Objective: We studied diagnosis and treatment of Parkinson’s disease in cases of psychiatric disorders treated with dopamine receptors antagonists for a long time.

Background: Schizophrenia is one of main disorders in psychiatric disorders which has been reported to occur around 1% of population and occur the symptoms between the ages of teens and thirties. Parkinson’s disease is one of  common neurological disorders, especially in elder people. Drug-indued parkinsonism is a rather common disorder in movement disorder clinic, however, it is not always clear to diagnosis Parkinson’s disease in elder cases treated with dopamine receptor antagonists on psychiatric disorders.

Method: Six cases of parkinsonism with diagnosis of schizophrenia who were referred to our neurology clinic were studied. They were diagnosed at their ages from twenties and thirties by the psychiatrists. The clinical course, neurological findings, brain MRI and/or CT scan and DATSPECT and/or MIBG scintigram were performed. According to the diagnosis, results of clinical course and treatment of Parkinson’s disease were summarized.

Results: Two cases showed tremor at hands with rigidity with mild bradykinesia showed normal scan on DATSPECT. They were advised to reduce the doses of anti-antipsychotics as much as possible. 4 cases showed decreased DATSPECT and MIBG scintigram with bradykinesia and rigidity. They were treated as Parkinson’s disease in collaboration with the psychiatrists. 3 cases were treated with levodopa at doses between 25 to 150mg per day with zonisamide at a dose of 25mg per day. Their bradykinesia reduced and improved ADL for up to now (2 to 6 years). One cases who needed increase of the levodopa dose up to 600 mg/day to keep ADL showed relapse of psychiatric symptoms 3 years later, and had to admitted to the psychiatric hospital.

Conclusion: DATSPECT and MIBG scintigram are useful on diagnosis of Parkinson’s disease, especially parkinsonism who had been treated with dopamine receptor antagonists for a long time because of psychiatric disorders. Combination therapy with small dose of levodopa and small dose of zonisamide will be recommended for the treatment in such cases.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/parkinsons-disease-in-a-special-population-diagnosis-and-treatment-of-parkinsons-disease-in-cases-of-psychiatric-disorders-treated-with-dopamine-receptors-antagonists/