Citation

Floris GL, Cannas A, Spissu A, Cossu G, Saddi MV, Melis M, Mura M, Congia S. Ital. J. Neurol. Sci. 1999; 20(4): e278.

Copyright

(Copyright © 1999, Holtzbrinck Springer Nature Publishing Group)

DOI

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PMID

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Abstract

Psychiatric side-effects of dopaminergic drugs are a well known reality in patients with advanced PD. Not well known and of great theoretical interest is psychosis which occurs in young parkinsonian patients and/or early in the course of dopaminergic treatment. A 51year-old woman, in dopaminergic therapy over the past 5 years for a classic type of PD, was recently hospitalized in the Psychiatric Service of Cagliari because of a manic state characterized by hyperactivity, sleeplessness, sexual preoccupation, behavior untimely with intrusiveness and grandiosity. Her past clinical history documented a frequent and severe depressive state with suicidal attempts. Several years ago her sister committed suicide. For four years she took dopaminoagonist (pramipexole before, pergolide after), amantadine and low doses of SSRA and tricyclic antidepressant drugs. The amantadine was discontinued and the levodopa/carbidopa CR (100/25 mg t.d.s. orally) was subscribed in the last year due to a serious depressed mood with delusional disorder, with delusion of persecution and ideas of reference, and severe anxiety frequently coinciding with profound psychomotor retardation. After two months she began to experience rapid and ultrarapid mood cycling of depressed mood, hypomanic episodes and euthymic periods, lasting from 24-48 hours to one week. For several months the cyclic mood variability was interpreted like mood fluctuations (ON-OFF motor fluctuations correlate), but the onset of hypomanic and afterwards of manic episodes cleared the peculiarity of the BAD. Levodopa-carbidopa was discontinued, pergolide was reduced and a treatment with carbamazepine and olanzapine was initiated. Currently, after seven weeks, the patient presents bearable mood fluctuations without manic or hypomanic manifestations. To our knowledge this is the first reported case of PD associated with BAD who has developed rapid and ultrarapid mood cycling after levodopa therapy.

Language: en