Medication-induced delirium — RACGP Fellowship MCQ

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HardGeriatricsMedication-induced deliriumRACGP Fellowship

A 69‑year‑old man with Parkinson disease reports visual hallucinations and confusion after starting oxybutynin for urinary urgency. His temperature is normal, urinalysis is negative, and his cognition was previously stable. What is the most appropriate immediate management?

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Correct answer: B — Stop the anticholinergic medication and review cognition and urinary symptoms

Explanation lettering: C = shown as B · E = shown as C · B = shown as E

The patient’s presentation is consistent with medication‑induced delirium due to oxybutynin’s anticholinergic properties, particularly in the context of Parkinson disease. Australian guidance emphasises stopping drugs that precipitate delirium, especially anticholinergics, as the key first step in management. Evidence shows that symptoms improve with withdrawal of oxybutynin. Increasing levodopa (A) does not address the cause and may worsen hallucinations. Starting haloperidol (B) is not indicated initially and may exacerbate parkinsonism; moreover, antipsychotics are reserved for severe agitation. Treating asymptomatic bacteriuria (D) or diagnosing schizophrenia (E) are not supported by the clinical context.

Reference: Australian Prescriber (Therapeutic Guidelines). Managing delirium in older patients. 2011. https://australianprescriber.tg.org.au/articles/managing-delirium-in-older-patients.html