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Delusions in an elderly patient: case report A 74-year-old man developed delusions during treatment with amantadine and pramipexole for parkinsonism [duration of treatments to reaction onset not stated]. The man had a 10-year history of parkinsonism, preceded by schizophrenia. He was receiving olanzapine, levodopa and pramipexole 4 mg/day. However, because he began experiencing peak-dose dyskinesias and on/off fluctuations, treatment with amantadine 200 mg/day was commenced. He rapidly began experiencing severe delusions and was hospitalised. He underwent a single-photon emission CT which revealed a marked bilateral reduction of striatal dopamine transporter binding in the putamen. Amantadine and pramipexole were stopped and the man’s mental state improved markedly after receiving quetiapine. His motor symptoms worsened. Once entacapone was started and the levodopa dose was increased, he achieved good motor control. Author comment: "In our case, the reduction of amantadine and pramipexole led to marked improvement of the delusions. This points to a relationship between medication and psychosis." Habermeyer B, et al. Psychosis in a case of schizophrenia and Parkinson’s disease. Journal of Neuropsychiatry and Clinical Neurosciences 20: 373-375, No. 3, Aug 801124440 2008 - Switzerland

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Reactions 8 Nov 2008 No. 1227