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Parkinson disease psychosis — ABIM Board MCQ

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HardNeurologyParkinson disease psychosisABIM Board

A 74-year-old man with Parkinson disease has recurrent formed visual hallucinations despite correction of infection, sleep disruption, and anticholinergic exposure. Reducing dopaminergic therapy worsens disabling rigidity. ECG QTc is normal and cognition is stable. Which treatment best targets psychosis while avoiding dopamine D2 blockade?

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Correct answer: A — Start pimavanserin and monitor clinical response and QT effects

The best answer is “Start pimavanserin and monitor clinical response and QT effects”. Pimavanserin is a serotonin 5-HT2A inverse agonist approved for Parkinson disease psychosis and does not block D2 receptors, so it is less likely to worsen parkinsonism. QT risk, mortality warning in dementia-related psychosis, interactions, and clinical response still require review. Typical antipsychotics and dopamine-blocking antiemetics can markedly worsen motor function.

Reference: DailyMed: Pimavanserin Prescribing Information: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1e6bea44-57d6-4bac-9328-46e1ee59f83b