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Parkinson disease psychosis — RACP Adult Medicine MCQ

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HardNeurologyParkinson disease psychosisRACP Adult Medicine

A 78-year-old man with Parkinson disease has formed visual hallucinations and confusion after his dopamine agonist dose was increased. He has no fever, urinary symptoms or metabolic abnormality. Motor symptoms are acceptable on levodopa. What is the most appropriate management?

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Correct answer: B — Reduce or stop the dopamine agonist and review other precipitating medicines

Parkinson disease psychosis is commonly medication-related, and reducing dopamine agonists is usually an early step when motor status permits. Increasing dopaminergic therapy worsens psychosis. Haloperidol can markedly worsen parkinsonism, abrupt levodopa withdrawal is unsafe, and thrombolysis is irrelevant.

Reference: Movement Disorder Society guidance; AMH