Antipsychotic Choice in PD Psychosis — SCE Palliative Medicine MCQ

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HardNon-Malignant Palliative CareAntipsychotic Choice in PD PsychosisSCE Palliative Medicine

A patient with Parkinson’s disease psychosis has persistent distressing hallucinations despite medication rationalisation and an adequate quetiapine trial. Which treatment should now be offered with mandatory blood monitoring?

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Correct answer: D — Clozapine

NICE advises considering quetiapine for Parkinson’s disease psychosis and offering clozapine when standard treatment is ineffective. Clozapine has the strongest efficacy evidence with relatively little motor worsening, but agranulocytosis risk requires the formal blood-monitoring service. Typical antipsychotics, risperidone and olanzapine can substantially worsen parkinsonism. Apply this conclusion only to the clinical circumstances stated, with appropriate specialist review, contraindication checks, shared decision-making and follow-up. Reassess if the physiology, treatment response or competing risk changes. The competing options would require a different haemodynamic profile, diagnosis, procedural indication or risk balance from the one described here.

Reference: NICE NG71: Parkinson’s disease in adults. https://www.nice.org.uk/guidance/ng71/chapter/recommendations