Delusions and Hallucinations Preceding the Onset of Dementia due to Progressive Supranuclear Palsy

Changing a patient’s diagnosis as a disease progresses is not uncommon. This patient had been exhibiting symptoms of psychosis and Parkinsonism, but the final diagnosis, progressive supranuclear palsy, was made only after progressive neurological symptoms were evident. Although progressive supranuclear palsy has been recognized as a subcortical dementia, psychotic symptoms have been reported in only a few patients with this disorder. This patient, however, exhibited psychotic symptoms as the initial presentation. Furthermore, the use of antipsychotics in patients with progressive supranuclear palsy represents a difficult issue because these medications can exacerbate neurological symptoms. In this case, however, a low dosage of quetiapine did not exacerbate the Parkinsonism and was somewhat helpful in treating psychotic symptoms and impulsivity.