A 67-year-old male with Parkinson's disease has been experiencing visual hallucinations for the last few weeks. He often sees small children playing in his room. His current medications include carbidopa/levodopa and pramipexole. What could be causing these symptoms and what are the next steps?
Visual hallucinations can occur in patients with Parkinson's disease, often as a side effect of dopaminergic medications like pramipexole. However, they can also occur due to the progression of the disease itself. After ruling out other causes of hallucinations such as infections or metabolic abnormalities, a medication review should be undertaken. The dose of pramipexole might need to be reduced or discontinued. If hallucinations persist, an antipsychotic medication that is safe in Parkinson's disease, such as quetiapine or pimavanserin, might be considered.