American Board of Internal Medicine (ABIM) Certification Practice Exam

In managing medication-induced psychosis in Parkinson's patients, what is a primary consideration?

1. Increasing antipsychotic medication

2. Discontinuing other Parkinson's medications

3. Starting deep brain stimulation

4. Prescribing higher doses of levodopa

The correct answer is: Discontinuing other Parkinson's medications

In managing medication-induced psychosis in patients with Parkinson's disease, a primary consideration is to discontinue other Parkinson's medications. This approach is essential because certain medications used to treat Parkinson's can exacerbate psychotic symptoms. Dopaminergic therapies, such as levodopa or dopamine agonists, can lead to or worsen psychosis, including hallucinations and delusions. Reducing or temporarily stopping these medications can help alleviate the psychotic symptoms while still considering the overall management of Parkinson's disease. Addressing this issue effectively often involves finding a balance between managing the patient's motor symptoms and minimizing psychiatric side effects. In some cases, after reevaluating the patient's condition and symptoms, clinicians may consider adjustments to the medication regimen. However, the first step in reducing medication-induced psychosis often requires the careful withdrawal of those Parkinson's medications that are most likely contributing to the psychiatric symptoms, hence prioritizing patient safety and mental health.