Citation

Mori Y, Miura I, Nozaki M, Osakabe Y, Izumi R, Akama T, Kimura S, Yabe H. Clin. Psychopharmacol. Neurosci. 2021; 19(3): 572-575.

Copyright

(Copyright © 2021, Korean College of Neuropsychopharmacology)

DOI

10.9758/cpn.2021.19.3.572

PMID

unavailable

Abstract

Parkinson's disease is often complicated by psychiatric symptoms. Psychiatrists are caught in a dilemma between such symptoms and physical treatment since Parkinson's disease sometimes shows treatment resistance based on pharmacological treatment-induced dopamine dysfunction. Here, we report on a 64-year-old woman with a 15-year history of Parkinson's disease with stage IV severity based on the Hoehn and Yahr scale. She was admitted to our hospital with a diagnosis of major depressive disorder with psychotic features. Unfortunately, her treatment course for depression was complicated by neuroleptic malignant syndrome. Because we were concerned about the persistence of her depressive symptoms, the risk of psychotropic drugs causing adverse effects, and progressive disuse syndrome, we administered modified electroconvulsive therapy. Her symptoms of neuroleptic malignant syndrome and depression sufficiently improved after five sessions of modified electroconvulsive therapy. Additionally, the primary motor symptoms of her Parkinson's disease also markedly improved. The improvement of neuroleptic malignant syndrome and her motor symptoms based on dopamine dysfunction can be explained by electroconvulsive therapy's effectiveness in activating dopamine neurotransmission. Besides, the marked improvement of her depressive episode with psychotic features was presumed to involve dopamine receptor activation and regulation. Because advanced Parkinson's disease can sometimes be refractory to treatment based on pharmacological treatment-induced dopamine dysfunction, psychiatrists often have difficulty treating psychiatric symptoms; electroconvulsive therapy may stabilize the dopaminergic system in such cases, presenting a possible non-pharmacologic treatment option for Parkinson's disease. Copyright © 2021, Korean College of Neuropsychopharmacology

Language: en

Keywords

adult; human; Depression; female; case report; insomnia; suicidal ideation; psychosis; scoring system; suicide attempt; major depression; disease severity; Electroconvulsive therapy; Dopamine; fatigue; risk; psychiatrist; blood sampling; clinical article; hospital admission; clomipramine; hallucination; quetiapine; middle aged; dopamine; electroconvulsive therapy; delusion; dopamine receptor; hospital discharge; computer assisted tomography; valproic acid; electrostimulation; dopaminergic transmission; antibiotic agent; levodopa; aspiration pneumonia; Parkinson disease; neuroleptic malignant syndrome; Montgomery Asberg Depression Rating Scale; Article; consciousness level; dopaminergic system; drug dose increase; treatment duration; Neuroleptic malignant syndrome; donepezil; DSM-5; bed rest; loss of appetite; Hoehn and Yahr scale