PD Psychosis Antipsychotic — RACP Adult Medicine MCQ

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ModerateNeurologyPD Psychosis AntipsychoticRACP Adult Medicine

A 65-year-old man with PD psychosis (visual hallucinations, paranoid ideation) on levodopa. Which antipsychotic is safest?

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Correct answer: B — Quetiapine 12.5–25 mg nocte

In PD psychosis, quetiapine tried first (low D2 affinity). Standard antipsychotics worsen parkinsonism dramatically. Clozapine if quetiapine fails.

Reference: eTG – 2025 – Neurology; MDS – 2023