Azienda Ospedaliero – Universitaria

Policlinico Universitario - Monserrato - Cagliari

“Malattia di Parkinson,

e disturbi della sfera psichiaca”Antonino Cannas

Congresso AINAT –Cagliari, 2 Dicembre 2017

Parkinson’s disease: the

quintessential neuropsychiatric

disorder

Weintraub D, Burn DJ.

Mov Disord. 2011 May; 26 (6): 1022-31

Parkinson’s disease may be preceded, and is frequently

accompanied by a wide range of cognitive and

neuropsychiatric features.

These problems may be underrecognized and are frequently

underteated

Nigro-striatal pathway

Normale Malattia di Parkinson

1) meso-cortico-frontal 2) Meso-limbic 3) Tubero-infundibular

Dopaminergic pathways

•

• Le vie della dopamina

1) Nigro-striatale

2) Meso-cortico-frontale

3) Meso-limbica

4) Tubero-infundibulare

Circuiti meso-cortico-frontali (non motori) coinvolti nella Malattia di Parkinson

Corteccia

prefrontale

dorso-laterale

Globo pallido

(dorso-mediale

laterale)

Talamo (nucleo

ventrale anteriore

e medio dorsale)

Circuito prefrontale

dorso-laterale

Caudato

(dorso-laterale) Questo tipo di funzione include la capacità di organizzare

una risposta comportamentale per risolvere un problema

complesso e l’attivazione di memorie remote,

l’indipendenza dalle contingenze ambientali, la

generazione di programmi motori.

Funzione esecutiva

Circuiti meso-cortico-frontali (non motori) coinvolti nella Malattia di Parkinson

Corteccia orbito-

frontale mediale

Globo pallido interno

(medio-dorsale)

Pars reticulata SN

Talamo (nucleo

ventrale anteriore

e medio dorsale)

Nucleo Accumbens

Caudato ventro-mesiale

Media aspetti empatici, civili e sociali e del

comportamento ed è coinvolto nelle associazioni

oggetto/affetto.

Lesioni o disfunzioni in questo sistema stanno spesso

alla base di soggetti che non rispondono correttamente

alle regole sociali e sono incapaci di entrare in empatia

con i sentimenti degli altri.

Circuito

orbito frontale mediale Coinvolto nelle associazioni

oggetto/affetto

Circuiti meso-cortico-frontali (non motori) coinvolti nella Malattia di Parkinson

Corteccia del

cingolo anteriore

Globo pallido interno

Sostanza Nera

Talamo dorsale

medio dorsale magnocellulare

Circuito del

cingolo anterioreComportamento motivazionale

Caudato ventro-mediale

Putamen ventrale

Nucleo accumbens

L’apatia è il dato comportamentale più rilevante

che indica una disfunzione di questo sistema.

Lesioni bilateali del cingolo anteriore determinano

il mutismo acinetico.

Una lesione monolaterale può dare un mutismo

acinetico transitorio.

Tali pazienti non manifestano emozioni, anche

quando soffrono e mostrano una totale

indifferenza alle circostanze

psychopathological implicationsmeso-cortico-frontal pathway

It is essential to the normal cognitive function and is thought to be involved

in motivation and emotional response.

It is thought to be associated with the negative symptoms of schizophrenia

[avolition,alogia and flat affect]

This pathway is closely associated with the mesolimbic pathway

Mesolimbic pathway

It is thought to be involved in producing pleasurable feeling, and is often

associated with feelings of desire and reward.

Because of this, this pathway is heavily implicated in neurobiological theories

of addiction.

It has been found that an excess of dopamine in this area is linked to

psychosis and the 'positive symptoms' of schizophrenia (particularly

delusions and hallucinations).

psychopathological implicationsmeso-limbic pathway

Dopaminergic and Serotoninergic Mesolimbic pathways

I recettori dopaminergici

D2(DRD2)

D3(DRD3)

D4(DRD4)

D1-like family(excitatory)

D2-like family(inhibitory)

D1(DRD1)

D5(DRD5)

D2-like family

• D3 (DRD3): Maximum expression in the islands of Calleja and nucleus accumbens.

• D4 (DRD4). D4 has the following variants D4.2, D4.3a, D4.3b, D4.4a, D4.4b, D4.4c, D4.4d, D4.4e, D4.5a, D4.5b, D4.6a, D4.6b, D4.7a, D4.7b, D4.7c, D4.7d, D4.8, D4.10.

• For example, the D4.7 alleles have an established association with attention-deficit hyperactivity disorder (ADHD).

