Bashir Adam Yakasai
Case report: We present a 68-year-old male, retired civil servant who was seen in the neurology clinic at Barau Dikko Teaching hospital, Kaduna-Nigeria with a complaint of abnormal movements of upper and lower limbs for one year, and difficulty in walking for two months. The abnormal movement started on the distal part of both upper limbs simultaneously. It was noticed more at rest and got aggravated during movements. He was diagnosed with PD and was treated with L-dopa and Artane. However, six weeks after the commencement of his therapy he started developing a visual hallucination that subsequently became so intense that he started isolating himself and became suspicious of the wife conniving with strange people to kill him. His psychosis was initially treated with clozapine which controlled the hallucination to some extent but made his dyskinesia worse. This prompted us to stop the clozapine and to decrease the l-dopa, while introducing an anticholinesterase pyridostigmine which helped in treating the psychotic episode.
Discussion: The use of psychotropic medication may control the psychotic features but will aggravate the PD. A trial with anticholinesterases has been found to be effective in the control of psychosis in PD.
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