Psychiatric complications of Parkinson’s disease

Parkinsonian patients are prone to develop anxiety and depression.
•Depression is not easy to diagnose because signs like motor and mental slowness, poor sleep, weight loss can be related to both the depression and the Parkinson disease
•Also mood can fluctuate with the motor state. Mood swings are responsible of depression and panic attacks when the patient is Off ( very slow ) and of excitation or euphoria when the patient is On dyskinetic (involuntary movements.)
Impulse control disorders with the dopaminergic agonists.
•It’s more frequent in young male patients with a past history of depression or addiction, but can affect any parkinsonian patients. Patients become addicted to gambling or shopping; they put on weight as they are sweet craving and /or become obsess by  sexuality, watching porn movies and browsing on porn website, sometimes cross dressing or having compulsion for exhibitionism.
•All these addictions need early interventions from the neurologists to protect the patient and his family.
Dopaminergic dysregulation:
•Parkinsonian patients can become addict to their antiparkinsonian treatment, increasing sometimes secretly the daily doses of  levodopa or dopaminergic agonists. They feared so much to be Off  that they keep taking tablets, despite being mobile and often too mobile with wild and permanent involuntary movements (dyskinesias)). It is exhausting physically for the patient and psychologically for the family around him. It can end up in a psychotic state due to the very high total daily doses, taken by the patient.
Punding behavior
•Parkinsonian patients may feel the need to repetitively classify papers, to work endlessly  on the computer forgetting lunch, to dismantle some devices, to organise collections of objects, labeling them, pulling them in and out. This repetitive active is non productive and has to be performed by the patient, every day, often at night , the patient , being carried away by the activity. and forgetting the time for going to bed. It is important to recognise this abnormal behavior before an inversion of the sleep cycle and an exclusion of the patient from normal daily life.
Hypersexual behavior and pathological jealousy in severe advanced Parkinson’s disease:
• Severely affected Parkinsonian patients who have developed  cognitive decline and are treated with dopaminergic agonist can have  disturbing hypersexual behavior, despite sometimes a sexual impotence. which is extremely distressing for the partner, usually also quite senior.
•Pathological jealousy is also not rare at that stage, the patient being convinced that his/her partner has an affair. Both the patient and the partner who is the target of the delusional belief are distressed.
All these psychiatric and cognitive complications represent the more severe and complex issues to deal when treating Parkinsonian patients.
•Dr MH Marion is an experienced neurologist with knowledge in both neuropsychiatry and Parkinson’s disease. Dr MH Marion worked in the psychiatric departement in Salpetriere Hospital in Paris as an interne and also graduated in neuro- psycho-pharmacology, testing the drugs acting on the dopaminergic system.