Background. Parkinson’s disease psychosis (PDP) is a common, nonmotor symptom of Parkinson’s disease (PD), which may affect up to 60% of patients and is associated with impaired quality of life, increased healthcare costs, and nursing home placement, among other adverse outcomes. Characteristic symptoms of PDP include illusions; visual, auditory, tactile, and olfactory hallucinations; and delusions. PDP symptoms typically progress over its course from being mild, infrequent, and often untroubling to complex, sometimes constant, and potentially highly disturbing. PDP has traditionally been treated with atypical antipsychotics (e.g., clozapine and quetiapine) although these are not approved for this indication and clozapine requires frequent white blood cell count monitoring due to the risk of agranulocytosis. Pimavanserin is a newer atypical antipsychotic with highly selective binding to serotonergic receptors, no evidence for worsening motor symptoms in PD, and no need for white blood cell count monitoring. It is currently the only approved medication indicated for PDP treatment. However, because it was approved relatively recently (2016), clinical experience with pimavanserin is limited. Case Presentations. A wide variety of representative clinical scenarios are presented, each with distinct variables and complications. Issues addressed include distinguishing PDP from similar symptoms caused by other disorders such as dementia, coordinating pimavanserin with other PD medications and with deep brain stimulation, adapting pimavanserin dosing for optimal benefit and tolerability, and recognizing variability of PDP symptoms due to patients’ changing life circumstances. Conclusions. These scenarios provide multiple insights regarding PDP management and the role of pimavanserin. Effective treatment of PDP may reduce disturbing symptoms of psychosis, thus improving patient function and quality of life. In addition, effective pharmacotherapy for PDP may also facilitate the use of other medications needed to treat neurological symptoms of PD (e.g., tremor, bradykinesia, and dyskinesia), although they may also have adverse effects that contribute to symptoms of PDP.

中文翻译：

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Pimavanserin 治疗帕金森病精神病的临床实践

背景. 帕金森病精神病 (PDP) 是帕金森病 (PD) 的一种常见非运动症状，可能影响多达 60% 的患者，并与生活质量受损、医疗费用增加和疗养院安置等不良后果有关. PDP 的特征性症状包括幻觉；视觉、听觉、触觉和嗅觉幻觉；和妄想。PDP 症状通常会在其过程中从轻微、不常见且通常不令人不安发展到复杂、有时持续且可能非常令人不安。PDP 传统上使用非典型抗精神病药物（如氯氮平和喹硫平）治疗，尽管这些药物未被批准用于该适应症，并且由于存在粒细胞缺乏症的风险，氯氮平需要经常监测白细胞计数。Pimavanserin 是一种较新的非典型抗精神病药，与 5-羟色胺能受体具有高度选择性结合，没有证据表明 PD 运动症状恶化，并且不需要监测白细胞计数。它是目前唯一被批准用于 PDP 治疗的药物。然而，由于它是最近才获得批准的（2016 年），因此匹马万色林的临床经验有限。案例演示。提出了各种具有代表性的临床场景，每个场景都有不同的变量和并发症。解决的问题包括区分 PDP 与其他疾病（如痴呆）引起的类似症状，协调匹马万色林与其他 PD 药物和深部脑刺激，调整匹马万色林剂量以获得最佳益处和耐受性，以及识别由于患者不断变化的生活环境而导致的 PDP 症状的可变性. 结论. 这些情景提供了关于 PDP 管理和匹马万色林作用的多种见解。PDP的有效治疗可以减少令人不安的精神病症状，从而改善患者的功能和生活质量。此外，PDP 的有效药物治疗也可能有助于使用其他治疗 PD 神经系统症状（例如震颤、运动迟缓和运动障碍）所需的药物，尽管它们也可能具有导致 PDP 症状的副作用。