Treatment of Parkinson’s Psychosis

PMHNP is asked to evaluate a 71-year-old male patient who is reportedly having visual hallucinations. His adult daughter accompanies him to the appointment and reports that he was diagnosed with Parkinson’s disease approximately 2 years ago. It began with the classic motor symptoms, but over the last year he has developed more and more difficulty with memory loss, difficulty with decision making, and episodes of depression and apathy. Sinemet has helped his motor symptoms, but he has not responded well to medications for cognitive symptoms. A few months ago he started having visual hallucinations. At first it was a sense of things moving in his peripheral vision, but lately he is seeing people who are not there, or interpreting inanimate objects as people.

Which of the following is the most appropriate medication for this patient?

A. Bupropion (Wellbutrin)

B. Pimavanserin (Nuplazid)

C. Quetiapine (Seroquel)

D. Sertraline (Zoloft)