Management of Madopar-Induced Psychosis in Parkinson's Disease

Assessment and Management

• The American Academy of Family Physicians recommends assessing for delirium, which may present with similar symptoms to psychosis but requires different management, in patients with Parkinson's disease 1, 2
• The American Academy of Family Physicians suggests that atypical antipsychotics, such as quetiapine, risperidone, and olanzapine, be used as first-line treatment for psychosis in Parkinson's disease patients, with quetiapine starting at 12.5 mg twice daily and a maximum dose of 200 mg twice daily 3
• The British Journal of Psychiatry recommends including families in the treatment plan and providing education about the nature of the problem, as well as emotional support and practical advice to families in crisis 4, 5
• The American Academy of Family Physicians advises monitoring for impulse control disorders, such as gambling, increased sexual urges, and uncontrolled spending, which may develop with dopaminergic medications, and avoiding typical antipsychotics, such as haloperidol and fluphenazine, due to the risk of worsening motor symptoms 3