Delirium in patients with Parkinson's disease

Seek specialist advice when managing delirium in Parkinson's disease

• a major problem in the management of patients with Parkinson's disease can be drug-induced neuropsychiatric problems such as visual hallucinations and confusion
• consider quetiapine to treat hallucinations and delusions in people with Parkinson's disease who have no cognitive impairment.
• if standard treatment is not effective, offer clozapine to treat hallucinations and delusions in people with Parkinson's disease. Be aware that registration with a patient monitoring service is needed.
• be aware that lower doses of quetiapine and clozapine are needed for people with Parkinson's disease than in other indications.
• do not offer olanzapine to treat hallucinations and delusions in people with Parkinson's disease.
• recognise that other antipsychotic medicines (such as phenothiazines and butyrophenones) can worsen the motor features of Parkinson's disease
  
• other causes of an acute confusional state should be considered

Reference:

1. NICE. Parkinson’s disease in adults. NICE guideline NG71. Published July 2017