Parkinson disease (PD) psychosis (PDP) is a spectrum of illusions, hallucinations and delusions that are associated with PD throughout its disease course. Psychotic phenomena can manifest from the earliest stages of PD and might follow a continuum from minor hallucinations to structured hallucinations and delusions. Initially, PDP was considered to be a complication associated with dopaminergic drug use. However, subsequent research has provided evidence that PDP arises from the progression of brain alterations caused by PD itself, coupled with the use of dopaminergic drugs. The combined dysfunction of attentional control systems, sensory processing, limbic structures, the default mode network and thalamocortical connections provides a conceptual framework to explain how new incoming stimuli are incorrectly categorized, and how aberrant hierarchical predictive processing can produce false percepts that intrude into the stream of consciousness. The past decade has seen the publication of new data on the phenomenology and neurobiological basis of PDP from the initial stages of the disease, as well as the neurotransmitter systems involved in PDP initiation and progression. In this Review, we discuss the latest clinical, neuroimaging and neurochemical evidence that could aid early identification of psychotic phenomena in PD and inform the discovery of new therapeutic targets and strategies.

帕金森病 (PD) 精神病 (PDP) 是一系列与帕金森病整个病程相关的错觉、幻觉和妄想。精神病现象可以从帕金森病的最早阶段就显现出来，并且可能遵循从轻微幻觉到结构化幻觉和妄想的连续过程。最初，PDP 被认为是与多巴胺能药物使用相关的并发症。然而，随后的研究提供的证据表明，PDP 是由 PD 本身引起的大脑改变的进展以及多巴胺能药物的使用引起的。注意力控制系统、感觉处理、边缘结构、默认模式网络和丘脑皮层连接的综合功能障碍提供了一个概念框架来解释新传入的刺激如何被错误分类，以及异常的分层预测处理如何产生侵入信息流的错误感知的意识。在过去的十年中，关于 PDP 的现象学和神经生物学基础（从疾病的初始阶段）以及参与 PDP 起始和进展的神经递质系统的新数据不断发表。在这篇综述中，我们讨论了最新的临床、神经影像和神经化学证据，这些证据可以帮助早期识别帕金森病的精神病现象，并为新的治疗靶点和策略的发现提供信息。