Psychosis (olanzapine, quetiapine), inappropriate sexual behavior, visual hallucinations refractory to donepezil

• A. Lewy Body dementia treatment
• B. Quetiapine, fluoxetine/olanzapine combo
• C. Treatment-resistant MDD
• D. Postpartum psychosis treatment

Answer: (A)

In Lewy body dementia, visual hallucinations and psychosis are common and often persist despite cholinesterase inhibitors like donepezil. When psychosis is refractory to donepezil, management focuses on using an antipsychotic with a lower risk of worsening parkinsonism and other motor symptoms, since Lewy body pathology makes patients particularly sensitive to typical antipsychotics. Quetiapine is favored for this reason, as it tends to have fewer extrapyramidal effects, while olanzapine can still worsen motor symptoms and metabolic side effects. This pattern—psychosis and visual hallucinations in the context of dementia with parkinsonian features, treated with cautious use of atypical antipsychotics—fits Lewy body dementia treatment best.

The other options don’t align as well with this clinical picture. Postpartum psychosis is tied to the peripartum period and mood instability rather than a dementia syndrome with fluctuating cognition and parkinsonism. Treatment-resistant major depressive disorder would emphasize mood symptoms and require different pharmacologic strategies. A mood-psychosis approach like combining quetiapine with fluoxetine or olanzapine isn’t the typical framework for a dementia-related psychosis pattern, especially when core features point to Lewy body pathology.