Patients with Parkinsons disease, stroke, and other brain disorders occasionally experience delusions and hallucinations without prominent cognitive impairment or other evidence of psychiatric disorder.
- Psychotic symptoms may be secondary to a prescribed dopaminergic agent, but some patients experience visual hallucinations before any medications are started. Education and support should be offered to all patients with these symptoms. If the patients experience significant emotional distress or if the symptoms lead to dangerous or upsetting behavior, cautious use of an antipsychotic medication is appropriate (see Table 1).
- For patients with Parkinsons disease and hallucinations, quetiapine 12.5–75 mg/d may be beneficial. Some patients require clozapine 12.5–75 mg/d. However, patients taking clozapine must have a CBC with absolute neutrophil count done once a week for 6 mo and then biweekly thereafter because of the risk of granulocytopenia.