Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030567 (Parkinson's disease)
 63,064 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The author reviews the association between Parkinson's disease and depression and presents evidence to support the hypothesis that depression may be not only reactive but biochemically related to the disease. A psychotically depressed patient with parkinsonism responded positively to ECT as shown by improvement on a depression rating scale, two extrapyramidal rating scales, and handwriting samples. The beneficial effect on parkinsonian signs occurred before the improvement in depression, which suggests that ECT has a specific antiparkinsonian effect. Possible explanations for this observation based on biochemical theories of depression are discussed.
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PMID:Parkinson's disease, depression, and ECT: a review and case study. 83 44

Improvement in signs of parkinsonism and symptoms of depression was observed in a patient with Parkinson's disease who underwent a course of ECT for depression. Empirically this patient was observed by a blind rater to show a pattern of improvement in parkinsonian signs similar to that observed in parkinsonian patients treated with L-dopa. The time course of improvement of this patient's depression was also seen to parallel improvement in his Parkinson's disease. These results are consistent with the hypothesis that ECT increases catecholamine synthesis and more specifically would be evidence that ECT improves depression by increasing norepinephrine synthesis.
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PMID:Improvement of depression and parkinsonism during ECT: a case study. 101 51

Two patients with severe Parkinson's disease were treated with electroconvulsive therapy for a supervening depression. Not only did the symptoms of depression clear up after only four treatments, but the parkinsonian signs also showed striking and sustained improvement. This may be related to ECT-induced changes in dopamine and norepinephrine metabolism. Parkinsonism does not appear to be a contraindication to ECT. On the contrary, ECT may be the treatment of choice for certain patients with Parkinson's disease, whether nor not it is complicated by intractable depression.
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PMID:Improvement of Parkinsonism in depressed patients treated with ECT. 111 72

Primary care physicians have a vital role to play in identifying depression in their elderly patients. Diagnosis may be difficult, because symptoms are atypical and frequently include psychomotor agitation, somatic symptoms, and complaints of memory loss. Patients with medical illnesses, such as cancer, postmyocardial infarction, stroke, Parkinson's disease, and early Alzheimer's disease are particularly vulnerable to depression. Drugs that may cause depressive symptoms are digitalis at toxic levels, beta-blockers, centrally acting antihypertensives, immunosuppressants, and nonsteroidal anti-inflammatory agents. Cyclic antidepressants are the drugs of first choice. Selection depends on the patient's physical health and current medications and the side effect profile of the drug. Side effects are more pronounced in old age because of drug accumulation owing to slowed clearance. Troublesome side effects are anticholinergic effects, orthostatic hypotension, sedation, cardiotoxicity, and weight gain. The most useful antidepressants for geriatric patients are the secondary amines, desipramine and nortriptyline. The second-generation drug trazodone has the advantage of causing the least anticholinergic effects, but it is very sedating. Before treatment, the patient should have an electrocardiogram, liver function tests, tonometry, sitting and standing blood pressures, evaluation of urinary symptoms for outflow obstruction, review of current medications, and estimation of suicide risk. Cyclic antidepressants are contraindicated during recovery from myocardial infarction, in heart disease when there is severe impairment of myocardial performance, in seizure disorders, and in the presence of glaucoma or a large prostate. Drug interactions that may cause trouble can occur with epinephrine, MAO inhibitors, thyroid hormone, cimetidine, and centrally acting antihypertensives. Dosage should start low, increasing usually by 25 mg every 4 to 5 days until a therapeutic level is reached. Failure of a noradrenergic antidepressant after 4 to 5 weeks can be followed by a trial of a serotonergic drug. Drug serum level monitoring is useful for imipramine, desipramine, and nortriptyline. Monoamine oxidase inhibitors are effective in many elderly patients who are resistant to TCAs. Sympathomimetic drugs must be avoided with MAOIs. Elderly patients are at high risk of toxicity and drug interactions with lithium. Electroconvulsive therapy is useful for patients who do not respond to drug treatment, but medical complications, particularly cardiovascular, often occur in patients 75 or older. Many patients relapse after ECT. Psychotherapy together with pharmacotherapy may be the optimal treatment for elderly depressives. Older patients are more likely to become chronically depressed than younger patients. The risk of suicide in depressed elderly males is high, particularly in those with psychosocial problems, and depression rises with age.
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PMID:Management of depression in the elderly. 266 41

In an open study, seven patients with Parkinson's disease received ECT for major depression. Both the motor dysfunction and the mood impairment of these patients improved following an average of seven ECT sessions. Significant improvement in motor function occurred after only two treatments. All aspects of Parkinson's disease improved significantly after ECT. Older patients showed greater improvement in motor function. The authors conclude that the therapeutic utility of ECT in depressed and nondepressed patients with Parkinson's disease should be further evaluated.
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PMID:ECT and Parkinson's disease revisited: a "naturalistic" study. 238 59

