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Parkinson disease hallucinations from dopamine agonist — USMLE Step 3 MCQ

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ModerateInternal Medicine (chronic management)Parkinson disease hallucinations from dopamine agonistUSMLE Step 3

A 72-year-old man with Parkinson disease has worsening visual hallucinations. He takes carbidopa-levodopa and pramipexole. His wife says he sees children in the living room at night but is not violent. Cognition is mildly impaired. Urinalysis and metabolic panel are normal. Which of the following is the most appropriate next step in management?

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Correct answer: B — Reduce or discontinue pramipexole if feasible

Dopamine agonists commonly worsen hallucinations in Parkinson disease. Reducing nonessential dopaminergic medications is first-line when psychosis is not dangerous. Typical antipsychotics and metoclopramide can worsen parkinsonism.

Reference: Movement Disorder Society Parkinson disease management guidance