Attempted Suicide in a Parkinsonian Patient Treated with DBS of the VIM and High Dose Carbidopa-Levodopa

Ayobello, Ayotunde; Saway, Brian F.; Greenage, Michael

Attempted Suicide in a Parkinsonian Patient Treated with DBS of the VIM and High Dose Carbidopa-Levodopa

dc.contributor.author	Ayobello, Ayotunde	en
dc.contributor.author	Saway, Brian F.	en
dc.contributor.author	Greenage, Michael	en
dc.date.accessioned	2019-05-08T11:46:44Z	en
dc.date.available	2019-05-08T11:46:44Z	en
dc.date.issued	2019-03-26	en
dc.date.updated	2019-05-08T11:01:38Z	en
dc.description.abstract	Introduction. Parkinson’s disease (PD) is a complex disease that is often treated with dopaminergic medications such as carbidopa-levodopa and now with innovative interventions such as deep brain stimulation (DBS). While PD frequently presents with depression and apathy, research must elucidate whether its treatment modalities have an additive or synergistic effect that can lead to an increased suicide risk. DBS has been associated with depression, behavioral changes, and suicidality while dopaminergic treatment has also been shown to cause behavioral changes such as hypersexuality and impulsivity. Considering the now frequent practice of utilizing both DBS and carbidopa-levodopa to treat PD, it is crucial to understand how to properly manage PD patients who are displaying this overlap in symptomology. Case Report. A 56-year-old Caucasian male with a 6-year diagnosis of PD who was being treated with high dose carbidopa-levodopa and left DBS of the ventral intermediate nucleus (VIM) presented after a suicide attempt. The patient was found to be severely depressed and had exhibited behavioral changes in the weeks leading up to the attempt. Imaging was performed to assess positional changes of DBS and carbidopa-levodopa dosage adjusted while under close observation in the inpatient unit. The patient was started on fluoxetine to treat the depressive symptoms and was eventually discharged with close monitoring. Discussion. With PD and DBS being associated with behavioral changes and depressive symptoms and carbidopa-levodopa therapy being linked to behavioral changes such as impulsivity, it is important that these patients be closely monitored and research analyzes how these factors may interact and lead to an increased risk of suicide. Furthermore, when symptoms appear, a clear protocol must be established on managing these patients. We therefore recommend an approach that utilizes imaging to assess any changes in DBS placement, dose management of carbidopa-levodopa, and behavior monitoring in an inpatient setting.	en
dc.description.version	Published version	en
dc.format.mimetype	application/pdf	en
dc.identifier.citation	Ayotunde Ayobello, Brian Saway, and Michael Greenage, “Attempted Suicide in a Parkinsonian Patient Treated with DBS of the VIM and High Dose Carbidopa-Levodopa,” Case Reports in Psychiatry, vol. 2019, Article ID 2903762, 4 pages, 2019. doi:10.1155/2019/2903762	en
dc.identifier.doi	https://doi.org/10.1155/2019/2903762	en
dc.identifier.uri	http://hdl.handle.net/10919/89370	en
dc.language.iso	en	en
dc.publisher	Hindawi Publishing Corp	en
dc.rights	Creative Commons Attribution 4.0 International	en
dc.rights.holder	Copyright © 2019 Ayotunde Ayobello et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.	en
dc.rights.uri	http://creativecommons.org/licenses/by/4.0/	en
dc.title	Attempted Suicide in a Parkinsonian Patient Treated with DBS of the VIM and High Dose Carbidopa-Levodopa	en
dc.title.serial	Case Reports in Psychiatry	en
dc.type	Article - Refereed	en
dc.type.dcmitype	Text	en