LAUSR

Table 1 summarizes the key characteristics of the three patients with bipolar illness. Figure 1 provides a partial life chart of patient 1 over the time that she has been diagnosed with Parkinson’s disease; the patient actually had fewer mood episodes while on pimavanserin, but not significant (symptomatic on 22% of all visits versus 33% on aripiprazole, 44% on lurasidone, and 29% on divalproex alone, all p > 0.1 [z test for significance of proportional data]). All patients had developed type I bipolar illness in their twenties and had experienced at least one hospitalization for mania during their lifetime. All had developed disability after a lifelong history of productive, high level employment function (patient 1: social worker; patient 2: business manager; patient 3: pharmacist). Antipsychotic was added predominantly for mood stabilization (patients 1 and 3) and treatment of depressive symptoms (patients 1 and 2). Discontinuation of the previous antipsychotic was required due to significant worsening of parkinsonian symptoms and replacement with pimavanserin resulted in motor function stabilization, and either stable (patient 1), or improved (patient 2) mood state. Patient 3 developed hypomania after reduction of oxcarbazepine dose due to hyponatremia, which responded to reincrease of oxcarbazepine dose. However, it should be noted that this patient was also receiving oxcarbazepine, which may induce CYP 3A4 activity and lower the level and reduce the efficacy of the pimavanserin.1 All patients experienced persistent worsening of motor function over time.