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Prosthetic socket skin injury — MRCGP AKT MCQ

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HardDisability SportProsthetic socket skin injuryMRCGP AKT

A person with Parkinson disease has a harmful impulse-control disorder. Specialist-led reduction of the dopamine agonist has been completed as far as motor function permits, but the behaviour remains problematic. What should be offered next?

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Correct answer: B — Specialist cognitive behavioural therapy targeted at impulse control

The best answer is “Specialist cognitive behavioural therapy targeted at impulse control”. NICE recommends specialist cognitive behavioural therapy targeted at impulse-control disorders when modification of dopaminergic treatment has not been effective. This follows specialist-led medication change rather than replacing it at the outset. The therapy should address the specific behaviour and its harms while safeguarding, financial and family consequences continue to be managed. Increasing the dopamine agonist could worsen the disorder, and sedatives or dopamine-blocking antipsychotics are not routine substitutes for targeted therapy and may introduce substantial adverse effects.

Reference: NICE NG71: Parkinson disease in adults: https://www.nice.org.uk/guidance/ng71/chapter/recommendations