Psychosis Management in Parkinson’s Disease

Q. Which antipsychotic is preferred for management of psychosis in elderly with parkinson's disease?












Quetiapine is the drug of choice for psychosis in parkinson’s disease.


Reason: Due to quetiapine’s low potency D2 receptor blockade. Parkinson’s disease involves degeneration of neurons in the basal ganglia which makes them more susceptible to EPS (extrapyramidal symptoms) when given antipsychotics.



Among the atypical antipsychotics:

  • Highest incidence of extrapyramidal symptoms is with = risperidone.

  • Lowest incidence of extrapyramidal symptoms is with= quetiapine and clozapine.


Source (must read for residents):
  • Atypical antipsychotic use in patients with dementia: managing safety concerns. Am J Psychiatry. 2012 Sep;169(9):900-6.

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Dr. Harvinder Singh, M.D. (Admin)

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