Parkinson's Psychosis
- common
- can occur in context of PD dementia or in cognitively normal individuals
- characterised by:
- hallucinations - visual - tactile - auditory
- delusional thinking
- disrupted sleep-wake cycle
First Steps
- refer to movement disorder team or old age psychiatrist - URGENTLY
- rule out infectious precipitant
- consider stopping/reducing culprit medications - in this order:
- trihexyphenidyl
- amantadine
- selegiline/rasagiline
- dopamine agonist - must be reduced slowly
Non-drug Management
- CPN appointed via mental health team
- carer support instituted
- baseline bloods
- in case new treatment is required
- baseline ECG
- to access QT interval, if anti-psychotics are to be commenced
- montreal cognitive assessment (MoCA)
- to screen for dementia www.mocatest.org
Drug Management
- if dementia syndrome:
- consider donepezil 5-10 mg nocte
- consider rivastigmine 1.5 mg bd (max 6 mg bd)
- consider rivastigmine patch 4.6 mg per 24 hour (max 13.3 mg) check lying/standing BP and ECG first
- check lying/standing BP and ECG first
- avoid typical anti-psychotic drugs
- haloperidol, chlorpromazine
- consider atypical anti-psychotic agent
- quetiapine 25-50 mg nocte
- aripiprazole 1-5 mg daily
- for treatment failure:
- clozapine 6.25-12.5 mg daily
- requires specialist initiation and monitoring