Psych · Consultation-liaison psychiatry
Parkinson disease psychiatry
Also known as Parkinson's disease psychosis · PD psychosis · Impulse control disorders Parkinson · Dopamine dysregulation syndrome · Parkinson disease depression · Neuropsychiatric Parkinson disease · Pimavanserin · Clozapine Parkinson psychosis
Exam-exhaustive fellowship topic on the psychiatry of Parkinson disease: depression and apathy, PD psychosis (Ravina criteria, visual hallucinations), clozapine and pimavanserin, impulse control disorders from dopamine agonists, dopamine dysregulation syndrome, cognitive spectrum, and joint CL–neurology management. FRANZCP-primary, globally tagged.
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10 MCQs with explanations
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Meet the patient
A 66-year-old retired engineer with eight years of idiopathic PD is brought in by his wife. Six months ago his neurologist added pramipexole for motor control. Three months ago he started buying lottery tickets in bulk. Last night he lost the house deposit on an online gambling site. He is not psychotic, not depressed, and has no insight at all — "it's just a hobby."[4][5]
Two exam questions are now live. Is this the disease or the drug? and what do you change first? The whole topic is the answer to those two, plus the one no one should ever get wrong: which antipsychotic is forbidden in PD?[4][11][15]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.
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- [1]Ravina B, Marder K, Fernandez HH, et al. Diagnostic criteria for psychosis in Parkinson's disease: report of an NINDS, NIMH work group Mov Disord, 2007.PMID 17266092
- [2]Fénelon G, Mahieux F, Huon R, Ziégler M Hallucinations in Parkinson's disease: prevalence, phenomenology and risk factors Brain, 2000.PMID 10734005
- [3]Reijnders JS, Ehrt U, Weber WE, Aarsland D, Leentjens AF A systematic review of prevalence studies of depression in Parkinson's disease Mov Disord, 2008.PMID 17987654
- [4]Weintraub D, Koester J, Potenza MN, et al. Impulse control disorders in Parkinson disease: a cross-sectional study of 3090 patients Arch Neurol, 2010.PMID 20457959
- [5]Voon V, Sohr M, Lang AE, et al. Impulse control disorders in Parkinson disease: a multicenter case--control study Ann Neurol, 2011.PMID 21416496
- [6]Parkinson Study Group Low-dose clozapine for the treatment of drug-induced psychosis in Parkinson's disease N Engl J Med, 1999.PMID 10072410
- [7]Pollak P, Tison F, Rascol O, et al. Clozapine in drug induced psychosis in Parkinson's disease: a randomised, placebo controlled study with open follow up J Neurol Neurosurg Psychiatry, 2004.PMID 15090561
- [8]Cummings J, Isaacson S, Mills R, et al. Pimavanserin for patients with Parkinson's disease psychosis: a randomised, placebo-controlled phase 3 trial Lancet, 2014.PMID 24183563
- [9]Richard IH, McDermott MP, Kurlan R, et al. A randomized, double-blind, placebo-controlled trial of antidepressants in Parkinson disease Neurology, 2012.PMID 22496199
- [10]Dobkin RD, Menza M, Allen LA, et al. Cognitive-behavioral therapy for depression in Parkinson's disease: a randomized, controlled trial Am J Psychiatry, 2011.PMID 21676990
- [11]Seppi K, Ray Chaudhuri K, Coelho M, et al. Update on treatments for nonmotor symptoms of Parkinson's disease-an evidence-based medicine review Mov Disord, 2019.PMID 30653247
- [12]Emre M, Aarsland D, Albanese A, et al. Rivastigmine for dementia associated with Parkinson's disease N Engl J Med, 2004.PMID 15590953
- [13]Giovannoni G, O'Sullivan JD, Turner K, Manson AJ, Lees AJ Hedonistic homeostatic dysregulation in patients with Parkinson's disease on dopamine replacement therapies J Neurol Neurosurg Psychiatry, 2000.PMID 10727476
- [14]O'Sullivan SS, Evans AH, Lees AJ Dopamine dysregulation syndrome: an overview of its epidemiology, mechanisms and management CNS Drugs, 2009.PMID 19173374
- [15]Weintraub D, Chiang C, Kim HM, et al. Association of Antipsychotic Use With Mortality Risk in Patients With Parkinson Disease JAMA Neurol, 2016.PMID 26999262
- [16]Connolly BS, Lang AE Pharmacological treatment of Parkinson disease: a review JAMA, 2014.PMID 24756517