The development of psychotic symptoms in Parkinson's disease requires a careful, stepwise clinical response. When cognitive impairment is absent, the therapeutic approach follows a specific sequence designed to address both triggering factors and disease-related medication.
This protocol applies to patients with established Parkinson's disease who present with psychotic symptoms in the absence of cognitive impairment. The co-occurrence of psychosis without cognitive decline defines a distinct sub-population that informs both the priority and sequence of interventions.
Management begins with non-pharmacological measures — including stimulus shielding, reorientation, and restoration of circadian rhythm — alongside addressing any identifiable general medical contributors. A structured review and adjustment of the patient's current medication follows.
DOI: 10.1186/s42466-024-00325-4
If the symptomatology allows, the treatment should start with implementation of general non-pharmacological measures (e.g. stimulus shielding, reorienting measures, re-establishment of a circadian rhythm).
Implementation of general therapeutic measures such as fluid supplementation for exsiccosis and treatment of an infection should be started, followed by reduction/adjustment of triggering medication in general (anticholinergic, antiglutamatergic, or sedative drugs) followed by PD medication, especially amantadine, MAO-B inhibitors, dopamine agonists and COMT inhibitors, or combination treatments.
Alternatively, quetiapine can be offered off-label in PD patients without cognitive impairment.
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