Idiopathic Parkinson’s Disease and Schizophrenia: Dilemma in Diagnosis and Treatment of a Case

Abstract

The relationship between schizophrenia and idiopathic Parkinson’s disease is still not clear and rare when they coexist. Diagnosing coexisting schizophrenia and idiopathic Parkinson’s disease is a chal-lenge, especially in developing countries due to lack of experts and advance imaging facilities. Treatment options are also limited. A 58- year- old male was admitted due to relapse of psychotic symptoms following non-compliance to antipsychotic medications. The patient was previously diag-nosed with schizophrenia and later developed Parkinson’s disease while non-compliant to antipsy-chotic medications. While the patient was at our center, his detailed history was taken and general physical examination was done to distinguish Parkinson’s disease from anti-psychotic induced ex-trapyramidal symptoms. All the routine investigations were within normal limits. This case report highlights the clinical factors that help make a distinction and help use appropriate drugs to manage schizophrenia with comorbid Parkinson’s disease in developing countries, where lack of precise di-agnostic imaging modalities interferes in making a conclusive diagnosis.

Increased Risk of Parkinson's Disease in Patients With Schizophrenia Spectrum Disorders

“…However, these studies did not exclude patients with drug‐induced parkinsonism, which is a common condition in patients with SCZ who are treated with neuroleptics. Thus, the prevalence of comorbidity was likely inflated, and in general, the relevant literature mostly includes single case reports, underlining the rarity of PD and SCZ comorbidity 16,17,20‐33 …”

“…Thus, the prevalence of comorbidity was likely inflated, and in general, the relevant literature mostly includes single case reports, underlining the rarity of PD and SCZ comorbidity. 16,17,[20][21][22][23][24][25][26][27][28][29][30][31][32][33] To obtain an accurate estimate, the psychotic symptoms as a manifestation of neurodegenerative diseases and parkinsonism as a manifestation of antipsychotic medications would need to be excluded from the analysis. A critical factor is the partially overlapping phenotypes of PD and SCZ.…”