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P.2.b.006 Depression and apathy in patients with Parkinson's disease in a hospital in Romania
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P.2.b. Mood disorders and treatment − Affective disorders (clinical)
most of the mood stabilizers were administered to bipolar patients. Valproic acid was the most commonly used medication in this study by far. Altogether the statistic analysis revealed a different pattern of medication in schizophrenic patients compared to the other diagnostic entities of SAD and bipolar disorders which, on the other hand, are comparable. The study reflects the prescription of drugs in clinical routine care.
Parkinson disease. These two conditions should be periodically evaluated and included in the therapeutic management of patients with Parkinson’s disease. Physicians should be aware of these issues, so appropriate diagnosis and treatment of depression will be increasing the quality of life of patients with Parkinson’s disease. References
P.2.b.006 Depression and apathy in patients with Parkinson’s disease in a hospital in Romania M.M. Dumitru1 ° , R. Chirita1 , V. Chirita1 1 Clinical Hospital of Psychiatry Socola and University Medicine and Pharmacy Gr. T Popa, Adult psychiatry, Iasi, Romania Introduction: The severity of depression in Parkinson’s disease (PD) may range from mild dysthymia to a major depression. Depression and anxiety are the most psychiatric and behavioral disorders associated with Parkinson disease and a major source of additional disability and affecting quality of life of patients [1]. Although depression includes symptoms of apathy, apathy can appear in absence of depression and vice versa. Purpose of the study: The objective of this cross-sectional study was to examine the prevalence of depression and apathy in a hospitalized population with PD. The second objective was to examine the demographic and clinical correlates of depression and apathy and to assess whether apathy can be present as a primary behavioral disorder. Methods: This cross-sectional study was conducted in Clinical Hospital of Recovery, Iasi, over a period of 6 months and included hospitalized patients with a PD diagnosis according to published diagnostic criteria [2]. All patients with motor fluctuations were examined during the on-period. All patients were on some form of dopaminergic medication and were tested while on medications. Treatment with anti-depressants/anticonvulsants was already prescribed to 7.5% of patients with the intent of anti-depressive or pain-relieving effects. The patients were investigated psychiatric with Starkstein Apathy scale (AS), Hamilton Depression Rating scale (HAMD) and Mini-Mental State Examination (MMSE), motor scoring with Hoehn and Yahr staging (HY) and Unified Parkinson Disease Rating scale (UPDRS). Results: Forty patients from University Hospital of Recovery were included in this cross-sectional study. A number of 40 patients fulfilled the inclusion criteria, 40% were women, the mean age was 67.8 (SD 8.4). The mean duration of Parkinson’s disease was 7.8 years (SD 5.7). The mean UPDRS part 3 was 22.6 (SD11.5). The mean Hoehn and Yahr stage was 2.73 (SD 0.89). Patients were classified into four groups: (1) patients with apathy and depression 37.5%, (2) apathy without depression 22.5%, (3) depression without apathy 5%, and (4) neither depression, nor apathy 35%. Also, patients were classified in three severity groups according to the HY stage of the disease: (1) mild with HY stages 1−2, 52.5% of patients, (2) moderate with HY stages 2.5−3, 37.5% of patients, and (3) severe with HY stages 4−5, 10% of patients. Depression and apathy were present at 42.5% and respectively 60% of patients. Depression was associated with more advanced HY stages and younger age of patients with Parkinson disease, while apathy was correlated with higher UPDRS impairement score, lower MMSE score and higher l-dopa dosage. Conclusions: Depression and apathy may occur separately in Parkinson disease, although both are common in patients with
[1] Aarsland, D., Marsh, L., Schrag, A., 2009 Neuropsychiatric symptoms in Parkinson’s disease Mov Disord. 15; 24(15), 2175–2186. [2] Larsen, J.P., Dupont, E., Tandberg, E., 1994 Clinical diagnosis of Parkinson’s disease. Proposal of diagnostic subgroups classified at different levels of confidence. Acta Neurol Scand 89, 242−25.
