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Background: Deep brain stimulation (DBS) is a modern neuromodulation method used in the treatment of advanced movement disorders such as Parkinson’s disease (PD) and dystonia. Patients with PD may have multiple psychiatric comorbidities, notably anxiety, depression, mania or hypomania, and psychosis. DBS surgery may indirectly alleviate psychiatric symptoms by allowing reduction of dopaminergic medications, or as a result of functional improvement. Patients who are considering DBS for PD often have more advanced disease and may be more vulnerable to perioperative psychiatric decline. Albeit infrequently, increased depression, apathy, irritability, hypomania or mania, and suicidal behavior have been observed after DBS surgery. </P><P> Objective: This review aimed to present current evidence and empirical recommendations for the management of the psychiatric symptoms in patients with PD treated with DBS. </P><P> Method: Relevant literature was reviewed and synthesized, along with recommendations informed by the authors’ clinical experience in a large, academic DBS center. Results: Careful evaluation of DBS candidacy, including assessing the risk for perioperative psychiatric decompensation is advised. Maintaining at least eight weeks of psychiatric stability prior to DBS surgery is strongly recommended. Postoperative management can be challenging due to advanced disease, concurrent psychiatric comorbidities, and possible DBS stimulation-related effects on mood and impulse control. Stimulation-induced elevated mood states (mania, hypomania) have started to be recognized as distinct clinical entities, although not included in the current psychiatric nomenclature. Conclusion: Insufficient evidence-based strategies for managing psychiatric symptoms in PD patients with DBS exist at this time. Further research is necessary to uncover best practices in this complex, expanding field.

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A higher prevalence of mental illness in inmates is also shown when looking at specific psychiatric disorders. For example, major depressive disorder ranged between 9 and 31% compared to 7% of the general population; bipolar disorder ranged between 6 and 25% among inmates compared to 2.8% in the general population; and schizophrenia spectrum and other psychotic disorders ranged between 2 and 12% versus an estimated prevalence between 0.25 and 0.64% in the general population (1,3,4,5,6).Catatonia is a severe motor disturbance associated with these primary psychotic disorders and mood disorders, which is also associated with other medical or neurological etiologies. According to the DSM-V, at least three of the following symptoms must be present for a diagnosis of catatonia: stupor (no psychomotor activity, no reactivity to the environment), cataplexy (passive induction of postures held against gravity), waxy flexibility (slight and even resistance to repositioning by the examiner), mutism (no verbal response), negativism (not responding to external stimuli), posturing (spontaneous and active maintenance of posture against gravity), mannerism (odd caricatures of ordinary actions), stereotypy (repetitive, frequent, non-goal directed movement), agitation (not influenced by external stimuli), grimacing, echolalia (repeating the words spoken by the examiner), and echopraxia (mimicking of movements made by the examiner) (7,8) There are three subtypes of catatonia: stuporous, excited, and malignant catatonia (9). Symptoms of stuporous catatonia include rigidity and "freezing" in place, mutism, inability to eat or drink, posturing, grimacing, and waxy flexibility. Excited catatonia is associated with purposeless and repetitive motor activity. Malignant

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