Fast Five Quiz: Are You Familiar With Conditions Associated With Hallucinations?

Stephen Soreff, MD; Selim Benbadis, MD; Amy Kao, MD

Disclosures

October 26, 2015

Hallucinations and agitation are especially troublesome in DLB. When these symptoms are mild, no medical treatment may be necessary.

When medication is used, acetylcholinesterase inhibitors should usually be tried first. For example, double-blind, placebo-controlled studies have demonstrated that the cholinesterase inhibitor rivastigmine may decrease psychiatric symptoms associated with DLB, particularly apathy, anxiety, hallucinations, and delusions.

Studies have also shown that patients with DLB treated with cholinesterase inhibitors do better on neuropsychological tests than do patients treated with placebo. Cholinesterase inhibitors that may be effective in the treatment of DLB also include donepezil and galantamine. In a small minority of patients, motor features are worsened with cholinesterase inhibitors.

Most experts recommend atypical neuroleptics, such as clozapine, quetiapine, or aripiprazole, when cholinesterase inhibitors are ineffective. Avoid standard neuroleptics, such as haloperidol, because of neuroleptic sensitivity.

Some experts have tried antiepileptic drugs to treat agitation and hallucinations, but clinical data supporting their use is lacking.

For more the treatment of DLB, read here.

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