Queste 2 classi principali recettori (D1-like e D2-like) e le varie sottoclassi, diversamente distribuiti nei principali sistemi dopaminergici centrali,

mediano funzioni nervose con effetti clinico-

comportamentali differenti in ambito, • motorio, affettivo e cognitivo

• Seeman P et al.. Nature, 1993, 30 365:441-5

• Seeman P and Van Tol. 1993, Current Opinion Neurol Neurosurg, 6(4).602-608.

• Seeman P, Arch Neurol, 1993,50 (10):1093:95

Dopamine and psychosis

Glutamate receptor antagonism: neurotoxicity, anti-akinetic effects, and psychosis.

•

• Decreased glutamatergic activity appears to contribute toparanoid hallucinatory psychosis in schizophrenia andpharmacotoxic psychosis in Parkinson's disease.

It has been suggested that a loss of glutamatergic function causes dopaminergic over-activity.

Riederer P; Lange KW; Kornhuber J; Jellinger K J Neural Transm Suppl, 1991,

34:203-10

ketaminephencyclidine

Decreasedglutamatergic

activity

dopaminergic over-activity

Dopaminergicactivity

Glutamatergicactivity

Glutamatergic/dopaminergic (im)-balance

Dopamine and affective disorders

Dopamine and affective disorders

• 1) Menza M.A., Sage J., Marshall E., Cody R., Duvoisin R.: Mood changes and "On-Off" phenomena inParkinson's disease. Mov. Disord., 5: 148-151, 1990.

• 2) Maricle R.A., Nutt J.G., Valentine R.J., Carter J.H.: Dose-response relationship of levodopa with moodand anxiety in fluctuating Parkinson' disease: A double-blind, placebo-controlled study. Neurology, 45,1757-1760, 1995

• 3) Przedborski S., Liard A., Hildebrand J.: Induction of mania by apomorphine in a depressedparkinsonian patient. Mov. Disord., 7 (3): 285-287, 1992.

• 4) Ko G.N., Leckman J.F., Heninger G.R.. Induction of rapid mood cycling during L-Dopa treatment in abipolar patient. Am. J. Psychiatry, 138, 1624-1625, 1981.

5) Cannas A, Solla P, Manca E, Floris G, Tacconi P, Marrosu MG. Ultrarapid mood cycling in a

parkinsonian patient : is not always simply an “on-off” fluctuaction – a case report

• Parkinsonism Relat Disord. 2008;14(3):262-3.

• 6) Larmande P., Palisson E., Saikali I., Maillot F.: Disappearance of akinesia in Parkinson disease during amanic attack. Rev. Neurol.(Paris), 149 (10): 557-558, 1993.

“Variabilità ed espressività clinica dei disturbi psichiatrici

lungo il decorso della malattia di Parkinson”

Variabili fondamentali

ComponenteIatrogena

Drug induced

ComponenteOrganicaInvolutiva

Brain injury

età,

sesso,

anni di malattia,

anni di terapia,

grado di compromissione

motoria,

variante clinica,

comorbilità organiche

tipo e dosaggio dei

farmaci associati,

.

variabili complementari

ComponentePsicopatologica

Premorbid

personality

Range di variabilità degli “affective disorders”

nella MP

Depressive disorders

“malinconia (1891)“

Depression occurs in approximately 40% of patients with Parkinson's disease;

depression in Parkinson's disease is distinguished from other depressivedisorders by greater anxiety and less self-punitive ideation. Female gender,early age at onset of Parkinson's disease, and greater left brain involvement may alsobe risk factors.

Approximately half of depressed patients with Parkinson's disease meet criteria formajor depressive episodes; half have dysthymia. Depression is more common inParkinson's disease with prominent bradykinesia and gait instability than in tremor-dominant syndromes.

Depressed patients with Parkinson's disease have greater frontal lobe dysfunctionand greater involvement of dopaminergic and noradrenergic systems thannondepressed patients with the disease.

Depression ad Parkinson’s disease: A rewiewCummings, Am J Psychiatry .1992, 149(4): 443-54.

Depressione malattia specifica ?

Reattiva ?

Biochimica ?

Distimia?

Depressione Maggiore?

Altre?

Quale depressione ?

PD: what depression ?

Spesso si presenta con semeiologia simile

alla depressione unipolare [1],ma altre

volte assume peculiarità

siontomatologiche tali da giustificare la

definizione di “sindrome depressiva

malattia specifica” [2] con

predominante ansietà e scarsità di

ideazione autopunitiva e di autoaccusa,

e di propositi suicidiari [2]

[1] Haltnhof e Schroter, Neurol. Psychiatry, 1994.

