Parkinson’s Disease and Bipolar Disorder: a case report and narrative review
Introduction Bipolar disorder (BD) is considered a risk factor for developing Parkinson’s Disease (PD) because of an altered dopamine activity in both entities. Comorbidity may delay diagnosis and difficult therapeutic management. Objectives To describe the case of a patient with both BD and PD an...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2022-06-01
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| Series: | European Psychiatry |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S0924933822012196/type/journal_article |
| _version_ | 1797616853889056768 |
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| author | H. Andreu Gracia L. Ilzarbe O. Marco Estrada L. Bueno Sanya O. De Juan Viladegut L. Olivier Mayorga L. Pintor F. Valldeoriola I. Grande |
| author_facet | H. Andreu Gracia L. Ilzarbe O. Marco Estrada L. Bueno Sanya O. De Juan Viladegut L. Olivier Mayorga L. Pintor F. Valldeoriola I. Grande |
| author_sort | H. Andreu Gracia |
| collection | DOAJ |
| description |
Introduction
Bipolar disorder (BD) is considered a risk factor for developing Parkinson’s Disease (PD) because of an altered dopamine activity in both entities. Comorbidity may delay diagnosis and difficult therapeutic management.
Objectives
To describe the case of a patient with both BD and PD and to determine the appropriate diagnostic and therapeutic approach for patients presenting both entities.
Methods
We present the case of a 58-year-old woman attended in our neurology unit due to the initial presence of visual hallucinations as a core symptom.
Results
Psychotic symptoms as hallucinations and off-times, frequently observed in PD, may be misdiagnosed with a worsening of depressive polarity of BD. Thus, overlap between symptoms may lead to a challenging differential diagnosis. Moreover, there is no consensus about the therapeutic management of the comorbidity, due to the bidirectional worsening of symptoms when treatment is adjusted. In our case, a diagnosis of dopaminergic psychosis was made so antipsychotic treatment with quetiapine 50 mg/d was initiated. A worsening of symptoms was observed, presenting the patient a stuporous status, mutism and generalized rigidity. Neuroimaging and lumbar puncture were performed showing no alterations; electroencephalogram showed diffuse slowing. Final diagnosis was an off-episode of PD and a multifactorial encephalopathy resulting in visual hallucinations.
Conclusions
Coexistence of PD and BD may lead to a diagnostic and therapeutic delay and therefore a worse prognosis. Although these diseases are well-known, it is still challenging to manage patients presenting both entities. Further research is needed to clarify the proper diagnostic and therapeutic approach for these patients.
Disclosure
No significant relationships.
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| first_indexed | 2024-03-11T07:46:19Z |
| format | Article |
| id | doaj.art-718b0ecceb6c4a83a792af8cf399c1c5 |
| institution | Directory Open Access Journal |
| issn | 0924-9338 1778-3585 |
| language | English |
| last_indexed | 2024-03-11T07:46:19Z |
| publishDate | 2022-06-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | European Psychiatry |
| spelling | doaj.art-718b0ecceb6c4a83a792af8cf399c1c52023-11-17T05:07:29ZengCambridge University PressEuropean Psychiatry0924-93381778-35852022-06-0165S480S48010.1192/j.eurpsy.2022.1219Parkinson’s Disease and Bipolar Disorder: a case report and narrative reviewH. Andreu Gracia0L. Ilzarbe1O. Marco Estrada2L. Bueno Sanya3O. De Juan Viladegut4L. Olivier Mayorga5L. Pintor6F. Valldeoriola7I. Grande8Hospital Clínic de Barcelona, Psychiatry, Barcelona, SpainHospital Clínic de Barcelona, Psychiatry, Barcelona, SpainHospital Clínic de Barcelona, Psychiatry, Barcelona, SpainHospital Clínic de Barcelona, Psychiatry, Barcelona, SpainHospital Clínic de Barcelona, Psychiatry, Barcelona, SpainHospital Clínic de Barcelona, Psychiatry, Barcelona, SpainHospital Clínic de Barcelona, Consultation Liaison Psychiatry, Barcelona, SpainHospital Clínic de Barcelona, Neurology, Barcelona, SpainHospital Clínic de Barcelona, Psychiatry, Barcelona, Spain Introduction Bipolar disorder (BD) is considered a risk factor for developing Parkinson’s Disease (PD) because of an altered dopamine activity in both entities. Comorbidity may delay diagnosis and difficult therapeutic management. Objectives To describe the case of a patient with both BD and PD and to determine the appropriate diagnostic and therapeutic approach for patients presenting both entities. Methods We present the case of a 58-year-old woman attended in our neurology unit due to the initial presence of visual hallucinations as a core symptom. Results Psychotic symptoms as hallucinations and off-times, frequently observed in PD, may be misdiagnosed with a worsening of depressive polarity of BD. Thus, overlap between symptoms may lead to a challenging differential diagnosis. Moreover, there is no consensus about the therapeutic management of the comorbidity, due to the bidirectional worsening of symptoms when treatment is adjusted. In our case, a diagnosis of dopaminergic psychosis was made so antipsychotic treatment with quetiapine 50 mg/d was initiated. A worsening of symptoms was observed, presenting the patient a stuporous status, mutism and generalized rigidity. Neuroimaging and lumbar puncture were performed showing no alterations; electroencephalogram showed diffuse slowing. Final diagnosis was an off-episode of PD and a multifactorial encephalopathy resulting in visual hallucinations. Conclusions Coexistence of PD and BD may lead to a diagnostic and therapeutic delay and therefore a worse prognosis. Although these diseases are well-known, it is still challenging to manage patients presenting both entities. Further research is needed to clarify the proper diagnostic and therapeutic approach for these patients. Disclosure No significant relationships. https://www.cambridge.org/core/product/identifier/S0924933822012196/type/journal_articlebipolar disorderdifferential diagnosiscomorbidityParkinson’s Disease |
| spellingShingle | H. Andreu Gracia L. Ilzarbe O. Marco Estrada L. Bueno Sanya O. De Juan Viladegut L. Olivier Mayorga L. Pintor F. Valldeoriola I. Grande Parkinson’s Disease and Bipolar Disorder: a case report and narrative review European Psychiatry bipolar disorder differential diagnosis comorbidity Parkinson’s Disease |
| title | Parkinson’s Disease and Bipolar Disorder: a case report and narrative review |
| title_full | Parkinson’s Disease and Bipolar Disorder: a case report and narrative review |
| title_fullStr | Parkinson’s Disease and Bipolar Disorder: a case report and narrative review |
| title_full_unstemmed | Parkinson’s Disease and Bipolar Disorder: a case report and narrative review |
| title_short | Parkinson’s Disease and Bipolar Disorder: a case report and narrative review |
| title_sort | parkinson s disease and bipolar disorder a case report and narrative review |
| topic | bipolar disorder differential diagnosis comorbidity Parkinson’s Disease |
| url | https://www.cambridge.org/core/product/identifier/S0924933822012196/type/journal_article |
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