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Attempted suicide under high dose dopaminergic therapy including apomorphine
Walter Struhal1, Michael Guger, Stephanie Hödl
1Department of Neurology and Psychiatry, General Hospital of the city of Linz, Krankenhaussstr. 9, 4020, Linz, Austria. walter.struhal@akh.linz.at
Wiener Klinische Wochenschrift
|July 17, 2012
Summary
Continuous subcutaneous apomorphine infusion (CAI) may trigger impulse control disorders, psychosis, and depression. This report details a Parkinson's patient's attempted suicide during CAI, highlighting potential severe adverse events.
Area of Science:
- Neuroscience
- Pharmacology
- Movement Disorders
Background:
- Continuous subcutaneous apomorphine infusion (CAI) is used for Parkinson's disease management.
- Impulse control disorders (ICDs) have been anecdotally linked to CAI.
- Managing advanced Parkinson's disease often involves multiple medications, including levodopa and amantadine.
Observation:
- A 54-year-old patient with familial Parkinson's disease was initiated on CAI.
- The patient was also receiving high-dose levodopa and amantadine.
- Following CAI initiation, the patient developed significant impulse control disorder, psychosis, and depression.
Findings:
- The patient exhibited ICD symptoms including risky financial transactions and self-medication.
- Psychotic symptoms and depression were observed during CAI.
- The patient's condition culminated in an attempted suicide.
Implications:
- This case highlights the potential for severe psychiatric adverse events, including attempted suicide, with CAI in Parkinson's disease.
- Clinicians should carefully monitor patients on CAI for psychiatric side effects, especially those with pre-existing risk factors.
- The complex interplay of medications (CAI, levodopa, amantadine) may contribute to adverse psychiatric outcomes.
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