Osman VIRIT, Abdurrahman ALTINDAĞ, AYLİN AKÇALI, Mahmut BULUT, Haluk Asuman SAVAŞ

Parkinson hastalığı, psikoz ve depresyonu olan üç olgunun elektrokonvulsif tedavi ile etkili tedavisi

Parkinson hastalığının (PH) seyrinde sıklıkla psikiyatrik bozukluklar ortaya çıkmaktadır. Yaklaşık olarak %40 dolayında depresyon ve %30 dolayında psikoz görülmektedir. Ortaya çıkan psikoz çoğunlukla dopaminerjik ilaçlara bağlıdır. Bu yazıda, PH, PH ile ilişkili psikoz ve depresyonu olan üç olgunun elektrokonvulsif tedavi (EKT) ile başarılı tedavisini bildirmekteyiz. Bir olguya özkıyım riski nedeniyle, iki olguya ise tedaviye direnç nedeniyle EKT başlanmıştı. Üç olguda da EKT ile psikotik ve depresif belirtilerde belirgin iyileşme elde edildi. Aynı zamanda EKT ile PH belirtilerinde de gerileme sağlandı. EKT’nin PH ile beraber görülen depresyonda ve psikozda etkili ve güvenli bir tedavi seçeneği olduğunu söyleyebiliriz. Ayrıca EKT, PH belirtilerini iyileştirmede de faydalı bir tedavi yöntemidir.

Effective treatment with electroconvulsive therapy of three cases with Parkinson disease, psychosis and depression

Parkinson disease (PD) is frequently complicated by a range of psychiatric disorders. Depression occurs approximately 40% and psychosis is seen in up to 30% in patients with PD. Psychosis is predominantly as a side effect of dopaminergic treatment. Herein, we present three cases with PD, psychosis and depression which treated with electroconvulsive therapy (ECT). ECT was started for suicide risk in one case and for treatment resistance in two cases. All cases demonstrated marked improvement with ECT in psychotic and depressive symptoms. In addition, PD symptoms were reduced in the cases. We suggest ECT is a safe and effective treat-ment option for depression and psychosis in PD. However, ECT is a beneficial treatment method for improvement of PD symptoms.

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1. Freeman CP. The Second Report of the Royal College of Psychiatrists’ Special Committee on ECT. The ECT Handbook. London, Royal College of Psychiatrists, 1995.
2. Chou KL, Hurtig HI, Jaggi JL, Baltuch GH, Pelchat RJ, Weintraub D. Electroconvulsive therapy for depression in a Parkinson's disease patient with bilateral subthalamic nucleus deep brain stimulators. Parkinsonism Relat Disord 2005; 11:403-406.
3. Stella F, Banzato CE, Barasnevicius Quagliato EM, Viana MA. Depression in patients with Parkinson's disease: impact on functioning. J Neurol Sci 2008; 272:158-163.
4. Fregni F, Simon DK, Wu A, Pascual-Leone A. Non-invasive brain stimulation for Parkinson’s disease: a systematic review and meta-analysis of the literature. J Neurol Neurosurg Psychiatry 2005; 76:1614-1623.
5. Fenelon G, Mahieux F, Huon R, Ziegler M. Hallucinations in Parkinson’s disease: prevalence, phenomenology and risk factors. Brain 2000; 123:733-745.
6. Cummings JL. Managing psychosis in patients with Parkinson’s disease. N Engl J Med 1999; 340:801-803.
7. Friedman JH, Factor SA. Atypical antipsychotics in the treatment of drug-induced psychosis in Parkinson's disease. Mov Disord 2000; 15:201-211.
8. Factor SA, Molho ES, Brown DL. Combined clozapine and electroconvulsive therapy for the treatment of drug-induced psychosis in Parkinson's disease. J Neuropsychiatry Clin Neurosci 1995; 7:304-307.
9. Höflich G, Burghof KW, Kasper S, Möller HJ. Electroconvulsive therapy in comorbidity of treatment refractory paranoid hallucinatory psychoses with Parkinson disease. Nervenarzt 1994; 65:202-205.
10. Ozer F, Meral H, Aydin B, Hanoglu L, Aydemir T, Oral T. Electroconvulsive therapy in drug-induced psychiatric states and neuroleptic malignant syndrome. J ECT 2005; 21:125-127.
11. Balke LD, Varma A. A case of long-term maintenance ECT in a 78- year-old with depression and possible parkinson’s disease. CNS Spectr 2007;12:325-326.
12. Chou KL, Hurting HI, Jaggi JL, Baltuch GH, Pelchat RJ, Weintraub D. Electroconvulsive therapy for depression in a parkinson’s disease patient with bilateral subthalamic nucleus deep brain stimulators. Parkinsonism Relat Disord 2005;11:403-406.
13. Bailine S, Kremen N, Kohen I, Linder H, Schwartz GJ, Mogilner AY, et al. Bitemporal electroconvulsive therapy for depression in a Parkinson disease patient with a deep-brain stimulator. J ECT. 2008;24:171-172.
14. Epstein CM, Evatt ML, Funk A, Girard-Siqueira L, Lupei N, Slaughter L, et al. An open study of repetitive transcranial magnetic stimulation in treatment-resistant depression with Parkinson's disease. Clin Neurophysiol 2007;118:2189-2194.
15. Takeshita S, Kurisu K, Trop L, Arita K, Akimitsu T, Verhoeff NP. Effect of subthalamic stimulation on mood state in Parkinson's disease: evaluation of previous facts and problems. Neurosurg Rev 2005;28:179-186.
16. Modigh K. Electroconvulsive shock and postsynaptic catecholamine effects: increased psychomotor stimulant action of apomorphine and clonidine in reserpine pretreated mice by repeated ECS. J Neural Transm 1975; 36:19-32.