[2] Cummings, Am. J Psychiatry, 1992“malinconia“

Ansiety symptoms and ansiety syndromes

are prominent

L’urlo (1893) Angoscia (1893) Disperazione (1893)

Schiffer et al.. Am J Psychiatry, 1988, 145: 1020-1022.

Marsh l. Ansiety disorders in PD. Int Rev Psychiatry 2000, 12: 307-318.

Symptoms less evident

• Self-blame • Guilt • Delusions• Negative self attitude• Self destructive thoughts • Sense of failure • Anhedonia

Brown GL,Wilson WP. Parkinsonism and depression South Med J, 1972, 65:540-545

Taylor et al., PD and depression: a critical re-evaluation, Brain 1986, 109:279-292.

Suicide

• Can occur, but the reported rate is comparable with that of the general population

• Stenager EN et al., Suicide in patients with PD: an epidemologic study: Acta Psychiatr Scand 1994, 90, 70-72

“disperazione“

Depressione Anedonia

Perdita di:

motivazione

interazioni sociali

• Diminuita capacità di concentrazione ed iniziativa

• Ridotto interesse per stimoli piacevoli (sesso, cibo, fumo alcool)

Perdita di:

autostima

appetito

Senso di disperazione,

inutilità e colpa

Ricorrenti pensieri

di morte e suicidio

Eutimia - mania - depressione -

Przedborski S., Liard A., Hildebrand J.: Induction of mania by apomorphine in a

depressed parkinsonian patient. Mov. Disord., 7 (3): 285-287, 1992.

Edvard Munch: la donna in tre fasi (1894)

“Cotard syndrome” in severe major depression of PD

• Cannas A, Spissu A, et al,Bipolar affective disorder and Parkinson's disease: a rare, insidious and often unrecognized association

• Neurol Sci. 2002 Sep;23 Suppl 2:S67-8.

• Factor et al., threatening auditory hallucinations and Cotard syndrome in Parkinson’ disease.

• Clin Neuropharmacol 2004; 27: 205-207

Pablo Picasso, Evocation (L'enterrement de Casagemas), 1901

Other psychiatric disorders

[93] Holroyd S,et al (2001) Prospective study of hallucinations + delusions in PD. J Neurol Neurosurg Psychiatry, 2001, 70:734-738

[94] Aarsland D, et al (1999). Prevalence + clinical correlates of psychotic symptoms in PD. Arch Neurol, 56: 595-601

[95] Cannas A, et al (2001) Chronic delusional hallucinatory psychosis in early-onset Parkinson’s disease: drug-induced

complication or psychiatric illness? Neurol Sci. 2001, 22(1):53-4.

[96] Goetz CG, et al (1998). Early dopaminergic drug-inducet hallucination in PD. Neurology, 51;811-814.

other psychiatric disorders

Marsh and Berk – Neuropsychiatric aspects of Parkinson’s Disease: Recent

Advances. Geriatric Disorders, 2003 (5): 68-76

Dopaminergic medications induce psychosis approximately 20% of

the time, but recent studies show that the dose and duration of anti-

parkinsonian treatment are not related to the incidence of psychosis

[93, 94]. Other risk factors are clearly important, including cognitive

impairment, disease severity, mood disorders, impaired visual acuity,

other psychoactive medications. In some cases, pre-existing

psychopathology emerges with dopaminergic treatment [95].

However, psychosis in the early stages of PD suggest alternative

diagnoses, such as dementia with Lewy bodies or Alzheimer disease

with extrapyramidal features [96]

età,

sesso,

anni di malattia,

anni di terapia,

grado di compromissione

motoria,

variante clinica,

comorbilità organiche

tipo e dosaggio dei

farmaci associati,

.

Variabile fondamentale

Componente

Psicopatologica

Premorbid personality

Premorbid personality

Comorbilità latente e misconosciuta (spettro

schizofrenico, schizo-affettivo, affettivo)

Frequenti deliri monotematici (gelosia –

persecuzione, religiosi, etc)

Disturbi del controllo degli impulsi

Disturbi della sfera comportamentale

Esordio precoce

Pochi anni di

malattia

Bassi o moderati

dosaggi

di farmaci

dopaminergici

Assenza di

disturbi

cognitivi

Familiarità per

Disturbi

Psichiatrici

o alcolismo

età,

sesso,

anni di malattia,

anni di terapia,

grado di compromissione

motoria,

variante clinica,

comorbilità organiche

tipo e dosaggio dei

farmaci associati,

.

