Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Seritan); Weill Institute for Neurosciences, University of California, San Francisco (Seritan, Spiegel, Racine, Brown, Volz, Starr, Ostrem); Department of Neurology, University of California, San Francisco (Spiegel, Brown, Volz, Ostrem); Kaiser Permanente Group, Roseville, Calif. (Weinstein); Department of Neurological Surgery, University of California, San Francisco (Racine, Starr); and the Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville (de Hemptinne).
J Neuropsychiatry Clin Neurosci. 2021 Fall;33(4):314-320. doi: 10.1176/appi.neuropsych.20080205. Epub 2021 Jul 2.
Deep brain stimulation (DBS) is an effective surgical treatment for patients with Parkinson's disease (PD). DBS therapy, particularly with the subthalamic nucleus (STN) target, has been linked to rare psychiatric complications, including depression, impulsivity, irritability, and suicidality. Stimulation-induced elevated mood states can also occur. These episodes rarely meet DSM-5 criteria for mania or hypomania.
The investigators conducted a chart review of 82 patients with PD treated with DBS.
Nine (11%) patients developed stimulation-induced elevated mood. Five illustrative cases are described (all males with STN DBS; mean age=62.2 years [SD=10.5], mean PD duration=8.6 years [SD=1.6]). Elevated mood states occurred during or shortly after programming changes, when more ventral contacts were used (typically in monopolar mode) and lasted minutes to months. Four patients experienced elevated mood at low amplitudes (1.0 V/1.0 mA); all had psychiatric risk factors (history of impulse-control disorder, dopamine dysregulation syndrome, substance use disorder, and/or bipolar diathesis) that likely contributed to mood destabilization.
Preoperative DBS evaluations should include a thorough assessment of psychiatric risk factors. The term "stimulation-induced elevated mood states" is proposed to describe episodes of elevated, expansive, or irritable mood and psychomotor agitation that occur during or shortly after DBS programming changes and may be associated with increased goal-directed activity, impulsivity, grandiosity, pressured speech, flight of ideas, or decreased need for sleep and may persist beyond stimulation adjustments. This clinical phenomenon should be considered for inclusion in the bipolar disorder category in future DSM revisions, allowing for increased recognition and appropriate management.
深部脑刺激（DBS）是治疗帕金森病（PD）患者的有效手术方法。DBS 疗法，特别是以丘脑底核（STN）为靶点，与罕见的精神并发症有关，包括抑郁、冲动、易怒和自杀倾向。刺激诱导的情绪升高状态也可能发生。这些发作很少符合 DSM-5 躁狂或轻躁狂的标准。
研究人员对 82 名接受 DBS 治疗的 PD 患者进行了图表回顾。
9 名（11%）患者出现刺激诱导的情绪升高。描述了 5 个说明性病例（均为男性，接受 STN DBS；平均年龄=62.2 岁[SD=10.5]，平均 PD 病程=8.6 年[SD=1.6]）。情绪升高状态发生在编程更改期间或之后不久，此时使用更多的腹侧触点（通常在单极模式下），持续数分钟至数月。4 名患者在低幅度（1.0 V/1.0 mA）时出现情绪升高；所有人都有精神风险因素（冲动控制障碍、多巴胺失调综合征、物质使用障碍和/或双相情感障碍），这可能导致情绪不稳定。
术前 DBS 评估应包括对精神风险因素的全面评估。提出“刺激诱导的情绪升高状态”一词来描述在 DBS 编程更改期间或之后不久发生的情绪升高、扩张或易怒以及精神运动激越的发作，可能与增加目标导向活动、冲动、夸大、言语急促、思维奔逸或减少睡眠需求有关，并可能在刺激调整后持续存在。这种临床现象应考虑在未来的 DSM 修订版中纳入双相情感障碍类别，以提高认识和适当管理。
