Quetiapine for l -dopa–induced psychosis in PD

Treatment of PD with carbidopa/levodopa or dopamine agonists can induce psychotic behavior characterized by agitation, paranoia, delusions, and visual hallucinations.1 Management of these psychotic symptoms is often difficult and involves the reduction of dopaminergic medications and the limited use of traditional dopamine receptor antagonists (neuroleptics). These therapeutic maneuvers are unsatisfactory and usually lead to worsening of motor disability.1,2 The introduction of atypical neuroleptics to treat psychosis in PD shows promise,3 but it is unclear which agent is associated with the fewest adverse events. We report a patient with levodopa-induced psychotic behavior who did not respond well to olanzapine because of substantial worsening of motor function at very low dosages but who was treated successfully with quetiapine. The patient is an 81-year-old man with a 14-year history of PD. Despite increasing motor symptomatology (Hoehn …