What medications do you prioritize or avoid in Parkinson’s Disease-related psychosis and behavioral disturbance?  

From an evidence-based perspective, clozapine continues to have the most solid support for its efficacy in Parkinson's disease-related psychosis. Pimavanserin has FDA approval (albeit with some mixed data) specifically for this indication. Quetiapine and olanzapine are perhaps the most frequently us...

Clozapine (Clozaril): This is often considered the gold standard due to its efficacy and relatively low risk of worsening motor symptoms. Quetiapine (Seroquel): This may be effective, but its use is limited due to concerns about increased risk of cognitive decline. Pimavanserin (Nuplazid): FDA-a...

I have found rivastigmine to help with psychotic symptoms in PD and DLB. I would consider mild symptoms before or concurrent with pimavanserin or low-dose quetiapine. Pimavanserin may take 1-2 months to take full effect, just something to keep in mind. I have no personal experience with clozapine, b...