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Parkinson's psychosis — DGM MCQ

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HardMovement disordersParkinson's psychosisDGM

An 84-year-old man with Parkinson's disease reports distressing visual hallucinations after a dopamine agonist increase. He is not delirious and has no infection. His mobility benefit has been modest. Current medicines include ropinirole, co-careldopa and amlodipine. What is the most appropriate management?

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Correct answer: C — Review dopamine agonist and seek specialist advice

Dopamine agonists can cause hallucinations and impulse-control symptoms, so medication review with specialist input is appropriate. Haloperidol worsens Parkinsonism, increasing ropinirole may worsen psychosis, abrupt levodopa withdrawal is unsafe, and schizophrenia is less likely. Psychosis in Parkinson's often reflects medication, dementia or delirium and needs careful drug selection.

Reference: NICE NG71; BNF