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| Case # | Treatment | Disease course | Takeaways |
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| 1 | PIM 34 mg | Improved PDP symptoms at 4 weeks | (i) Delusions may occur isolated from other, typically earlier, symptoms of PDP such as illusions and hallucinations |
| 2 | PIM 17 mg; excess sedation with 34 mg | PDP symptoms resolved by week 5 | (ii) PDP may be mistaken for dementia |
| (iii) Pimavanserin dosed at 17 mg/d may be effective in some patients |
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| 3 | PIM 34 mg reduced to 17 mg for sedation | At PIM 17 mg, PDP symptoms resolved by week 4 | (i) Pimavanserin may be added without disrupting or adversely affecting other multidrug PD regimens |
| 4 | PIM 34 mg | Reduction in PDP symptoms at 3 weeks and complete resolution of PDP and RBD symptoms at 6 weeks | (ii) Screening for psychosis may reveal PDP symptoms that might otherwise go unreported without elicitation by the clinician |
| 5 | Selegiline
PIM 34 mg | Hallucinations continued with selegiline, although motor fluctuations improved; PIM resolved hallucinations | (iii) After an initial onset of symptoms, PDP may often progress in frequency and severity to require urgent treatment |
| 6 | PIM 34 mg | No response to pramipexole; after starting PIM, hallucinations improved |
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| 7 | Escitalopram 10 mg
PIM 34 mg
Donepezil 10 mg | Hallucinations had resolved with 1-2 weeks of PIM; RBD symptoms persisted, so started clonazepam; DC escitalopram and added venlafaxine | (i) RBD, along with other parasomnias, is associated with visual hallucinations and cognitive impairment in patients with PD |
| (ii) Concomitant RBD in a patient with PD reporting symptoms of possible psychosis requires assessment if the symptoms are related to RBD or to PDP |
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| 8 | DBS initiated
PIM 34 mg | Symptoms worsened after DBS; after starting PIM, symptoms improved | (i) Patients with PD who have DBS may be at increased risk of PDP |
| (ii) Pimavanserin may be effective for treating PDP in patients with DBS |
| 9 | PIM 34 mg
Quetiapine 150 mg | Discontinued amantadine and rotigotine; PDP partly resolved | (iii) Both pimavanserin and another antipsychotic may be necessary to manage PDP |
| 10 | Nonpharmacological; quetiapine 75–100 mg; PIM 34 mg | No response to nondrug intervention; marked improvement at 6 weeks |
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| 11 | PIM 34 mg | After 4–6 weeks, marked improvement; no AEs | (i) PDP may emerge soon after PD diagnosis (e.g., within 1 year) |
| (ii) PDP symptoms may be unrecognized in patients living in a nursing home or assisted living facility by the facility staff |
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