Parkinson's Disease – Psychosis — SCE Neurology MCQ

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ModerateMovement DisordersParkinson's Disease – PsychosisSCE Neurology

A 70-year-old man with Parkinson's disease develops visual hallucinations of small children in his living room. He knows they are not real. He is on co-careldopa 25/100 four times daily and ropinirole 8 mg three times daily. What is the most appropriate first step?

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Correct answer: C — Reduce and stop ropinirole

NICE NG71 advises reducing or stopping dopaminergic medication as the first approach to managing hallucinations in PD. Dopamine agonists (ropinirole) are more likely to cause hallucinations than levodopa, so should be reduced first. If hallucinations persist after medication adjustment, quetiapine or clozapine may be considered. A: Quetiapine is second-line after medication reduction. B: Clozapine is effective but requires monitoring and is reserved for refractory cases. D: Rivastigmine is for PD dementia-associated hallucinations. E: Increasing co-careldopa would worsen hallucinations.

Reference: NICE NG71 Parkinson's Disease (2017)