21st June 2023

A 79-year-old woman with Parkinson’s Disease was brought into A&E by her carer after being extremely agitated and attacking a member of staff

A 79-year-old woman with Parkinson’s Disease was brought into A&E by her carer after being extremely agitated and attacking a member of staff at the nursing home.

Paramedics injected 1mg lorazepam IM to sedate her enough to get her into the ambulance, which has now had good effect.

The carer reports that one year ago, she developed hallucinations, which were well controlled with quetiapine. In the last 6 months, she has developed paranoid delusions and has no insight with them.

She is currently on levodopa 300mg OD and ropinirole 1g TDS, quetiapine 125mg ON and lorazepam 1mg PRN.

What is the most appropriate next step in management?