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Parkinson disease psychosis – A case report

Published online by Cambridge University Press:  23 March 2020

M.D.C. Ferreira*
Affiliation:
Hospital de Braga, Psychiatry, Braga, Portugal
S. Varanda
Affiliation:
Hospital de Braga, Neurology, Braga, Portugal
G. Carneiro
Affiliation:
Hospital de Braga, Neurology, Braga, Portugal
B. Santos
Affiliation:
Hospital de Braga, Psychiatry, Braga, Portugal
Á. Machado
Affiliation:
Hospital de Braga, Neurology, Braga, Portugal
*
*Corresponding author.

Abstract

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Introduction

Psychosis is one of the most prevalent non-motor complications in Parkinson's disease (PD). Risk factors for PD psychosis are advancing age, longer disease duration, severe motor symptoms, presence of dementia, sleep disorders, depression and autonomic dysfunction. Treatment is challenging in this setting because antipsychotic medications are known to worse motor symptoms.

Objectives

To highlight the therapeutic difficulties in PD-related psychosis.

Methods

Case description and literature review.

Results

We report a case of a 74-year-old woman with a 9-year history of PD, who presented a complex psychotic disorder consisting in auditory, olfactory and visual (gulliverian and lilliputian) hallucinations, persecutory and sexual delusions. Additionally, the patient presented euthymic mood, without evidence of cognitive impairment or impulse-control disorder. These symptoms began after dopamine agonist therapy (ropinirole 4 mg/day). Other medical conditions that could justify these symptoms were excluded. Initially, ropinirole was removed, but without psychotic remission. Then, she was treated with antipsychotic medication (clozapine 25 mg/day) with full psychotic remission and without significant worsening of motor symptoms.

Conclusions

Clozapine treatment is frequently delayed, mainly for fear of its side effects, particularly agranulocytosis. However, this antipsychotic drug presents many benefits regarding the management of PD-related psychosis, namely few motor effects and even improvement of motor fluctuations.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Type
EW140
Copyright
Copyright © European Psychiatric Association 2016
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