Parkinson disease psychiatry

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Red flags

• New visual hallucinations or paranoid jealousy in PD — treat as PD psychosis spectrum; exclude delirium first
• Never use high-potency D2 blockers (haloperidol, typical antipsychotics; risperidone/olanzapine traps) for PD psychosis — risk of severe motor worsening
• Pathological gambling, hypersexuality, binge eating, or compulsive shopping after dopamine agonist start — reduce/stop the agonist with neurology
• Compulsive extra levodopa use, severe dyskinesias, and craving — dopamine dysregulation syndrome, not simple non-adherence
• Acute fluctuation with fever or infection — delirium until proven otherwise, not 'just PD psychosis'
• Starting clozapine without FBC monitoring pathway and very low starting dose is unsafe
• Untreated depression and suicide risk in PD are not 'understandable demoralisation' only