P.2.b.007 Efficacy and tolerability of bupropion in major depressive disorder associated with Parkinson’s disease D. Vasile1 ° , R.A. Macovei2 , O. Vasiliu1 1 Emergency University Central Military Hospital, Psychiatry Clinic, Bucharest, Romania; 2 Floreasca Emergency Clinical Hospital, ICU Department, Bucharest, Romania Background: Psychiatric manifestations in Parkinson’s disease (PD) could be met in up to 88% of cases [1], while the incidence of depression in the same population is evaluated at 20−50% and is associated with increasing disability [2]. Bupropion is an antidepressant agent with dopamine reuptake blocking properties, with no sympathomimetic, anti-cholinergic or MAO-inhibitor effects [3]. Dopamine agonists showed some anti-depressant activity in several studies with depressive PD patients, but these agents may cause various side effects, like dizziness, somnolence, confusion, hallucinations [1]. Bupropion was associated with improvements in the PD symptoms and PD associated depressive symptoms [3]. Objective: The primary objective was to evaluate the efficacy of bupropion in the treatment of major depressive disorder associated to PD. The secondary objective was to assess the tolerability of this drug in the PD diagnosed patients. Methods: A group of 20 patients, 12 male and 8 female, mean age 64.9, diagnosed with PD for at least 2 years, who were admitted in our department for a major depressive episode (DSM IV TR), received antidepressant treatment with bupropion XL (flexible dose 150–300 mg daily) for 6 months. These patients were diagnosed with depressive disorder only after the onset of PD. All the subjects were stabilized with anticholinergic agents (n = 6), levodopa/carbidopa/entacapone (n = 7) or pramipexole/ropinirole (n = 7) and were monitored by a neurologist throughout the study. Patients were evaluated monthly using Montgomery Asberg Depression Rating Scale (MADRS), Clinical Global ImpressionImprovement (CGI-I), Global Assessment of Functioning (GAF), Monitoring of Side Effects Scale (MOSES), the Movement Disorders Society-Unified Parkinson’s Disease Rating Scale (MDSUPDRS) and SF-36 questionnaire. Inclusion criteria: ability to sign informed consent, MADRS score at screening over 20, age between 18 and 80. Exclusion criteria: prior treatment with bupropion, other comorbid axis I disorder or axis III chronic pathology, personal history of cerebral traumas or seizures. Intent-to-treat-analysis and last-observation-carried-forward were used in the statistical processing of data.
P.2.b. Mood disorders and treatment − Affective disorders (clinical)
most of the mood stabilizers were administered to bipolar patients. Valproic acid was the most commonly used medication in this study by far. Altogether the statistic analysis revealed a different pattern of medication in schizophrenic patients compared to the other diagnostic entities of SAD and bipolar disorders which, on the other hand, are comparable. The study reflects the prescription of drugs in clinical routine care.
Parkinson disease. These two conditions should be periodically evaluated and included in the therapeutic management of patients with Parkinson’s disease. Physicians should be aware of these issues, so appropriate diagnosis and treatment of depression will be increasing the quality of life of patients with Parkinson’s disease. References
P.2.b.006 Depression and apathy in patients with Parkinson’s disease in a hospital in Romania M.M. Dumitru1 ° , R. Chirita1 , V. Chirita1 1 Clinical Hospital of Psychiatry Socola and University Medicine and Pharmacy Gr. T Popa, Adult psychiatry, Iasi, Romania Introduction: The severity of depression in Parkinson’s disease (PD) may range from mild dysthymia to a major depression. Depression and anxiety are the most psychiatric and behavioral disorders associated with Parkinson disease and a major source of additional disability and affecting quality of life of patients [1]. Although depression includes symptoms of apathy, apathy can appear in absence of depression and vice versa. Purpose of the study: The objective of this cross-sectional study was to examine the prevalence of depression and apathy in a hospitalized population with PD. The second objective was to examine the demographic and clinical correlates of depression and apathy and to assess whether apathy can be present as a primary behavioral disorder. Methods: This cross-sectional study was conducted in Clinical Hospital of Recovery, Iasi, over a period of 6 months and included hospitalized patients with a PD diagnosis according to published diagnostic criteria [2]. All patients with motor fluctuations