Pimavanserin vs. Quetiapine for the Treatment Parkinson's Psychosis
Pimavanserin vs. Quetiapine for the Treatment Parkinson's Psychosis
Patients with Parkinson's disease (PD) sometimes experience symptoms affecting their
 movement, such as slowness, tremor, stiffness, and balance or walking problems. Many patients
 also have other symptoms not related to movement, called non-motor symptoms, which may affect
 one's mood or emotions, memory or thinking, or cause one to see or hear things that aren't
 real (hallucinations) or believe things that aren't true (delusions). Hallucinations or
 delusions, together called psychosis, occur in up to 60% of PD patients at some point in
 time. Parkinson's disease psychosis can sometimes be associated with decreased quality of
 life, increased nursing home placement, increased rate of death, and greater caregiver
 burden. There are approximately 50,000 Veterans with Parkinson's disease receiving care in
 the VA, and up to 30,000 (60%) of them will experience psychosis at some point in time.

 Quetiapine is an antipsychotic drug approved by the Food and Drug Administration (FDA) that
 is the most commonly used medication to treat PD psychosis, but more studies are needed to
 determine if it works for this condition and is also well tolerated and safe. Pimavanserin is
 a newer antipsychotic drug approved by the Food and Drug Administration (FDA) specifically to
 treat PD psychosis, but more studies are needed to determine if it works and its safety.

 The purpose of this research is to gather additional information on the safety and
 effectiveness of both Quetiapine and Pimavanserin. By doing this study, the investigators
 hope to learn which of these medications is the most effective course of treatment for people
 with PD psychosis. Your individual participation in this research will last approximately 54
 weeks.
Inclusion Criteria:

 -  Veteran

 -  Diagnosis of idiopathic PD for 2 or more years

 -  Psychosis [with Neuropsychiatric Inventory (NPI) hallucinations (B) or delusions (A)
 score 4 or greater]

 -  Stable dose of PD medications for at least 1 month If on an acetylcholinesterase
 inhibitor (AChEI) initially prescribed at least 3 months prior and stable dose (no
 dose or medication change) for past month Informed other must provide informed consent
 and agree to attend all study visits. The informed other must be at least 18 years of
 age and have regular in-person contact with the patient (at least 5 days per week, and
 at least 4 hours per day that is spent with patient) English-speaking

 Exclusion Criteria:

 -  Psychosis symptoms severe enough to preclude enrollment in a clinical trial and
 require prompt clinical care instead

 -  Treatment with an antipsychotic, including pimavanserin in the past year, except
 quetiapine <50 mg/day which has been discontinued for at least 1 month prior to study
 enrollment

 -  Deep brain stimulation (DBS) surgery occurring within 6 months prior or having
 unstable stimulator settings in the previous month

 -  History of a psychotic disorder prior to PD, including schizophrenia and bipolar
 disorder

 -  Suspected atypical parkinsonian disorder or dementia with Lewy bodies (DLB)

 -  Psychosis secondary to other toxic or metabolic disorder

 -  Congestive heart failure

 -  History of stroke within the last 6 months

 -  History of myocardial infarction within the last 6 months

 -  History of long QT syndrome or prolonged QTc [>450ms in men, >470ms in women] at
 screening/baseline (or baseline, if applicable)

 -  Current uncontrolled serious medical illness

 -  Clinically significant hepatic impairment or severe renal impairment (eGFR <30 mL/min)

 -  Currently taking medications that are significant CYP3A4 inhibitors or inducers

 -  Comorbid medical condition determined too severe by SI to allow participation in
 clinical trial

 -  Failure to tolerate quetiapine or pimavanserin previously

 -  Moderate to severe PD dementia (MoCA score <13)

 -  Currently enrolled in another therapeutic or interventional study

 -  Nursing home placement at baseline or planned placement during the study

 -  Active suicidality

 -  Pregnancy/Pregnant, or a female of child-bearing potential who is unwilling to use a
 reliable form of contraception