A 65-year-old man with Parkinson's disease on levodopa-carbidopa and pramipexole reports formed visual hallucinations of people in the house. He is cognitively intact and insight is preserved. Which is the most appropriate next step?
- A Start haloperidol
- B Reduce or stop pramipexole ✓
- C Start donepezil
- D Start clozapine
Correct answer: B. Reduce or stop pramipexole
Explanation
Visual hallucinations in Parkinson's disease are often medication-induced, particularly by dopamine agonists like pramipexole. The first step is to reduce or withdraw the offending dopaminergic agent. Haloperidol worsens parkinsonism and is contraindicated. Clozapine is reserved for refractory psychosis. Donepezil is used if dementia with Lewy bodies is suspected.
Reference: Parkinson's Disease and Movement Disorders (Jankovic/Tolosa), 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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