رجل عمره ٧٦ سنة عنده باركنسون، يأخذ ليفودوبا منذ ١٠ سنوات. صار يرى أشخاصاً غير موجودين في غرفته ليلاً ويتكلم معهم، وزوجته خائفة. لا توجد عدوى أو حرارة. أي دواء مضاد للذهان يجب تجنبه غالباً؟

A 76-year-old man with Parkinson’s on levodopa for 10 years has begun seeing people who are not there in his room at night and talking to them; his wife is frightened. There is no infection or fever. Which antipsychotic should usually be avoided?

1. Clozapine with careful monitoring
2. Reviewing the Parkinson’s drug doses
3. Haloperidol
4. Low-dose quetiapine

Answer: C) Haloperidol. Haloperidol and other potent antipsychotics block dopamine and markedly worsen parkinsonism. Drug doses are reviewed first; quetiapine, clozapine or pimavanserin may be used.