorf, Günter Höglinger, Matthias Höllerhage, Franziska Hopfner, Wolfgang Jost, Elke Kalbe, Jan Kassubek, Stephan Klebe, Christine Klein, Martin Klietz, Thomas Köglsperger, Andrea Kühn, Paul Krack, Florian Krismer, Gregor Kuhlenbäumer, Johannes Levin, Inga Liepelt-Scarfone, Paul Lingor, Kai Loewenbrück, Matthias Löhle, Stefan Lorenzl, Sylvia Maaß, Walter Maetzler, Regina Menzel, Philipp T. Meyer, Brit Mollenhauer, Manuela Neumann, Per Odin, Tiago Outeiro, Monika Pötter-Nerger, René Reese, Kathrin Reetz, Olaf Rieß, Viktoria Ruf, Anja Schneider, Christoph Schrader, Alfons Schnitzler, Klaus Seppi, Friederike Sixel-Döring, Alexander Storch, Lars Tönges, Claudia Trenkwalder, Thilo van Eimeren, Uwe Walter, Tobias Wächter, Tobias Warnecke, Florian Wegner, Christian Winkler, Karsten Witt, Dirk Woitalla, Kirsten Zeuner, Martina Bantel, Jonas L. Witt

• Background and objective Impulse control disorders (ICD), psychosis and delirium are part of the spectrum of behavioural changes associated with Parkinson’s disease (PD). The diagnostic and therapeutic management of these rather complex neuropsychiatric conditions has been updated in the clinical guideline by the German Society of Neurology (DGN). Methods Recommendations are based on a systematic literature reviews, other relevant guidelines and expert opinion. Results Patients receiving dopamine agonists (DA) therapy should be informed about the symptoms and risks of an ICD and should be routinely screened for ICD symptoms. In the presence of an ICD, DA should be reduced or discontinued and psychotherapeutic treatment may be considered. Non-oral therapies (levodopa/carbidopa intestinal gel infusion or deep brain stimulation) may also be an option for appropriate candidates. Psychosis in PD often has a gradual onset. Cognitive and affective disorders, psychiatric and medicalBackground and objective Impulse control disorders (ICD), psychosis and delirium are part of the spectrum of behavioural changes associated with Parkinson’s disease (PD). The diagnostic and therapeutic management of these rather complex neuropsychiatric conditions has been updated in the clinical guideline by the German Society of Neurology (DGN). Methods Recommendations are based on a systematic literature reviews, other relevant guidelines and expert opinion. Results Patients receiving dopamine agonists (DA) therapy should be informed about the symptoms and risks of an ICD and should be routinely screened for ICD symptoms. In the presence of an ICD, DA should be reduced or discontinued and psychotherapeutic treatment may be considered. Non-oral therapies (levodopa/carbidopa intestinal gel infusion or deep brain stimulation) may also be an option for appropriate candidates. Psychosis in PD often has a gradual onset. Cognitive and affective disorders, psychiatric and medical comorbidities as well as polypharmacy are risk factors for a psychosis. Non-pharmacological treatments should be implemented as soon as possible and anti-parkinsonian medications should be adjusted/reduced if feasible. For psychosis associated with PD, quetiapine or clozapine should be used on an as-needed basis and for as short a time as is necessary, with safety monitoring. Delirium in PD may be underdiagnosed due to an overlap with chronic neuropsychiatric features of PD. Although transient by definition, delirium in PD can lead to permanent cognitive decline, motor impairment and increased mortality. Management of delirium includes pharmacological and non-pharmacological interventions. Conclusion The updated guideline encompasses the evidence-based diagnostic, non-pharmacological and pharmacological management of ICD, psychosis and delirium in PD.…