Prevalence of Psychosis Spectrum Symptoms, Association with Quality of Life and Caregiver Burden in Yoruba Nigerians with Parkinson's Disease: A Matched Case Control Study.

Abstract

BACKGROUND: Up to 60% of persons with idiopathic Parkinson's disease (PD) will develop psychosis spectrum symptoms at some point during the course of illness. These symptoms are often undetected by attending physicians but are associated with great distress to patients and their caregivers. OBJECTIVES: To investigate the prevalence and association of positive psychosis symptoms with quality of life (QoL) and caregivers' burden among clinic attendees with PD at two tertiary general hospitals in South western Nigeria. METHOD: A case-control study was conducted between February 2023 to June 2024. Cases (N=150) were neurology outpatients with PD. Controls (N=150) were neurologically healthy individuals matched for age, sex, education, and outpatient status. Psychosis, QoL, and caregiver burden were assessed using the Scale for the Assessment of Positive Symptoms (SAPS), PD-QoL questionnaire (PDQ-8), and Caregivers Strain Index (CSI), respectively. Adjusted odds ratios (aO.R) and standardized coefficients (aCoeff.) were estimated using regression analyses. Estimates were within 95% confidence intervals (C.I). RESULTS: Psychosis symptoms were present in 28% of cases. Hallucinations were the most frequent symptom (16.7%). Cases with Psychosis were more likely to be ≥60years (88.1%, p=0.020), ever users of alcohol (78.6%, p=0.012), had higher mean motor-severity scores (51.1±15.7, p<0.001), and probable dementia (21.4%, p=0.001). In unconditional logistic regression analyses, cases had approximately five-point increase in the independent odds psychosis (aOR=4.92, 95% C.I=2.20, 10.99), and two-point increase in the independent odds of requiring social support (aOR=1.95, 95% C.I=1.19, 3.21). CONCLUSION: The near five-point increase in the odds of psychosis spectrum symptoms in PD and their greater requirement for social support underscores the need for multidisciplinary approaches that include not only neurologists but psychiatrists, and social workers.