Management of Delusions of Infidelity in Early-Onset Parkinson's Disease

Assessment and Medication Review

The American Academy of Family Physicians recommends assessing for other potential causes of delusions, including metabolic disturbances, infections, or other medication side effects 3

Quetiapine is the preferred antipsychotic for managing delusions of infidelity in Parkinson's disease patients, starting at 25 mg immediate release orally at bedtime with careful titration, as recommended by the American Family Physician 1, 2
The American Academy of Neurology suggests that quetiapine can be given every 12 hours if scheduled dosing is required, and has advantages such as being less likely to cause extrapyramidal symptoms and having sedating properties 2, 4
The Annals of Oncology recommends using lower doses of quetiapine in older patients and those with hepatic impairment 4
Olanzapine may be considered as an alternative option if quetiapine is ineffective, with a starting dose of 2.5-5 mg orally at bedtime, according to the Annals of Oncology 3
Aripiprazole can be considered as a third option, with a starting dose of 5 mg orally daily, as suggested by the Annals of Oncology 3

The American Academy of Neurology advises avoiding haloperidol and other first-generation antipsychotics in patients with Parkinson's disease due to the high risk of worsening motor symptoms 4, 5
The Annals of Oncology recommends avoiding risperidone due to the increased risk of extrapyramidal symptoms at doses above 6 mg/24 hours 4

The Journal of the National Comprehensive Cancer Network recommends providing reorientation and cognitive stimulation regularly, implementing good sleep hygiene practices, and reducing or eliminating any medications with anticholinergic properties that may be contributing to delirium/psychosis 6
The Annals of Oncology suggests educating family members about the nature of delusions in Parkinson's disease to reduce distress and improve understanding 4

The Annals of Oncology recommends monitoring for response to antipsychotic therapy, sedation, and orthostatic hypotension, as well as other side effects including metabolic effects with long-term use 4, 5
The Journal of the National Comprehensive Cancer Network suggests considering psychiatric consultation for refractory symptoms 6

The Annals of Oncology recommends that the management approach must balance control of psychotic symptoms with maintaining adequate control of motor symptoms 3
The Journal of the National Comprehensive Cancer Network suggests that if delusions persist despite medication adjustments, consider reducing levodopa dose if motor symptoms allow 6