BACKGROUND Antidopaminergic medications, including
antipsychotics, are known to worsen motor and neuropsychiatric symptoms, including cognition and
psychosis, in patients with
dementia with Lewy body (DLB). The intensity of worsened clinical symptoms may vary and can result in mortality in certain situations. There have been some reports supporting
clozapine,
quetiapine and
pimavanserin use in
psychosis control in this population. CASE REPORT We describe the case of 75-year-old man with diagnosis of DLB and the post-treatment outcome with
olanzapine for
psychosis during hospitalization. He experienced worsened cognitive and motor functions. Discontinuation of
olanzapine resulted in resolution of the clinical worsening. Further, re-initiation of
Pimavanserin helped treat his
hallucinations. He returned back to his baseline during a follow-up visit in the clinic at 1 month after discharge. Further, we incorporated the use of Best Practice Alert (BPA) as a part of the electronic health record (EHR) system to help providers identify patients prone to
neuroleptic sensitivity and help select appropriate medications to treat
psychosis in this patient population. CONCLUSIONS Administration of
antipsychotics in patients with
parkinsonism, especially DLB, requires close clinical monitoring and judicious use. Awareness of morbidity and mortality associated with such use is of importance, especially during hospitalization. From our experience, we incorporated use of BPA, which can help providers make judicious choices while treating this patient population.
Pimavanserin, which is FDA-approved for
psychosis in
Parkinson's disease, could be a potential safe and effective treatment option in this patient population.