were examined during the on-period. All patients were on some form of dopaminergic medication and were tested while on medications. Treatment with anti-depressants/anticonvulsants was already prescribed to 7.5% of patients with the intent of anti-depressive or pain-relieving effects. The patients were investigated psychiatric with Starkstein Apathy scale (AS), Hamilton Depression Rating scale (HAMD) and Mini-Mental State Examination (MMSE), motor scoring with Hoehn and Yahr staging (HY) and Unified Parkinson Disease Rating scale (UPDRS). Results: Forty patients from University Hospital of Recovery were included in this cross-sectional study. A number of 40 patients fulfilled the inclusion criteria, 40% were women, the mean age was 67.8 (SD 8.4). The mean duration of Parkinson’s disease was 7.8 years (SD 5.7). The mean UPDRS part 3 was 22.6 (SD11.5). The mean Hoehn and Yahr stage was 2.73 (SD 0.89). Patients were classified into four groups: (1) patients with apathy and depression 37.5%, (2) apathy without depression 22.5%, (3) depression without apathy 5%, and (4) neither depression, nor apathy 35%. Also, patients were classified in three severity groups according to the HY stage of the disease: (1) mild with HY stages 1−2, 52.5% of patients, (2) moderate with HY stages 2.5−3, 37.5% of patients, and (3) severe with HY stages 4−5, 10% of patients. Depression and apathy were present at 42.5% and respectively 60% of patients. Depression was associated with more advanced HY stages and younger age of patients with Parkinson disease, while apathy was correlated with higher UPDRS impairement score, lower MMSE score and higher l-dopa dosage. Conclusions: Depression and apathy may occur separately in Parkinson disease, although both are common in patients with
[1] Aarsland, D., Marsh, L., Schrag, A., 2009 Neuropsychiatric symptoms in Parkinson’s disease Mov Disord. 15; 24(15), 2175–2186. [2] Larsen, J.P., Dupont, E., Tandberg, E., 1994 Clinical diagnosis of Parkinson’s disease. Proposal of diagnostic subgroups classified at different levels of confidence. Acta Neurol Scand 89, 242−25.
P.2.b.007 Efficacy and tolerability of bupropion in major depressive disorder associated with Parkinson’s disease D. Vasile1 ° , R.A. Macovei2 , O. Vasiliu1 1 Emergency University Central Military Hospital, Psychiatry Clinic, Bucharest, Romania; 2 Floreasca Emergency Clinical Hospital, ICU Department, Bucharest, Romania Background: Psychiatric manifestations in Parkinson’s disease (PD) could be met in up to 88% of cases [1], while the incidence of depression in the same population is evaluated at 20−50% and is associated with increasing disability [2]. Bupropion is an antidepressant agent with dopamine reuptake blocking properties, with no sympathomimetic, anti-cholinergic or MAO-inhibitor effects [3]. Dopamine agonists showed some anti-depressant activity in several studies with depressive PD patients, but these agents may cause various side effects, like dizziness, somnolence, confusion, hallucinations [1]. Bupropion was associated with improvements in the PD symptoms and PD associated depressive symptoms [3]. Objective: The primary objective was to evaluate the efficacy of bupropion in the treatment of major depressive disorder associated to PD. The secondary objective was to assess the tolerability of this drug in the PD diagnosed patients. Methods: A group of 20 patients, 12 male and 8 female, mean age 64.9, diagnosed with PD for at least 2 years, who were admitted in our department for a major depressive episode (DSM IV TR), received antidepressant treatment with bupropion XL (flexible dose 150–300 mg daily) for 6 months. These patients were diagnosed with depressive disorder only after the onset of PD. All the subjects were stabilized with anticholinergic agents (n = 6), levodopa/carbidopa/entacapone (n = 7) or pramipexole/ropinirole (n = 7) and were monitored by a neurologist throughout the study. Patients were evaluated monthly using Montgomery Asberg Depression Rating Scale (MADRS), Clinical Global ImpressionImprovement (CGI-I), Global Assessment of Functioning (GAF), Monitoring of Side Effects Scale (MOSES), the Movement Disorders Society-Unified Parkinson’s Disease Rating Scale (MDSUPDRS) and SF-36 questionnaire. Inclusion criteria: ability to sign informed consent, MADRS score at screening over 20, age between 18 and 80. Exclusion criteria: prior treatment with bupropion, other comorbid axis I disorder or axis III chronic pathology, personal history of cerebral traumas or seizures. Intent-to-treat-analysis and last-observation-carried-forward were used in the statistical processing of data.