Psych Vivas · Consultation-liaison psychiatry
Parkinson disease psychiatry — structured clinical viva
Fellowship viva on PD psychosis, dopamine-agonist ICD, depression, and psychopharmacology.
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Leading diagnoses: PD psychosis (visual hallucinations after PD onset; check Ravina duration/recurrence criteria and exclude delirium) plus agonist-related ICD (gambling after ropinirole) plus depression with passive SI.[1][2]
Differentials to voice: delirium/infection; DLB vs PDD if cognition dominant early; primary mood/psychotic disorder; DDS if compulsive DRT overuse rather than pure behavioural ICD.[1][6]
Acute/stepwise plan: safety and suicide assessment; collateral always for ICD; reduce/stop ropinirole with neurology; strip anticholinergics/amantadine if present; avoid haloperidol/risperidone/olanzapine traps; if needed low-dose clozapine with FBC or pimavanserin 34 mg where available.[3][4][7]
Depression: treat — CBT and/or SAD-PD agents (paroxetine/venlafaxine XR) with MAO-B interaction caution.[5]
Close: joint PD–psychiatry follow-up, financial safeguards, caregiver education, mortality-aware antipsychotic stewardship.[2][7]
References7ShowHide
- [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]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
- [3]Parkinson Study Group Low-dose clozapine for the treatment of drug-induced psychosis in Parkinson's disease N Engl J Med, 1999.PMID 10072410
- [4]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
- [5]Richard IH, McDermott MP, Kurlan R, et al. A randomized, double-blind, placebo-controlled trial of antidepressants in Parkinson disease Neurology, 2012.PMID 22496199
- [6]O'Sullivan SS, Evans AH, Lees AJ Dopamine dysregulation syndrome: an overview of its epidemiology, mechanisms and management CNS Drugs, 2009.PMID 19173374
- [7]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