Major Depressive Disorder Preceding the Onset of Progressive Supranuclear Palsy

Abstract

Progressive supranuclear palsy (PSP) is a neurodegenerative disease characterized by vertical supranuclear palsy and parkinsonian symptoms. The neuropsychiatric symptoms of PSP include anhedonia, depressed mood and cognitive impairment. Patients with PSP have an increased risk for developing depressive disorders within the next year. However, it is rare to find that major depressive disorder was the antecedent diagnosis of a patient who was later diagnosed with PSP. We present here a patient who suffered from PSP with repetitive falls, a masked face and dysarthria after developing a major depressive disorder.

Characteristics of Nonmotor Symptoms in Progressive Supranuclear Palsy

“…This finding is consistent with a case-control study [ 24 ] and several cross-sectional studies [ 5 , 12 ], which found that neuropsychiatric symptoms including apathy, depression, and anxiety are common in PSP. Moreover, two previous case reports [ 25 , 26 ] found that depression can be the first sign of PSP. These neuropsychiatric changes can be explained by frontal lobe dysfunction in PSP, which has been verified in several studies [ 27 , 28 ].…”

Fragile X-associated tremor/ataxia syndrome: phenotypic comparisons with other movement disorders

“…Litvan, Mega et al, 1996). Depression has been reported be over 50% higher in PSP patients than healthy controls (Bloise et al, 2014;Esmonde, Giles, Gibson et al, 1996;, and may even precede the motor impairments (W. H. Kim et al, 2009;Quante, Jakob, & Wolf, 2008). Hallucinations, psychosis, and delusions were thought to be rare in PSP (H. F. Chiu, 1995).…”

Neuropsychiatric Symptoms as Early Manifestation of Progressive Supranuclear Palsy

“…In the index case, depression developed around 9 months before the onset of PSP symptoms, although we could not clearly answer whether depression was the first symptom of PSP or depression was concurrent with PSP. In literature, there have been few reports of cases with depression as an antecedent symptom of PSP[ 6 7 ] similar to the index case. Unlike the reports which indicated apathy as the dominant behavioral change in PSP,[ 1 8 ] the main behavioral symptom, in this case, was depression.…”

“…[5] The disease has varied neuropsychiatric manifestations which include agitation, confusion, delirium, rigidity, dysarthria, mutism, split-brain syndrome, incontinence, dementia, psychotic symptoms, and gaze palsy. [6,7] We report a rare presentation of MBD in a 32-year-old male having a history of heavy alcohol consumption who presented with persecutory delusion, auditory hallucinations, dysarthria, and urinary incontinence and whose psychotic symptoms responded to olanzapine. This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.…”