Psychiatric Manifestations of Levodopa

Yaryura-Tobias, José A.; Diamond, Bruce J.; Merlis, Sidney

doi:10.1177/07067437720176s221

Cited by 8 publications

(5 citation statements)

References 18 publications

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“…The discovery that levodopa could also precipitate psychiatric symptoms in animals and man, coupled with the dramatic efficacy of dopamine receptor blockers (neuroleptics) in treating endogenous psychosis, has formed the basis for the dopamine theory of psychosis [14]. Clinical evidence that supports this hypothesis includes the de novo, dose-related appearance of hallucinations in PD patients treated with levodopa, the reliable disappearance of these symptoms with dose reduction, and the efficacy of traditional neuroleptics in treating this problem.…”

Section: Mechanisms Of Psychosismentioning

confidence: 97%

“…In some patients, anti-PD medications precipitate acute psychiatric symptoms by unmasking a premorbid psychiatric state. This has been shown to occur in schizophrenic patients [14] and patients with manic-depressive illness [15] who were exposed to levodopa. For the majority of PD patients, however, there is no premorbid psychiatric disorder.…”

Section: Mechanisms Of Psychosismentioning

confidence: 98%

“…It has been known for many years that drugs that are structurally similar to dopamine, such as lysergic acid diethylamide (LSD), mescaline, and amphetamines can cause elaborate hallucinations and other psychotic symptoms in otherwise healthy individuals [14]. The discovery that levodopa could also precipitate psychiatric symptoms in animals and man, coupled with the dramatic efficacy of dopamine receptor blockers (neuroleptics) in treating endogenous psychosis, has formed the basis for the dopamine theory of psychosis [14].…”

Section: Mechanisms Of Psychosismentioning

confidence: 99%

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Parkinson’s disease: The treatment of drug-induced hallucinations and psychosis

Molho

Factor

2001

Curr Neurol Neurosci Rep

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Drug-induced psychosis is one of the most disabling complications of advancing Parkinson's disease. It has also been one of the most difficult to treat. Clozapine was the first medication shown to be safe and effective in this setting, and it remains the standard by which newer atypical antipsychotics are measured. However, due to the small but significant risk of agranulocytosis and the need for frequent blood testing, alternatives have been sought. Risperidone, olanzapine, and quetiapine are new atypical antipsychotics that have each been proposed as an alternative to clozapine, but the literature concerning their use in Parkinson's disease is conflicted and confusing. Although quetiapine appears to be the best current choice, none of these medications have equaled clozapine's ability to safely treat drug-induced psychosis without the risk of worsening parkinsonism.

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Section: Mechanisms Of Psychosismentioning

confidence: 97%

Section: Mechanisms Of Psychosismentioning

confidence: 98%

Section: Mechanisms Of Psychosismentioning

confidence: 99%

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Parkinson’s disease: The treatment of drug-induced hallucinations and psychosis

Molho

Factor

2001

Curr Neurol Neurosci Rep

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“…Levodopa regularly precipitates mania when given to patients with a history of manic‐depressive illness 54,86,87 . When administered to patients with schizophrenia, levodopa produces an exaggeration of paranoid ideation, hallucinations, and behavioral dyscontrol 88,89 . These observations suggest that the behavioral properties of dopaminergic agents are not limited to parkinsonism but also occur in psychologically healthy individuals.…”

Section: Commentmentioning

confidence: 99%

Behavioral Complications of Drug Treatment of Parkinson's Disease

Cummings

1991

J American Geriatrics Society

170

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A variety of neuropharmacologic agents, including anticholinergic drugs, amantadine hydrochloride, levodopa, selegiline, bromocriptine, and pergolide, are now available for the treatment of Parkinson's disease. Of patients treated with dopaminergic agents, 30% develop visual hallucinations, 10% exhibit delusions, 10% have euphoria, 1% have mania, 10% to 15% experience increased anxiety, 15% have confusional periods, and a few exhibit altered sexual behavior. Anticholinergic drugs have a greater tendency to produce confusional states than dopaminergic compounds. Elderly patients and those with underlying dementia are most likely to have untoward side effects with anti-parkinsonism treatment. Dosage reduction is the optimum management strategy, although anti-psychotic agents may be necessary in patients with delusions, and lithium may help control drug-induced mania. Dopaminergic agents share the property of stimulation of D2 dopamine receptors, and this action may play an essential role in mediating their neuropsychiatric effects.

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“…Episodes of depression in Parkinsonian patients treated with levodopa were noted in early case reports and in the adverse effect data from early clinical trials (Celesia & Barr 1970;Cherington 1970;McDowell et al 1970;Wagshul & Daroff 1969;Yaryura-Tobias et al 1972). The apparent association between levodopa and depression has been difficult to confirm, primarily because depression is also a feature of Parkinson's disease (Cummings 1992;Starkstein et al 1990) hence, disease factors may confound associations between the drug and depression (Goodwin 1971).…”

Section: Levodopamentioning

confidence: 99%

Drug-Induced Depression

Patten

Love

1994

Drug Safety

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According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), drug-induced depression may be classified as an Organic Mood Syndrome, Depressed Type. Unfortunately, the DSM-III-R diagnostic criteria are not sufficiently precise for application in research, and studies of drug-induced depression have rarely utilised these criteria. Research concerned with drug-induced depression is characterised by a number of methodological complications. These include differing definitions of depression, including depression defined as a symptom, a syndrome, or by diagnostic criteria for a specific mental disorder. In addition, patients undergoing pharmacological treatments for medical illnesses are typically exposed to considerable psychosocial stress due to the suffering and disability associated with illness. These psychosocial factors may in themselves precipitate episodes of depression. Due to these complicating factors, sophisticated study designs are required to confirm an aetiological role for medications as risk factors for depression. Unfortunately, adequate studies have rarely been conducted, and much of the literature consists of case reports and clinical observations. Consequently, clinicians are frequently required to make clinical judgements about the aetiology of patients' depressive symptoms in the absence of definitive scientific information about the role of drugs. Nevertheless, a knowledge of the relevant literature will assist clinicians in making reasoned judgements about the aetiology, prevention and management of these disorders.

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Psychiatric Manifestations of Levodopa

Cited by 8 publications

References 18 publications

Parkinson’s disease: The treatment of drug-induced hallucinations and psychosis

Parkinson’s disease: The treatment of drug-induced hallucinations and psychosis

Behavioral Complications of Drug Treatment of Parkinson's Disease

Drug-Induced Depression

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