Bipolar affective disorder and Parkinson's disease: a rare, insidious and often unrecognized association

Abstract

Five patients (4 women) with Parkinson's disease (PD) and primary major psychiatric disorder (PMPD) meeting DSM-IV criteria for the diagnosis of bipolar affective disorder (BAD) were studied. Four patients had early onset PD. Four developed a severe psychiatric disorder a few years after starting dopaminergic therapy in presence of a mild motor disability and a mild cognitive impairment, with no evidence of cerebral atrophy at CT or MRI. Two patients developed a clear manic episode; the other three presented a severe depressive episode (in one case featuring a Cotard syndrome). None showed previous signs of long term L-dopa treatment syndrome (LTS), hallucinosis or other minor psychiatric disorders. The two manic episodes occurred shortly after an increase of dopaminergic therapy and in one case rapid cyclic mood fluctuations were observed. At the onset of psychiatric symptoms, all patients had an unspecific diagnosis of chronic delusional hallucinatory psychosis (CDHP).

Cotard's syndrome in adolescents and young adults is associated with an increased risk of bipolar disorder

“…We found 32 new reports of cases of CS published since 1994 (3, 6–36). One report (31) gave insufficient clinical data and six others were not considered because they were not written in English or French (32–37).…”

“…One report (31) gave insufficient clinical data and six others were not considered because they were not written in English or French (32–37). The 26 new reports (3, 6–30) that were eligible for this review included 38 new cases of CS reported since Berrios and Luque published their report (2). Therefore, the sample included 138 patients (94 females and 44 males).…”

Molecular mechanistic associations of human diseases

“…Host disease, pancreatitis as well as Sjögren's syndrome are immune system-related disorders which, like T1DM, involve immune response-driven tissue destruction. Connections between PD and schizophrenia as well as attention deficit disorder with hyperactivity are supported by dysregulation of dopamine-dependent neurotransmission shared by these morbidities [35,36], whereas clinical associations of PD with bipolar disorder and with dystonia have been previously described as effects of PD therapy with dopamine agonists, also suggesting common causal mechanisms [37,38]. …”

Fluctuating Cotard Syndrome in a Patient With Advanced Parkinson Disease

“…Cotard syndrome can appear in patients affected both by psychiatric and neurological disorders. [6][7][8][9] Usually, nonmotor fluctuations occurring during the "on" state tend to be easier to diagnose than those occurring in the "off" state. 6 Besides, among neurological disorders, this type of delusion has been previously described in 4 anecdotal cases affected by PD, although none of these patients presented with fluctuating delusional belief tightly related to "off" period.…”