Hostname: page-component-7c8c6479df-27gpq Total loading time: 0 Render date: 2024-03-28T13:40:07.748Z Has data issue: false hasContentIssue false

Psychiatric symptoms during L-dopa therapy for Parkinson's disease and their relationship to physical disability

Published online by Cambridge University Press:  09 July 2009

R. H. S. Mindham
Affiliation:
Department of Psychiatry, Nottingham University Medical School, Department of Neurology, Institute of Psychiatry, London
C. D. Marsden
Affiliation:
Department of Psychiatry, Nottingham University Medical School, Department of Neurology, Institute of Psychiatry, London
J. D. Parkes
Affiliation:
Department of Psychiatry, Nottingham University Medical School, Department of Neurology, Institute of Psychiatry, London

Synopsis

Fifty patients attending a neurological outpatient clinic for Parkinson's disease were assessed by standardized methods for both physical and psychiatric symptoms. The patients then received treatment with L-dopa, L-dopa with carbidopa or anticholinergic drugs and/or amantadine. During the following six-month period the subjects were assessed at intervals, both physically and psychiatrically. Forty patients were followed up for the full six-month period. The severity of physical signs and affective symptoms was shown to be significantly related at several stages of the investigation. Initially, the patients showed a high psychiatric morbidity. During treatment, 22 patients developed a depressive disorder, 12 of which had a history of previous depressive episodes. By contrast, of the 11 patients who showed very few affective symptoms during follow-up, none had a history of depression. Of the 22 patients with a depressive disorder, only two were in the anticholinergic/amantadine group, compared with nine and 11 in the other groups. L-dopa was not an effective antidepressant agent. The probable relevance of the findings of the study to the management of patients with Parkinson's disease is outlined.

