Which antipsychotics are considered acceptable for Parkinson disease psychosis according to avoidance guidelines?

Which antipsychotics are considered acceptable for Parkinson disease psychosis according to avoidance guidelines?

• A. Quetiapine, Clozapine, Pimavanserin
• B. Haloperidol
• C. Olanzapine
• D. Risperidone

Answer: (A)

In Parkinson disease psychosis, you want antipsychotics that don’t block dopamine receptors, so they don’t worsen the motor symptoms of Parkinson disease. Pimavanserin is a 5-HT2A receptor inverse agonist that treats PDP without dopamine blockade, so it’s a preferred option. Quetiapine is another good choice because it has low D2 occupancy and a relatively low risk of extrapyramidal symptoms, making it tolerable for many patients. Clozapine is effective for PDP and also carries a low EPS risk, though it requires careful monitoring for agranulocytosis. Haloperidol, a strong D2 blocker, tends to worsen motor symptoms and is avoided in PDP. Olanzapine and Risperidone have higher risks of extrapyramidal effects due to dopamine antagonism, so they’re less favored for PDP in guidelines. So the acceptable options are Pimavanserin, Quetiapine, and Clozapine, with the others less suitable because of their dopamine-blocking profiles and motor risks.

In Parkinson disease psychosis, you want antipsychotics that don’t block dopamine receptors, so they don’t worsen the motor symptoms of Parkinson disease. Pimavanserin is a 5-HT2A receptor inverse agonist that treats PDP without dopamine blockade, so it’s a preferred option. Quetiapine is another good choice because it has low D2 occupancy and a relatively low risk of extrapyramidal symptoms, making it tolerable for many patients. Clozapine is effective for PDP and also carries a low EPS risk, though it requires careful monitoring for agranulocytosis.

Haloperidol, a strong D2 blocker, tends to worsen motor symptoms and is avoided in PDP. Olanzapine and Risperidone have higher risks of extrapyramidal effects due to dopamine antagonism, so they’re less favored for PDP in guidelines.

So the acceptable options are Pimavanserin, Quetiapine, and Clozapine, with the others less suitable because of their dopamine-blocking profiles and motor risks.