Imlay Riley K, Alsayed Majd, Starcher Madison, Tager Alfred, Griffith James
Psychiatry, West Virginia University School of Medicine, Charleston, USA.
Psychiatry, Charleston Area Medical Center, Charleston, USA.
Cureus. 2024 Jul 11;16(7):e64316. doi: 10.7759/cureus.64316. eCollection 2024 Jul.
Parkinson's disease (PD) is among the most common neurodegenerative diseases. Parkinson's disease psychosis (PDP) is a potential psychiatric manifestation of PD that is associated with increased morbidity and mortality. The treatment of PD with concomitant PDP is challenging as standard-of-care medication to improve motor symptoms can cause or exacerbate PDP. In this case report, we present an atypical presentation of a 70-year-old female who developed PDP only four years after her initial PD diagnosis, much earlier than the established average. Treatment was particularly complex as her PDP symptoms were refractory to PD medication reduction and oral antipsychotics, yet her PD motor symptoms were well controlled with a deep brain stimulator (DBS). We discuss a combination of pimavanserin and maintenance electroconvulsive therapy (ECT) as a safe and efficacious treatment modality which has led to remission of her PDP while DBS continues to provide adequate management of her PD symptoms. This case improves upon the early recognition of PDP and outlines a unique treatment modality not well described in the literature. This is the only case that demonstrates the efficacy of combining pimavanserin and ECT for refractory PDP in a patient with a DBS.
帕金森病（PD）是最常见的神经退行性疾病之一。帕金森病精神病（PDP）是PD的一种潜在精神表现，与发病率和死亡率增加相关。PD合并PDP的治疗具有挑战性，因为改善运动症状的标准治疗药物可导致或加重PDP。在本病例报告中，我们介绍了一名70岁女性的非典型表现，她在首次诊断为PD仅四年后就出现了PDP，比既定的平均时间早得多。治疗特别复杂，因为她的PDP症状对减少PD药物和口服抗精神病药物无效，而她的PD运动症状通过深部脑刺激器（DBS）得到了很好的控制。我们讨论了匹莫范色林和维持性电休克治疗（ECT）联合使用作为一种安全有效的治疗方式，该方式已使她的PDP得到缓解，同时DBS继续对她的PD症状提供充分管理。该病例改善了对PDP的早期识别，并概述了一种文献中未充分描述的独特治疗方式。这是唯一一例证明匹莫范色林和ECT联合治疗对接受DBS治疗的难治性PDP患者有效的病例。
