Hypomania and mania related to dopamine replacement therapy in Parkinson's disease

Franziska Maier; Josuah Merkl; Anna L Ellereit; Catharine J Lewis; Carsten Eggers; David J Pedrosa; Elke Kalbe; Jens Kuhn; Thomas D Meyer; Mateusz Zurowski; Lars Timmermann

doi:10.1016/j.parkreldis.2014.01.001

Hypomania and mania related to dopamine replacement therapy in Parkinson's disease

Parkinsonism Relat Disord. 2014 Apr;20(4):421-7. doi: 10.1016/j.parkreldis.2014.01.001. Epub 2014 Jan 12.

Authors

Affiliations

¹ Department of Neurology, University of Cologne, Cologne, Germany. Electronic address: franziska.maier@uk-koeln.de.
² Department of Neurology, University of Cologne, Cologne, Germany.
³ Department of Neurology, University of Cologne, Cologne, Germany; Institute for Gerontology, University of Vechta, Vechta, Germany.
⁴ Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
⁵ Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, United Kingdom.
⁶ Department of Psychiatry, University of Toronto, University Health Network, Toronto, Canada.

PMID: 24467817
DOI: 10.1016/j.parkreldis.2014.01.001

Abstract

Objectives: To investigate hypomania and mania related to dopamine replacement therapy (DRT) in Parkinson's disease (PD).

Methods: We recruited 108 non-demented PD patients without deep brain stimulation from a movement disorders in and outpatient clinic. Forty-five age- and gender-matched controls were also included. Disease characteristics, cognitive functioning, comorbid psychiatric diseases, dopaminergic and psychiatric medication were evaluated. Diagnosis of DRT-related hypomania and mania was based on DSM-IV-TR criteria with supplementary assessment of two mania self-rating scales. First, patients and controls were compared. Patients with DRT-related hypomania or mania were then compared to the remaining patients. A binary logistic regression analysis was performed to identify correlates of DRT-related hypomania.

Results: Patients scored significantly higher on mania self-rating scales than controls. Twelve patients (11.1%) had DRT-related hypomania and six patients (5.6%) had DRT-related mania. Both groups had significantly higher self-rating mania-scores than patients without these mood states. DRT-related hypomania was significantly related to younger age, younger age at PD onset, dyskinesias, higher levodopa equivalent daily dose, dopamine dysregulation, and amantadine treatment. In contrast, DRT-related mania was significantly associated with hallucinations and delusions, history of levodopa-induced psychosis, quetiapine treatment, higher depression and daily levodopa dose, and cognitive deficits. Regression analysis revealed dopamine dysregulation, dyskinesias, amantadine treatment, and younger age at PD onset as significant correlates of DRT-related hypomania.

Conclusion: DRT-related hypomania and mania are relevant comorbidities in PD. DRT-related hypomania may exist as a distinct psychiatric symptom complex in young patients with early disease onset. Different patient profiles likely underlie DRT-related hypomania and mania.

Keywords: Dopamine dysregulation; Dopamine replacement therapy; Hypomania; Impulse control disorders; Mania; Parkinson's disease.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Bipolar Disorder / chemically induced*
Bipolar Disorder / epidemiology
Dopamine Agonists / adverse effects*
Humans
Middle Aged
Parkinson Disease / drug therapy*
Parkinson Disease / psychology
Prevalence

Substances

Dopamine Agonists