This Medical Alert Wallet Card has been developed to help you quickly inform Emergency Room medical professionals of important medication sensitivities in LBD. Present this card any time you are hospitalized, require emergency medical care, or meet with a new physician for the first time.
To request a printed copy, click here.
The card contains the following message to physicians:
Emergency Treatment of Psychosis in LBD
Psychotic symptoms such as visual hallucinations of people or animals, or misidentifying one’s spouse or one’s home are common in LBD. The goal of addressing these symptoms is to ensure the safety of the patient and others.
Up to 50% of patients with LBD who are treated with any antipsychotic medication may experience severe neuroleptic sensitivity (worsening cognition, heavy sedation, increased or possibly irreversible parkinsonism, or symptoms resembling neuroleptic malignant syndrome which can be fatal).
1. Identify possible etiologies of delirium, e.g., pain, infection, metabolic stress, alcohol withdrawal.
2. Reduce or eliminate anticholinergic medications, such as OTC sleep agents and bladder-control medications, and reduce dopaminergic drugs used to treat Parkinson’s disease, if clinically indicated.
3. Consult with a doctor experienced in treating LBD. Cholinesterase inhibitor drugs may improve cognition and
psychiatric symptoms, although such effects are not usually immediate.
4. Antipsychotic agents may be indicated if psychotic symptoms are severe and pose a significant safety risk. AVOID traditional antipsychotic agents (e.g., haloperidol). Newer atypical antipsychotic agents (e.g., quetiapine, clozapine) should only be used with caution at the lowest dose possible, under close supervision of a physician
and an RN, and should be switched to a safer medication as soon as possible.
A more comprehensive physician’s guide to treating behavioral disturbances in LBD patients can be found at https://lbda.org/emergency-room-treatment-of-psychosis/.