A 74-year-old with Parkinson disease has distressing visual hallucinations. Delirium and other triggers have been excluded, specialist-led reduction

Question

A 74-year-old with Parkinson disease has distressing visual hallucinations. Delirium and other triggers have been excluded, specialist-led reduction of contributory Parkinson medicines has not helped, and cognition is intact. Which pharmacological option should be considered next?

Accepted Answer

Use lower-dose quetiapine, explaining that this indication is off label

Answer

Start rivastigmine and retain the current dopaminergic regimen

Answer

Use standard-dose olanzapine because it is least likely to worsen parkinsonism

Answer

Use clozapine first without registration or haematological monitoring

Answer

Use haloperidol because preserved cognition prevents extrapyramidal deterioration

Fingolimod – First-Dose Bradycardia — SCE Neurology MCQ

A 74-year-old with Parkinson disease has distressing visual hallucinations. Delirium and other triggers have been excluded, specialist-led reduction of contributory Parkinson medicines has not helped, and cognition is intact. Which pharmacological option should be considered next?