hallucinations associated with Parkinson's disease

Etiology

• excessive medications
• cognitive impairment

Clinical manifestations

• may be associated with nightmares & paranoia
• often worse in the evening

Management

• reduce adjunctive medications (step 1)
  • selegiline
  • anticholinergics
  • amantadine
• reduce dopaminergic agonists (step 2)
  • reduce dose at time of day hallucinations occur
  • evening dose reduction most likely of benefit
• atypical antipsychotic may be needed if 1 & 2 fail
  • quetiapine (Seroquel) agent of choice
  • clozapine
    • most effective agent to control hallucinations without worsening motor function
    • begin 12.5 mg QD & increase slowly
    • monitor CBC weekly
  • avoid risperidone; worsens parkinsonism in most patients

More general terms

• hallucination