DLB – Antipsychotic Sensitivity — SCE Neurology MCQ

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ModerateNeurodegenerative DiseaseDLB – Antipsychotic SensitivitySCE Neurology

A 68-year-old woman with dementia with Lewy bodies is experiencing distressing visual hallucinations of strangers in her house. She is on no dopaminergic medication. Non-pharmacological measures have failed. Her cardiologist has confirmed a normal QTc interval. What is the most appropriate pharmacological option?

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Correct answer: C — Quetiapine at a low dose

Patients with DLB (and PDD) have a severe sensitivity to typical and most atypical antipsychotics, which can cause life-threatening rigidity, impaired consciousness, and autonomic instability. If an antipsychotic is absolutely necessary, only quetiapine (at a low dose) or clozapine should be used. NICE NG97 advises extreme caution. A: Haloperidol is contraindicated in DLB. B: Olanzapine carries significant risk. D: Risperidone is particularly dangerous in DLB. E: Chlorpromazine is a typical antipsychotic and contraindicated.

Reference: NICE NG97 Dementia (2018); DLB Consortium (2017)