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PD Psychosis – Stepwise Reduction — SCE Neurology MCQ

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ModerateMovement DisordersPD Psychosis – Stepwise ReductionSCE Neurology

A 74-year-old with Parkinson disease develops distressing formed visual hallucinations with loss of insight. He takes co-careldopa, ropinirole and amantadine. Urinalysis, renal function, oxygenation and medication reconciliation reveal no intercurrent delirium trigger. What is the most appropriate next step?

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Correct answer: D — Reduce amantadine and the dopamine agonist in sequence while monitoring motor function

After excluding delirium and reversible precipitants, review antiparkinsonian treatment with specialist input. Medicines most likely to exacerbate psychosis, including amantadine and dopamine agonists, are generally reduced before levodopa; abrupt withdrawal should be avoided.

Reference: NICE NG71, psychotic symptoms: https://www.nice.org.uk/guidance/ng71/chapter/Recommendations