This paper reviews the special indications for ECT. Included among these are delusional depression, affective illness which occurs in the geriatric population, depressions which are not responsive to pharmacologic intervention; depressed manic or schizophrenic patients who do not tolerate medication side effects; and drug-refractory Parkinson's disease. Technological advantages which have increased the safety of the procedure while reducing the side effects include: brief pulse electrical stimulation of the seizure, nondominant unilateral placement of electrodes, and simultaneous monitoring of EEG and EKG during the procedures. Finally, the five steps designed to address psychological issues as they relate to ECT are outlined and ECT is placed into the perspective of an overall therapeutic strategy in treating the patients.
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PMID:Electroconvulsive therapy in the eighties: technique and technologies. 714 86

Drug-induced psychosis is a serious late complication of Parkinson's disease (PD) that requires aggressive treatment. Recent studies have found clozapine a highly effective and ECT a possibly useful intervention. Two cases are presented that illustrate a possible treatment role for ECT. The cases demonstrate that ECT has significant but short-lived antipsychotic effects when used alone. However, patients who do not respond to clozapine monotherapy can be given adjunctive treatment with ECT. The combination therapy resulted in abrupt alleviation of psychotic symptoms in one of the cases, and maintenance with low-dose clozapine allowed for long-term efficacy. On the basis of these findings, a therapeutic approach to patients with drug-induced psychosis in PD is suggested.
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PMID:Combined clozapine and electroconvulsive therapy for the treatment of drug-induced psychosis in Parkinson's disease. 758 Jan 88

This review of the literature shows that Parkinson's disease can be considered as an indication of sismotherapy. The therapeutic effects of ECT on the extra-pyramidal syndrome are reviewed whether it is associated with a depression or not. The various biological mechanisms of the antiparkinsonian effect of ECT are discussed ie the increase of the permeability of the brain blood barrier, the action on the dopamin metabolism and the dopamin receptors and the action on the opioid receptors and melatonin. The role of maintenance ECT in the treatment of Parkinson's disease is cleared up. In conclusion, it appears that sismotherapy can be considered as an adjuvant therapy in Parkinson's disease especially when there is a resistance to dopatherapy.
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PMID:[Electroconvulsive therapy in the treatment of Parkinson disease]. 830 26

Electroconvulsive therapy is an important treatment of depressive states in late life. However in the Netherlands ECT is not often practiced and mostly indicated after a long period of fruitless clinical therapy. The primary aims of this literature study were to review the efficacy of ECT in late life depression, to identify predictors of good response, to discuss contraindications, side effects and finally modifications of technique. Eighteen studies were found addressing the topic of efficacy. Outcome ranged between 50%-100% clinically significant improvement. Positive predictors are melancholic features and delusional depression. Unlike in younger patients hypochondriacal symptoms and anxiety do not predict a negative outcome in older patients. ECT has been used successfully in depression complicated by dementia, cognitive decline and cerebrovascular disease. Depression in Parkinson's disease may be a special indication where ECT may have a positive effect on motor symptoms. There are no firm indications of long term cognitive decline associated with ECT. Guidelines for practicing ECT (unipolar, brief pulse and anaesthesia) are in line with the state of the art in the literature. It is concluded that, especially in severe depression associated with comorbidity, current Dutch practice in using ECT, often leads to unwarranted delay.
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PMID:[Electroconvulsive therapy in late life depression: a review]. 938 18

1. The effect of electroconvulsive shock (ECS) on the extracellular concentration of dopamine (DA), dihydroxyphenylacetic acid (DOPAC), homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) was examined in the frontal cortex of rats with the use of in vivo microdialysis. 2. The extracellular concentration of DOPAC, HVA and 5-HIAA was largely increased after the first ECS treatment. The increase after the eighth ECS treatment tended to be attenuated or was significantly attenuated as compared to that after the first ECS treatment. The baseline concentration of DOPAC and 5-HIAA was significantly increased after repeated ECS, though that of DA and HVA did not show any significant change after repeated ECS. 3. These results suggest that the activating effect of repeated ECT on 5-hydroxytryptaminergic (5-HT) and DA neurotransmission, (especially on 5-HT neurotransmission), is significant in improving depression both in patients with Parkinson's disease (PD) and in those who do not suffer from PD.
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PMID:Single and repeated electroconvulsive shocks activate dopaminergic and 5-hydroxytryptaminergic neurotransmission in the frontal cortex of rats. 960 12


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