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)

This study reports on the clinical effectiveness of the combined use of conventional major tranquillisers and augmented levodopa dosage for the management of paranoia, hallucinations and confusion in patients with Parkinson's disease (PD). The medical records of patients admitted with PD and target symptoms were retrospectively reviewed. A total of 52 patients were treated over the 3 year period. Approximately 70% demonstrated an improvement in psychotic symptoms, but only 54% could also maintain mobility. Side-effects occurred in 37% of patients and consisted of decreased mobility, excessive sedation and excessive salivation. The drop out rate on follow-up was 47% so that at the end of the 3 year period 23 patients still remained on the major tranquilliser from 44 patients who were discharged on a major tranquilliser. The effectiveness of this approach is similar to that published for atypical major tranquillisers; however, the tranquillisers used in this study do not carry the risks of serious side effects or high cost.
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PMID:Successful psychotropic management of drug related psychosis in Parkinson's disease. 1863 86

REM sleep behavior disorder (RBD) is commonly associated with Parkinson disease (PD), but it is unclear whether this association has implications for disease manifestations. We evaluated 36 PD patients for the presence of RBD by polysomnography. Patients underwent an extensive evaluation by a movement disorders specialist blinded to polysomnography results. Severity of motor manifestations, autonomic, visual, psychiatric, and olfactory dysfunctions and quality of life (QOL) were assessed, and compared using regression analysis that adjusted for disease duration, age and sex. Severity of motor manifestations did not differ between groups. However, the presence of RBD in PD was strongly associated with symptoms and signs of orthostatic hypotension (systolic blood pressure lying to standing = -25.7 +/- 13.0 mmHg vs. -4.9 +/-14.1, P < 0.001); and orthostatic symptom prevalence = 71% vs. 27%, P = 0.0076). There was no association between RBD and other autonomic symptoms. Color vision was worse in patients with RBD, but olfactory dysfunction did not differ between groups. The prevalence of depression, hallucinations, paranoia, and impulse disorders did not differ between groups. Emotional functioning and general health QOL measures were lower in those with RBD, but there were no differences between groups on disease-specific indices or on measures of overall physical QOL. These findings suggest that the pathophysiology of RBD and nonmotor manifestations of PD, particularly autonomic dysfunction, are linked.
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PMID:Manifestations of Parkinson disease differ in association with REM sleep behavior disorder. 1870 86

This paper summarizes the methods we devised for the treatment of psychosis, orthostatic hypotension, and mood disorders among the various non-motor complications of Parkinson's disease. Psychosis may not manifest when a patient believes in his/her delusions. If left untreated over a prolonged period, however, the delusions progress to paranoia that is very difficult to cure. Accordingly, enquiries should be made during routine examinations to detect the presence of psychosis and facilitate early discovery. Atypical antipsychotics are used when psychosis does not improve after reducing the doses of antiparkinson drugs. We achieved favorable results by using mianserin hydrochloride prior to this step, with efficacy being observed for hallucinations and mild delusions that often manifested at night. This drug does not act as a dopamine receptor blocker, so it has the advantage of not aggravating motor symptoms. With this therapy, it is also possible to improve motor symptoms without inducing psychosis by reducing the doses of antiparkinson drugs and locally stimulating the motor loop by deep brain stimulation of the subthalamic nucleus. We previously introduced leg-holding exercises for the treatment of orthostatic hypotension, through which blood pooled in the veins is returned to the systemic circulation by holding the knees. This can be done easily and is free of adverse reactions. Mood disorders are difficult to cope with in patients with Parkinson's disease, but may be treated by selecting an appropriate dopamine agonist while giving consideration to affinity for the dopamine D3 receptor. However, treatment becomes complicated when the dopamine receptor is overstimulated. Here we report on cases of successfully treated pathological gambling and dopamine dysregulation syndrome, which are considered difficult to manage. The solution may differ depending on a patient's environment, and it is not easy to prescribe therapy based on evidence-based medicine. The best therapy should be selected by maintaining communication with the patient and developing a relationship built on trust.
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PMID:Management of non-motor complications in Parkinson's disease. 1971 Nov 20

Psychosis has been recognized as a common feature in neurodegenerative diseases and a core feature of dementia that worsens most clinical courses. It includes hallucinations, delusions including paranoia, aggressive behaviour, apathy and other psychotic phenomena that occur in a wide range of degenerative disorders including Alzheimer's disease, synucleinopathies (Parkinson's disease, dementia with Lewy bodies), Huntington's disease, frontotemporal degenerations, motoneuron and prion diseases. Many of these psychiatric manifestations may be early expressions of cognitive impairment, but often there is a dissociation between psychotic/behavioural symptoms and the rather linear decline in cognitive function, suggesting independent pathophysiological mechanisms. Strictly neuropathological explanations are likely to be insufficient to explain them, and a large group of heterogeneous factors (environmental, neurochemical changes, genetic factors, etc.) may influence their pathogenesis. Clinico-pathological evaluation of behavioural and psychotic symptoms (PS) in the setting of neurodegenerative and dementing disorders presents a significant challenge for modern neurosciences. Recognition and understanding of these manifestations may lead to the development of more effective preventive and therapeutic options that can serve to delay long-term progression of these devastating disorders and improve the patients' quality of life. A better understanding of the pathophysiology and distinctive pathological features underlying the development of PS in neurodegenerative diseases may provide important insights into psychotic processes in general.
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PMID:Cerebral correlates of psychotic syndromes in neurodegenerative diseases. 2141 22

