Parkinson's disease and psychosis: Report of a case

Abstract

Introduction

Jealous delusional ideation appears in 7-14% of cases of Parkinson's disease. Treatment with dopaminomimetics drugs is a significant risk factor for psychosis. However, the most likely etiology of psychosis in these patients is a loss of central cholinergic function associated with age since described psychosis even before the introduction of the L-Dopamine. Cognitive impairment and sleep disorders are predictors of development of psychosis.

Objective

Present a clinical case of psychosis in Parkinson's disease and its treatment.

Method

Reason for consultation. Patient diagnosed with Parkinson's disease with behavioral disorder and delusional.

Current illness

The patient after antiparkinsonian medication has increased suspicion, self-referentiality, delusional jealousy ideation to her husband, delusional interpretations regarding somatic symptoms, insomnia and behavioral disorders with aggression.

Family background

Mother with Alzheimer's.

Personal history

No contact with mental health.

Psychopathological examination

Conscious, repetitive language, dysphoric mood with delusions of prejudice and jealousy.

Mixed insomnia.

Diagnosis

Psychosis in Parkinson's disease.

Treatment

Quetiapine 300 mg/day. Carbidopa 25 mg/L-dopa 100 mg: 1-0-1. On subsequent visits quetiapine was suspended and replaced by clozapine 200 mg/day.

Results

The treatment of psychosis was effective with the use of quetiapine and subsequently clozapine with good tolerance and effectiveness. He also said lower antiparkinsonian medication.

Conclusions

Psychotic symptoms are the most common psychiatric clinic in Parkinson's disease. Often not enough antiparkinsonian dopaminomimetics reduced to control psychotic symptoms and use of antipsychotics is required. The use of antipsychotics in Parkinson's disease should be careful for the likely increase in motor clinical and increased mortality. The most useful, are especially quetiapine and clozapine atypical antipsychotics.

Disclosure of interest

The authors have not supplied their declaration of competing interest.