Both the presence and severity of neuropsychiatric symptoms, in particular mood/apathy alterations,had a significant impact on quality of life in subjects with PD.

Parkinson's disease (PD) is characterized by a wide spectrum of motor and non-motor features; the latter include a high prevalence of neuropsychiatric symptoms 1 . Depression and psychosis are among the most frequent neuropsychiatric symptoms in PD 2,3 . Depression and psychosis have been associated with poor health-related quality-of-life and disability 4,5,6 . Psychopharmacotherapy is currently considered the first-line of treatment for depression, as well as for psychosis in patients with PD. A recent meta-analysis on treatment for depression reported a moderate, but non-significant, pooled effect for antidepressants over placebo 7 , The rate of depression remission in PD is 37% to 44 8 . Regarding psychosis, response rates to antipsychotics have been reported to be complete in 33% and partial in another 33% of the cases 9,10 . In refractory cases, the use of electroconvulsive therapy (ECT) has been proved to have beneficial effects on both, neuropsychiatric symptoms and motor symptoms of patients with PD 11,12 . The majority of these studies are uncontrolled prospective or retrospective studies, or case reports. Moreover, the stigma surrounding ECT has may also account for a reduced use of it in the treatment of neuropsychiatric symptoms in subjects with PD.The objective of the present study is to analyze the effectiveness of electroconvulsive therapy for the management of depression and/or psychosis refractory to drug therapy in AbstrActObjective: To analyze the effectiveness of electroconvulsive therapy for the management of depression and/or psychosis refractory to drug therapy in patients with Parkinson disease. Method: A retrospective study was carried out including patients treated with electroconvulsive therapy during the period between 2002 and 2013. A review of the literature was performed. Results: A total of 27 patients were included. In regards to the neuropsychiatric diagnosis, 14 patients had major depression, 12 patients had both psychosis and depression, and only one patient had isolated psychosis. The mean number of electroconvulsive therapy sessions was 12 ± 2.8. After electroconvulsive therapy, all patients showed a statistically significant improvement in the Brief Psychiatric Rating scale (reduction of 52% points) and Hamilton Depression Rating Scale (reduction of 50% points) independent of the presence of psychosis, depression or both. Conclusion: Electroconvulsive therapy is effective for the treatment of refractory neuropsychiatric symptoms in Parkinson's disease.Keywords: Parkinson's disease, electroconvulsive therapy, psychosis, depression.rEsumo Objetivo: Analisar a eficácia da eletroconvulsoterapia para o tratamento da depressão e/ou psicoses refratária ao tratamento medicamentoso em pacientes com doença de Parkinson. Método: Um estudo retrospectivo foi realizado com pacientes tratados com a eletroconvulsoterapia, durante o período entre 2002 e 2013. Uma revisão da literatura foi realizada. Resultados: Um total de 27 pacientes foram incluídos. Em relação ao diagnóstico neuropsiqu...

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Background Pharmacological management of subjects with Parkinson's disease (PD) is complex. Regardless of drug selection, adherence is one of the main concerns. Nonadherence is associated with poor symptomatic control and low quality of life. In general, adherence to once‐a‐day formulations is thought to be better in comparison to 3‐times‐daily dosing. Methods A cross‐sectional study was carried out. Consecutive uninsured subjects diagnosed with PD were treated either with an immediate‐ or extended‐release dopamine agonist formulation. Clinical and demographic data were collected. Subjects were assessed using the International Parkinson and Movement Disorder Society UPDRS. Adherence was evaluated using the Morisky‐Green test (MGT). Results A total of 314 (175 males and 139 females) subjects with PD were included. In regard to treatment, 188 (59.9%) were on an immediate‐release dopamine agonist and 126 (40.1%) on an extended‐release dopamine agonist. According to the MGT, 21 (6.7%) subjects were classified as nonadherent, 273 (86.9%) with a low adherence, and only 20 (6.4%) were considered with high adherence. Dopamine agonist levodopa equivalent daily dose was higher in the extended‐release group (296.6 ± 112.4 vs. 231.3 ± 133.4; P = 0.011); also, these subjects had more years of formal education (12.3 ± 5.2 vs. 9.5 ± 5.2; P = 0.630). No difference in adherence levels was found (P = 0.802) between subjects treated with an immediate‐release dopamine agonist and those receiving an extended‐release formulation. Conclusions Overall adherence in subjects with PD is low. Use of an extended‐release over an immediate‐release dopamine agonist formulation in this study population is not associated with a better adherence.

Introduction. Neuropsychiatric symptoms in Parkinson's disease can be assessed by the MDS-UPDRS part IA. The Scale for Evaluation of Neuropsychiatric Disorders in Parkinson's disease (SEND-PD) has been recently developed to assess the severity of some neuropsychiatric symptoms. The objective of this study is to compare the performance of the SEND-PD with the corresponding items of the MDS-UPDRS part IA. Methods. Patients with Parkinson's disease were evaluated using the MDS-UPDRS and the SEND-PD by independent raters. Partial SEND-PD and neuropsychiatric MDS-UPDRS part IA were constructed with equivalent items for comparison. Results. A total of 260 consecutive patients were included. Overall, 61.2% of the patients did not report any psychotic symptom and 83.5% did not report any ICD symptom. On the other hand, 78.5% of the patients did report at least one symptom related to apathy, depression, or anxiety. The partial SEND-PD score was 2.9 ± 3.1 (range from 0 to 16). The neuropsychiatric MDS-UPDRS part IA score was 2.9 ± 3 (range from 0 to 14). The correlation coefficient between corresponding items ranged from 0.67 to 0.98 and between both summary indexes was r s = 0.93 (all, P < 0.001). Conclusion. A high association between equivalent items of the SEND-PD and the MDS-UPDRS was found.