Variabile fondamentale

Componente organica

involutiva

Brain injury

Brain injury

PDPsy (Psychosis associated with advanced

parkinson’s disease)

DLB (dementia with Lewy bodies)

AD (Alzheimer Disease)

Neurodegenerative disorders with parkinsonism

(FTD, CBD, PSP, MSA-P, MSA-C, )

Deterioramento

cognitivo

palese

o

chiara

evoluzione

aggressiva

della

Malattia per

variabili dosaggi

di farmaci

dopaminergici

Marsh and Berk – Neuropsychiatric aspects of Parkinson’s Disease: Recent Advances. Geriatric

Disorders, 2003 (5): 68-76

Brain injury

Psychosis in the early stages of PD suggest alternative diagnoses, such as

dementia with Lewy bodies or Alzheimer disease with extrapyramidal features.

età,

sesso,

anni di malattia,

anni di terapia,

grado di compromissione

motoria,

variante clinica,

comorbilità organiche

tipo e dosaggio dei

farmaci associati,

.

Variabile fondamentale

Componente

Iatrogenica

Drug induced

Drug induced

Psicosi paranoidee -allucinatorie acute o

subacute (PPAA)

Disturbi del controllo degli impulsi

(ipesessualità, etc,,,)

PDPsy (Psychosis associated with advanced parkinson’s disease)

Deliri monosintomatici (gelosia,veneficio, persecuzione)

Psicosi che

insorge

in coincidenza di

chiaro incremento

di terapia

anti-parkinson

e si attenua e

scompare

con riduzione

di tale terapia.

+

Premorbid

Personality

e/o

Brain Injury

Max Ernst: The Temptation of St. Antony (1919)

Iatrogenic Delusional-Hallucinatory Acute or Subacute

Psychosis (Delirium).

PDPsy Diagnostic Criteria for Psychosis in Parkinson’s Disease: Report of an NINDS

(National Institute of Neurological Disorders and Stroke), NIMH (National Institute

of Mental Health) Work Group (2007)

• PDPsy has a well-characterized temporal and clinical profile of

hallucinations and delusions, which is different than the pattern seen

in other psychotic disorders such as substance induced psychosis or

schizophrenia.

• PDPsy is associated with a poor prognosis of chronic psychosis,

nursing home placement, and death.

• Movement Disorders 2007, Vol 22; 8:1061-1068

“Minor hallucinations” of PDPsy [presence and passage

(feeting, vague images in the periferial vision) hallucinations and visual

illusions]

Visual hallucinations in PDPsy

Max Ernst, 1919

Visual hallucinations in PDPsy

Clinical features

• Visual hallucinations are the most common psychotic symptoms [1-3] (more than 90% of patients)[4]

• Subject: people or animals, and less commonly inanimate objects [1,4]

• The experience tends to be present intermittently.[5]

• The frequency can vary. Often, they occur several times per day.

• The duration can last seconds to minutes at a time.

• Auditory hallucinations variably( 8-13%) [6] co-occur with visual hallucinations.

• Allucinations tend to occur during times of low ambient stimulation, most typically in the evening or when the patient is alone in a quiet anvironment. [1]

References:

1) NINDS, NIMH Work Group. Mov. Disorders, 22, 8,2007, 1061-1068.

2) Sanchez-Ramos JR, Ortoll R, Paulson GW. Arch Neurol 1996, 53: 1265-1268.

3) Fenelon G,, Mahieux F, Huon R, Ziegler M. Brain 2000; 123:733-745

4) Greene P, Cote L, fahn S. Adv Neurol, 1993; 60:703-706.

5) Barnes J, David AS, J Neurol Neurosurg Psychiatry, 2001: 70:727-733.

6) Inzelberg R, Kipervasser S, Korczyn AD. J Neurol Neurosurg Psychiatry, 1998: 64:533-535

Auditory hallucinations in PDPsy

Auditory hallucinations in PDPsy

Clinical features

• Auditory hallucinations variably( 8-13%) co-occur with visual hallucinations. [1,2]

• Subject: ranges from indistinct whispers or music to threatening voices [1,2,3]

• The experience tends to be present intermittently.[4]

• The frequency can vary. Often, they occur several times per day. [4]

The duration can last seconds to minutes at a time. [4]

• Allucinations tend to occur during times of low ambient stimulation, most typically in the

evening or when the patient is alone in a quiet anvironment. [1]

References:

1) Inzelberg R, Kipervasser S, Korczyn AD. J Neurol Neurosurg Psychiatry, 1998: 64:533-535

2) Marsh L, Williams JR, Rocco M, et al. Neurology 2004, 63, 293-300

3) Factor SA, Molho ES. Clin Neuropharmacol 2004; 27:205-207.

