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Parkinson disease psychosis with impulse control disorder — SCE Geriatric Medicine MCQ

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HardMovement disordersParkinson disease psychosis with impulse control disorderSCE Geriatric Medicine

A 79-year-old man with Parkinson disease is reviewed because of distressing evening hallucinations. He takes co-careldopa five times daily, ropinirole, rasagiline and amantadine. His wife reports new compulsive online shopping and he has no fever, dysuria or metabolic disturbance. Examination shows mild dyskinesia and MoCA is 24/30. What is the most important next step?

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Correct answer: C — Seek specialist advice to reduce Parkinson medicines most likely to provoke hallucinations and impulse control disorder

Dopamine agonists and amantadine can precipitate hallucinations and impulse control disorders in Parkinson disease, so medication rationalisation with specialist input is the key next step. NICE advises medical evaluation for triggers and reduction of provoking Parkinson medicines before antipsychotic treatment where feasible. Olanzapine can worsen motor features and should not be used for Parkinson psychosis. A clinical pearl is to ask directly about gambling, shopping, hypersexuality and binge eating when dopamine agonists are prescribed.

Reference: NICE NG71; BNF