Type
Research Article
Copyright
Copyright © Cambridge University Press 1976

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Barbeau, A. (1969). L-dopa therapy in Parkinson's disease: a critical review of nine years' experience. Canadian Medical Association Journal 101, 791800.Google ScholarPubMed
Carroll, B. J. (1971). Monoamine precursors in the treatment of depression. Clinical Pharmacology and Therapeutics 12, 743761.CrossRefGoogle ScholarPubMed
Celesia, G. G. & Wanamaker, W. M. (1972). Psychiatric disturbances in Parkinson's disease. Diseases of the Nervous System 33, 577583.Google ScholarPubMed
Coppen, A., Metcalfe, M., Carroll, J. D. & Morris, J. G. L. (1972). Levadopa and L-tryptophan therapy in Parkinsonism. Lancet i, 654658.CrossRefGoogle Scholar
Culpan, R. H., Davies, B. M. & Oppenheim, A. N. (1960). Incidence of psychiatric illness among hospital outpatients: an application of the Cornell Medical Index. British Medical Journal i, 855857.CrossRefGoogle Scholar
Damásio, A. R., Lobo-Antunes, J. & Macedo, C. (1971). Psychiatric aspects in Parkinsonism treated with L-dopa. Journal of Neurology, Neurosurgery and Psychiatry 34, 502507.CrossRefGoogle ScholarPubMed
Eastwood, M. R., Mindham, R. H. S. & Tennent, T. G. (1970). The physical status of psychiatric emergencies. British Journal of Psychiatry 116, 545550.CrossRefGoogle ScholarPubMed
Eastwood, M. R. & Trevelyan, M. H. (1972). Relationship between physical and psychiatric emergencies. Psychological Medicine 2, 363372.CrossRefGoogle Scholar
Eilenberg, M. D. & Whatmore, P. B. (1961). Physical disease and psychiatric emergencies. Comprehensive Psychiatry 2, 358363.CrossRefGoogle ScholarPubMed
Fogel, M. L. & Rosillo, R. H. (1969). Correlation of psychological variables and progress in physical rehabilitation. II. Motivation attitudes and flexibility of goals. Diseases of the Nervous System 30, 593601.Google Scholar
Fogel, M. L. & Rosillo, R. H. (1971). Correlation of psychologic variables and progress in physical rehabilitation. III. Ego functions and defensive and adaptive mechanisms. Archives of Physical Medicine and Rehabilitation 52, 1521.Google Scholar
General Practice Research Unit (1970). The General Practice Research Unit Interview Schedule. Institute of Psychiatry: London.Google Scholar
Godwin-Austen, R. B., Tomlinson, E. B., Frears, C. C. & Kok, H. W. L. (1969). Effects of L-dopa in Parkinson's disease. Lancet ii, 165168.CrossRefGoogle Scholar
Goldberg, D. P., Cooper, B., Eastwood, M. R., Kedward, H. B. & Shepherd, M. (1970). A standardized psychiatric interview for use in community surveys. British Journal of Preventive and Social Medicine 24, 1823.Google ScholarPubMed
Gowers, W. R. (1888). A Manual of the Diseases of the Nervous System. Macmillan: London.CrossRefGoogle Scholar
Granerus, A.-K., Steg, G. & Sanborg, A. (1972). Clinical analyses of factors influencing L-dopa treatment of Parkinson's syndrome. Acta Medica Scandinavica 192, 111.CrossRefGoogle ScholarPubMed
Hill, A. B. (1960). Controlled Clinical Trials. Blackwell: Oxford.Google Scholar
Ingvarssan, C. G. (1965). Orientierende klinische Versuche zur Wirkung des Dioxyphenylalanins (L-Dopa) bei endogener Depression. Arzneimittel-Forschung 15, 849852.Google Scholar
Jackson, J. A., Free, G. B. M. & Pike, H. V. (1923). The psychic manifestations in paralysis agitans. Archives of Neurology and Psychiatry 10, 680684.CrossRefGoogle Scholar
Jaspers, K. (1963). General Psychopathology. Manchester University Press: Manchester.Google Scholar
Jenkins, R. B. & Groh, R. H. (1970). Mental symptoms in Parkinsonian patients treated with L-dopa. Lancet ii, 177180.CrossRefGoogle Scholar
Lishman, W. A. (1968). Brain damage in relation to psychiatric disability after head injury. British Journal of Psychiatry 114, 373410.CrossRefGoogle ScholarPubMed
Maclay, I. (1965). The ‘functional’ medical outpatient. British Journal of Psychiatry 111, 3438.CrossRefGoogle Scholar
Maguire, G. P. & Granville-Grossman, K. L. (1968). Physical illness in psychiatric patients. British Journal of Psychiatry 114, 13651369.CrossRefGoogle ScholarPubMed
Marsh, G. G. & Markham, C. M. (1973). Does levodopa alter depression and psychopathology in parkinsonism patients? Journal of Neurology, Neurosurgery and Psychiatry 34, 925935.CrossRefGoogle Scholar
Mindham, R. H. S. (1970). Psychiatric symptoms in Parkinsonism. Journal of Neurology, Neurosurgery and Psychiatry 33, 188191.CrossRefGoogle ScholarPubMed
Mindham, R. H. S. (1974). Psychiatric aspects of Parkinson's disease. British Journal of Hospital Medicine 11, 411414.Google Scholar
Mjönes, H. (1949). Paralysis agitans: a clinical and genetic study. Acta Psychiatrica et Neurologica Scandinavica, suppl. 54.Google Scholar
Nichols, P. J. R. (1971). Some problems in rehabilitation of the severely disabled. Proceedings of the Royal Society of Medicine 64, 349353.CrossRefGoogle ScholarPubMed
Parkes, C. M. & Napier, M. M. (1970). Psychiatric sequelae of amputation. British Journal of Hospital Medicine 4, 610614.Google Scholar
Parkes, J. D., Zilkha, K. J., Calver, D. M. & Knill-Jones, R. P. (1970). Controlled trial of amantadine hydrochloride in Parkinson's disease. Lancet i, 259262.CrossRefGoogle Scholar
Patrick, H. T. & Levy, D. M. (1922). Parkinson's disease: a clinical study of one hundred and forty-six cases. Archives of Neurology and Psychiatry 7, 711720.CrossRefGoogle Scholar
Post, F. (1962). The Significance of Affective Symptoms in Old Age. Oxford University Press: London.Google Scholar
Rennie, T. A. C. (1942). Prognosis in manic-depressive psychosis. American Journal of Psychiatry 98, 801814.CrossRefGoogle Scholar
Rosillo, R. H. & Fogel, M. L. (1970). Correlation of psychologic variables and progress in physical rehabilitation. I. Degree of disability and denial of illness. Archives of Physical Medicine and Rehabilitation 51, 227233.Google ScholarPubMed
Rosillo, R. H., Fogel, M. L. & Freedman, K. (1971). Affect levels and improvement in physical rehabilitation. Journal of Chronic Disease 24, 651660.CrossRefGoogle ScholarPubMed
Sacks, O. W. & Kohl, M. (1970). Incontinent nostalgia induced by L-dopa. Lancet i, 1394.CrossRefGoogle Scholar
Schildkraut, J. J. (1969). Neuropsychopharmacology and the affective disorders. New England Journal of Medicine 281, 197201, 248–255, 302–308.CrossRefGoogle ScholarPubMed
Siegel, S. (1956). Nonparametric Statistics for the Behavioural Sciences. McGraw-Hill: New York.Google Scholar
Souqués, M. A. (1921). Rapport sur les syndromes parkinsoniens. Revue Neurologique 28, 534573.Google Scholar
Surridge, D. (1969). An investigation into some psychiatric aspects of multiple sclerosis. British Journal of Psychiatry 115, 749764.CrossRefGoogle ScholarPubMed
Wagshul, A. M. & Daroff, R. B. (1969). Depression during L-dopa treatment. Lancet ii, 592.CrossRefGoogle Scholar
Wilson, S. A. K. (1940). Neurology, 2 vols. Arnold: London.Google Scholar
Yahr, M. D., Duvoisin, R. C., Schear, M. J., Barrett, R. E. & Hoehn, M. M. (1969). Treatment of Parkinsonism with levodopa. Archives of Neurology 21, 343354.CrossRefGoogle ScholarPubMed
Yaryura-Tobias, J. A., Diamond, B. & Merlis, S. (1970). The action of L-dopa on schizophrenic patients. Current Therapeutic Research 12, 428531.Google ScholarPubMed
Zaphiropoulos, G. & Burry, H. C. (1974). Depression in rheumatoid disease. Annals of Rheumatic Diseases 33, 132135.CrossRefGoogle ScholarPubMed