4)NINDS, NIMH Work Group. Mov. Disorders, 22, 8,2007, 1061-1068.

Insight in hallucinations of PDPsy.

Malignant hallucinationsLoss of insight

Benign hallucinations

Diagnostic Criteria for Psychosis in Parkinson’s Disease:Report of an NINDS (National Institute of Neurological Disorders and Stroke),

NIMH (National Institute of Mental Health) Work Group (2007)Movement Disorders 2007, Vol 22; 8:1061-1068.

Normal

Delusions in PD and PDPsy.

Delusion of persecution

Max Ernst, 1924

Delusion of jealousy

Edvard Munch: “gelosia”

Delusion of ruin

Edvard Munch: “ceneri”

•

• Persecutory [1,5]

• Somatic [1,5]

• Spousal infedelity or abandonment [2,5]

• Othello’s syndrome [3]

• Grandiose [1,5]

• Religious (less frequently) [4,5]

Delusions in PD and of PDPsy.

References:

1) Factor SA, Molho ES. Clin Neuropharmacol 2004; 27:205-207.

2) Marsh L. Curr Treat Options Neurol, 2004; 6:181-189.

3) Cannas A, Solla P, Floris GL, Marrosu MG, Progress in Neuropharmacology and

Biologic Psychiatry, 2006

4) Diederich NJ, Pieri V, Goetz CG. Mov Disorders, 2003; 18:831-832.

5) Diagnostic Criteria for Psychosis in Parkinson’s Disease: Report of an NINDS (National Institute of

Neurological Disorders and Stroke), NIMH (National Institute of Mental Health) Work Group (2007)

Movement Disorders 2007, Vol 22; 8:1061-1068,

Delusional-Hallucinatory Chronic Psychosis.

Clinical features

Disinhibition in Parkinson’s disease

• Multiple Disinhibitory Psychopathologies

• ICDs:

• Pathological Gambling

• Hypersexuality (aberrant and paraphilias)

• Compulsive Eating

• Compulsive Shopping

• Punding

• DDS (Dopamine Dysregulation Syndrome)

Lim SY, Evans AH, Miyasaki J M (2008). Ann N Y Acad Sci, 1142:85-107.

Evans AH, Strafella Antonio P, Weintraub D, Stracy M (2009). Movement Disorders, 24, 11, 1561-1570.

Multiple Disinhibitory Psychopathologies

• Occur in approximately 13.6% of Parkinson’s disease patients.

• Weintraub et al, Impulse control disorders in Parkinson disease: a cross-sectonial study of 3090 patients,

Arch Neurol 2010; 67:589-595.

• Voon et al, Impulse control disorders in Parkinson’s disease: a multicenter case-control study, Ann Neurol

2011; 69-986-996.

ICDs in PD

• Preliminary studies have linked ICDs in PD

to

• dopaminergic therapy

• younger age,

• greater smoking history,

• personal or family history of alcohol use disorders,

• greater novelty seeking,

• impulsivity,

• impulsive choice,

• depressed mood

Weintraub et al, Impulse control disorders in Parkinson disease: a cross-sectonial study of 3090 patients, Arch Neurol 2010; 67:589-595.

Voon et al, Impulse control disorders in Parkinson’s disease: a multicenter case-control study, Ann Neurol 2011; 69-986-996.

ICDs in PD

ICDs in PD are associated with multiple psychiatric

and cognitive impairments, including affective and anxiety symptoms,

as wel as elevated obsessionality, novelty seeking, and impulsivity.

Voon et al, Impulse control disorders in Parkinson’s disease: a multicenter case-control study, Ann

Neurol 2011; 69-986-996.

The Rewarding System and Addictive Drugs

Fig.22: Mesolimbic Dopamine Pathway

Self-Stimulation Apparatus according to Olds (1976):The Switch of the Rewarding System.

Pathologic Gambling

Molina JA, Sainz-Artiga MJ, Fraile A, et al., Phatologic gambling in Parkinson’s

disease: a behavioral manifestation of pharmacologic treatment ? Mov Disord ,

2000,15: 869-872.

