Psychosis in parkinson's disease needs a well-concerted management. We know, positive symptoms of psychosis occurs due to dopamine hyperactivity in striatal region of brain whereas hypodopaminergic activity in the striatal region causes parkinson's ds. So treating psychosis with antipsychotics (that blocks dopamine receptors) can exacerbate parkinsonism (antipsychotics can cause extra pyramidal symps) whereas treating parkinsonism with dopsminergic agents can exacerbate psychosis. Thus treating psychosis in parkinsonism needs to be subtly balanced and a well tailored approach needs to be taken.
Recently FDA has approved Pimavanserin to treat psychosis in parkinsonism. One can also use quetiapine and clozapine (having low EPS potentiality) for the above situation. How else can these conditions together can be managed? Expecting expert opinions for this matter.
