Hallucinations in Parkinson's disease
February 21, 2012 | 20,00 EUR | answered by Dr. med. Ralf Berg
My mother is 83 years old and has Parkinson's. Lately, she always thinks someone has kidnapped her and she can't escape. She begs us to bring her back home. Recently, she also thought someone tried to shut her down at night. She is taking 200mg of Seroquel. Now I have read that antipsychotic drugs can cause hallucinations in Parkinson's patients. Is she taking too much? Should we give her a different medication for the hallucinations? Seroquel always helped her sleep very well. Can we give her a different medication for sleep? What do you think of Zopiclone? I know it can be addictive, like benzodiazepines. But maybe we can overlook that, as she probably won't live much longer. Please respond quickly. My mother is really suffering from her perceptual disturbances.
Dear questioner,
first of all, it would be important to clarify why and with what goal your mother is taking Seroquel. Since this is a medication used for bipolar disorders, both for depression and hallucinations (schizophrenia), I find it hard to imagine that it is only being used for sleep. There are of course alternatives for sleeping. However, you should discuss these with the treating general practitioner or specialist. In geriatrics, there are some medications that, in addition to their antipsychotic effects, also make you very tired. I do not think it is currently advisable to stop taking Seroquel. The dosage is more likely too low than too high. Daily doses of up to 800 mg may be necessary to break through delusions. The adjustment must be gradual, and I can only advise you to seek a neurologist/psychiatrist locally.
Furthermore, it should be examined whether there really is a productive psychosis with delusions, or whether it has already progressed to a "Parkinson's dementia" with a misinterpretation of reality, which could be the underlying cause of your mother's behavioral disorders. Since I know how high the distress in the family is due to these conditions, it would, in my opinion, be justified to consider treating and stabilizing your mother in a psychiatric facility if the situation worsens. That is the only place where her behavior can be observed medically and nursing-wise.
Conclusion:
1. Definitely seek outpatient qualified neurological/psychiatric help.
2. Consider adding another sleep aid to Seroquel as soon as possible.
3. "Titrate up" the Seroquel under medical guidance.
4. If the situation escalates, also consider a hospitalization for your mother.
Best regards,
Dr. R. Berg