Gille PlazyCezanne

“I giocatori di carte “

Compulsive eating

Nirenberg MJ, Waters C. Compulsive eating and weight gain relatedto dopamine agonist use. Mov Disord, 2006, 21:524-529.

Henri Matisse

Il mangiatoredi pasta

Compulsive hypersexuality

•

Klos KJ et al., (2005) Pathological

hypersexuality predominantly linked to

adjuvant dopamine agonist therapy in

Parkinson,s disease and multiple

system atrophy. Parkinsonism Relat

Disord 11: 381-386.

Voon V, et al.,(2006) Prospective

prevalence of pathologic gambling and

medication association in Parkinson

disease. Neurology 66:1750-1752.

Cannas A, Solla P, Floris GL, Marrosu

MG.(2007) Aberrant sexual behaviours

in Parkinson’s disease during

dopaminergic treatment. J. Neurol

2007- 254:110-112.

Pablo Picasso: l’embrasse brutal (1900)

Pathological Shopping

Voon V, Hassan K, Zurowski M et al.,(2006) Prospective prevalence of

pathologic gambling and medication association in Parkinson disease.

Neurology 66:1750-1752.

“Punding”

Miyasaki JM, Hassan K, Lang AE, Voon V. Punding prevalence in Parkinson’s

disease: Mov Disord, 2007 (Epub ahead of Print)

Punding

• Derivato dallo slang svedese, il termine “Punding”

fu coniato originariamente nel 1972 per descrivere

la condizione di "block-head", con la quale i tossicodipendenti

di anfetamine e cocaina definivano

la loro attività motoria ripetitiva e sterile *.

• In pazienti parkinsoniani che assumevano L-dopa

fu descritto per la prima volta da Friedman nel 1994 .

Successivamente, fu riportato con l'uso di dopaminoagonisti

e dopo assunzione di quetiapina, un neurolettico atipico.

Rylander G (1972). Psychoses and the punding and choreiform syndromes in addiction to central stimulant drugs. Psychiatr Neurol Neurochir, 75: 203-212.

• Friedman JH (1994): Punding on levodopa. Biol Psychiatry 1; 36(5): 350-1

Punding (a constellation of complex, sterile and

stereotyped behaviors)

• Cleaning

• Repairing things

• Man repetitively tinker with tecnical equipment such as radio sets, clocks, watches and car engines, the part of which may be analyzed, arranged, soted and cataloged but rarely put back together.

• Gardening

• Women, in contrast, incessantly sort through their handbags, tidy continuously, brush their hair or polish their nails.

• Writing

• Categorizing informations

• Artistic drawing or craft-making

• Siging or playing a musical instrument

• Playng cards, fishing

• Excessive computer use

• Compulsive risk-seeking (reckless) driving.

• Collecting pebbes and lining them up as perfecty as possible

• Disassembling doorknobs and putting them back together

• Building hundreds of small wooden boxes.

• Etc, etc

• Lim SY, Evans AH, Miyasaki J M (2008). Impulse Control and Related Disorders in Parkinson’s Disease (Review), Ann N Y Acad Sci, 1142:85-107.

• Evans AH, Strafella Antonio P, Weintraub D, Stracy M (2009). Impulsive and compulsive Behaviors in Parkinson’s disease. Movement Disorders, 24, 11, 1561-1570.

Dopamine Dysregulation Syndrome (DDS)Edonistic Homeostatic Dysregulation

Giovannoni G, et al., (2000) J Neurol Neurosurg Psychiatry , 68:423-428

Henri Matisse: Dance (1909)

Dopamine Dysregulation Syndrome (DDS) orHedonistic homeostatic dysregulation

Giovannoni G, et al., (2000) J Neurol Neurosurg Psychiatry , 68:423-428

• Prevalenza del 4%

• Soggetti di sesso maschile

• Età giovane• Incremento progressivo dei farmaci dopaminergici (Dopaminoagonisti)

• Precoce insorgenza di violente discinesie

• Negazione dell’abuso

• Alterata percezione dell’ON

• Scarso insight

• Sintomi (euforia ed eccitabilità in ON, intollerabile depressione in OFF): aggressività, agitazione psicomotoria, stati maniacali, andamenti dell’umore di tipo ciclotimico, disorganizzazione del pensiero fino alla paranoia, disturbi del controllo degli impulsi (gambling, ipersessualità etc, etc)

• Pezzella FR, Colosimo C, Vanacore N et al. Mov Disord, 2005, 20:77-81.

Pablo Picasso : la “joie de vivre”, 1946

Grazie per l’attenzione