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Delirium and Lewy body caution — DGM MCQ

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HardDeliriumDelirium and Lewy body cautionDGM

An 82-year-old man with suspected Lewy body dementia develops delirium and frightening visual hallucinations during a urinary infection. He is not violent and can be reassured with staff support. He has marked parkinsonism. Current medicines include co-careldopa and tamsulosin. What is the most appropriate management?

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Correct answer: A — Treat infection and use non-drug delirium measures while avoiding antipsychotics where possible

Lewy body dementia and parkinsonism increase sensitivity to antipsychotics, so cause treatment and non-drug measures are preferred when risk is manageable. Haloperidol can worsen parkinsonism, abrupt levodopa withdrawal is unsafe, moving wards worsens delirium, and benzodiazepines can aggravate confusion. Antipsychotic decisions in delirium must account for Parkinson's disease and Lewy body dementia.

Reference: NICE CG103; NICE NG97; BNF