Aripiprazole worsening visual hallucination in a patient with lewy body dementia

33 Sir, Lewy body dementia is the most common degenerative form of dementia, next to Alzheimer’s disease.[1] Patients with Lewy body dementia often experience psychotic symptoms such as delusions and hallucinations. In Lewy body dementia, hallucinations are the most common psychotic symptoms.[2] Evidence suggest the association of visual hallucinations, misidentifications, and delusions with dysfunctions of parieto‐occipital cortex, limbic–paralimbic cortex, and frontal lobe, respectively.[3] A recent systematic review and meta‐analysis on pharmacological treatments of Lewy body dementia highlights about the inadequacy of high‐level evidence‐based pharmacological interventions.[4] Donepezil and rivastigmine can improve cognitive and psychiatric symptoms in Lewy body dementia. Antipsychotic agents that may be of some use for the management of psychotic symptoms in Lewy body dementia are – quetiapine, clozapine, olanzapine, and risperidone.[4] High neuroleptic sensitivity is a challenge which limits the use of antipsychotic agents to treat psychotic symptoms associated with Lewy body dementia. We present here a case (after obtaining informed consent) of Lewy body dementia, who reported worsening of visual hallucinations with aripiprazole.