Theory of Mind is an important concept within social cognition and refers to the ability to attribute mental states to oneself and others. Other terms for this concept include mentalizing and mind reading. Deficits in Theory of Mind may contribute to behavioral abnormalities, such as paranoia and delusions that are common in dementia. There are several experimental tasks for measuring Theory of Mind. A classical example is the false belief test. Examples of other measures include tests of understanding metaphor, sarcasm, irony, deception, and faux pas, determining what a person is thinking or feeling from photographs of the eye region, and visual perspective taking. There are several anatomical areas related to Theory of Mind. These include regions within the frontal and temporal lobes, and temporoparietal junction. There is a small but emerging literature on Theory of Mind in Parkinson's disease (PD). The data suggest that Theory of Mind is impaired in PD and that the deficits precede the development of dementia. Future studies are needed to better define the nature of the Theory of Mind deficits in PD, as well as the impact of these deficits on clinical disability in this disorder.
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PMID:Theory of Mind in Parkinson's disease. 2170 20

Although levodopa and dopaminergic drugs remain the mainstay of therapy for the motor symptoms of Parkinson disease (PD), they fail to address many of the non-motor symptoms of PD including orthostatic hypotension, freezing of gait (FOG) and difficulty with balance, drug-induced paranoia and hallucinations, and drug-induced dyskinesias. Droxidopa, a drug that increases norepinephrine, treats orthostatic hypotension, cholinomimetic drugs sometimes help with FOG and difficulty with balance, pimavanserin, a drug that blocks serotonin receptors, treats paranoia and hallucinations, and anti-glutaminergic drugs treat dyskinesias. Thus, there are ample opportunities for non-dopaminergic drugs in PD.
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PMID:Is there room for non-dopaminergic treatment in Parkinson disease? 2322 3

The aim of this study was to evaluate the clinical efficacy of deep brain stimulation (DBS) and subthalamic nuclei stimulation (STN) in the treatment of Parkinson's disease. A total of 32 patients with Parkinson's disease who continuously treated in our hospital with STN-DBS from November 2011 to November 2013 were selected. All the patients received follow-up evaluation, psychological status questionnaire survey and analysis before surgery and 3 months after surgery using unified Parkinson's disease rating scale (UPDRS), Self-rating depression scale (SDS), and symptom checklist (SCL-90). After turned on the impulse generator (IPG), the daily activities and motor function of UPDRS in all the 32 cases of Parkinson's disease patients were in "turn off" state; the mean improvement rates were 51.7 and 60.9%; when the daily activities and motor function in the state of "turn on", the mean improvement rates were 21.4 and 22.3%. In 20 cases, the preoperative SDS > 50, the levels of depression, anxiety, somatization, interpersonal sensitivity, hostility, fear, and paranoia of SCL-90 were significant higher than the Chinese traditional levels (P < 0.05). Comparison of the preoperative and postoperative depression, somatization, fear, anxiety, and psychotic factor of SCL-90 found that there was negative correlation between preoperation and postoperation, and the differences were significant (P < 0.05), while there were no significant differences in interpersonal sensitivity and paranoia (P > 0.05). STN-DBS can improve the motor function and ability of daily life of Parkinson's disease patients and can significantly improve the psychological condition of the patients with Parkinson's disease and depression; it is a safe and effective method to the treatment of Parkinson's disease.
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PMID:Effect of subthalamic nuclei electrical stimulation in the treatment of Parkinson's disease. 2509 44

Research supports theories on valid differences between early-onset schizophrenia (EOS), which persists through life, versus late-onset schizophrenia. We differentiate between schizophrenia, late-onset schizophrenia (LOS), very late-onset schizophrenia-like psychosis (VLOSLP) and paranoid psychosis in the elderly. While LOS may resemble EOS, VLOSLP may resemble neurodegenerative disorders such as Parkinson's disease and Alzheimer's disease. In this review, a treatment guideline is proposed.
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PMID:[Diagnosis and treatment of paranoid and schizophrenia-like psychosis in elderly patients]. 3027 72

This is a case report on a 57-year-old lady who presented to the Psychiatry Department of Tallaght Hospital after being referred by Neurology Department. She was initially attending Neurology Department for idiopathic Parkinson's disease which was later refuted as there was no objective evidence of response to treatment. She attended the A&E department with altered consciousness and headache, but her computed tomography of the brain was normal, and was diagnosed with migraine. But it was noted that she was reporting paranoia and auditory hallucinations, and her family had noticed marked change in her accent. On assessment in psychiatric outpatient she was noted to have psychotic symptoms. She reported these symptoms to be ongoing for the last 4 years, but have worsened to an extent that she was extremely distressed by them. She had acquired a Scottish accent. The change in accent coincided with worsening of her psychotic symptoms. Based on her assessment she was diagnosed with schizophrenia and was commenced on olanzapine. Not only her psychotic symptoms resolved but also her accent reverted to native form.
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PMID:Foreign accent syndrome and psychosis: a case report. 3263 67


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