Meeting abstract

https://doi.org/10.24869/spsih.2026.228

Treatment of Psychotic Symptoms in Parkinson Disease – A Case Report

Kristina Divić ; University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia *
Marina Mustapić ; University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
Jelena Popović ; University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia

* Corresponding author.

Abstract

Parkinson’s disease is a progressive neurodegenerative
disorder characterized by motor symptoms
such as resting tremor, bradykinesia, rigidity,
and postural instability, as well as numerous
non-motor symptoms, including cognitive impairment,
depression, and psychotic symptoms.
Treating psychosis in Parkinson’s disease is a
therapeutic challenge because most antipsychotics
can worsen motor symptoms. Clozapine is often
considered the treatment of choice due to its
lower risk of extrapyramidal side effects, but its
use may be limited by adverse effects such as hypersalivation
and sedation. We present the case of
a female patient born in 1953 with a diagnosis of
Parkinson’s disease, who exhibited bradykinesia,
hypokinesia, hypomimia, and rigidity. Despite
increasing the dose of levodopa/benserazide and
introducing pramipexole during 2024, her motor
symptoms gradually worsened. Neuropsychological
assessment showed cognitive deficits and
pronounced speech disturbances, consistent with disease progression. In May 2025, she developed
anxiety-depressive symptoms, for which escitalopram
and alprazolam were introduced. Shortly after
starting this therapy, paranoid interpretations
of reality and auditory hallucinations appeared.
Escitalopram was discontinued, and clozapine
was introduced, titrated to a dose of 25 mg three
times daily, along with quetiapine 25 mg twice
daily. Despite treatment, psychotic symptoms
persisted, and marked hypersalivation developed,
further impairing the patient’s everyday functioning.
Due to the poor therapeutic response
and side effects, clozapine was discontinued, and
olanzapine was introduced at a dose of 5 mg in
the evening and 2.5 mg in the morning. After the
change in therapy, psychotic symptoms stabilized
without any worsening of motor function. This
case report highlights the complexity of treating
psychotic symptoms in Parkinson’s disease and
the importance of an individualized treatment
approach, with careful balancing between control
of psychiatric symptoms and preservation of the
patient’s motor functioning.

Keywords

antipsychotics; side effects; Parkinson’s disease

Hrčak ID:

352376

URI

https://hrcak.srce.hr/352376

Publication date:

15.6.2026.

Article data in other languages: croatian

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