Delusional Infestation Induced by Piribedil Add-On in Parkinson's Disease

Antiparkinsonian dopaminergic drugs increase the susceptibility to paranoid symptoms in many patients suffering from Parkinson's disease. Paranoid symptoms most often occur as visual, sometimes acoustical hallucinations. Abnormal tactile sensations and delusional infestation (DI) have only been described in a single case of Parkinson's disease treated with L-DOPA and amantadine but not with piribedil. Conversely, DI is often induced by illicit dopaminergic drugs. Apart from dysfunctional dopaminergic neurotransmission the pathophysiology of DI is poorly understood. A case of Parkinson's Disease with stable, but insufficient L-DOPA/decarboxylase inhibitor MAO-B-inhibitor treatment is described. The addition of piribedil led to marked DI, while previous additions of ropinirole and pramipexole had not. This is the first report of delusional infestation induced by piribedil add-on in Parkinson's disease and the second case of antiparkinsonian medication-induced DI in general. Piribedil's stronger antagonism at central alpha2-receptors, as compared to ropinirole and pramipexole, and the resulting increased cortico-limbic adrenergic neurotransmission and dopamine release best explain the formation of drug-induced DI in this case, carefully pointing to neural mechanisms beyond the dopamine system in this disorder.

References

• 1 Feuillerat J, Jaubert F, Vedy J. et al . [EU 4 200 (Piribedil) in current ophthalmologic practice. 1^st results].  Med Trop (Mars). 1970;  30 215-235
• 2 Shopsin B, Gershon S. Dopamine receptor stimulation in the treatment of depression: piribedil (ET-495).  Neuropsychobiology. 1978;  4 1-14
• 3 Zahodne LB, Fernandez HH. Pathophysiology and treatment of psychosis in Parkinson's disease: a review.  Drugs Aging. 2008;  25 665-682
• 4 Ecker D, Unrath A, Kassubek J. et al . Dopamine Agonists and their risk to induce psychotic episodes in Parkinson's disease: a case-control study.  BMC Neurol. 2009;  9 23
• 5 Swick BL, Walling HW. Drug-induced delusions of parasitosis during treatment of Parkinson's disease.  J Am Acad Dermatol. 2005;  53 1086-1087
• 6 Freudenmann RW, Lepping P. Delusional infestation.  Clin Microbiol Rev. 2009;  22 690-732
• 7 Tullett GL. Delusions of parasitosis.  Br J Dermatol. 1965;  77 448-455
• 8 Skott A. Delusions of infestation. Dermatozoenwahn – Ekbom's syndrome. Report from the Psychiatric Research Center.. In Goteborg: St. Jörgen Hospital, University of Goteborg. Sweden; 1978
• 9 Gross-Tsur V, Joseph A, Shalev RS. Hallucinations during methylphenidate therapy.  Neurology. 2004;  63 753-754
• 10 Krauseneck T, Soyka M. Delusional parasitosis associated with pemoline.  Psychopathology. 2005;  38 103-104
• 11 Huber M, Karner M, Kirchler E. et al . Striatal lesions in delusional parasitosis revealed by magnetic resonance imaging.  Prog Neuropsychopharmacol Biol Psychiatry. 2008;  32 1967-1971
• 12 Freudenmann RW, Lepping P. Second-generation antipsychotics in primary and secondary delusional parasitosis: outcome and efficacy.  J Clin Psychopharmacol. 2008;  28 500-508
• 13 Castro-Caldas A, Delwaide P, Jost W. et al . The Parkinson-Control study: a 1-year randomized, double-blind trial comparing piribedil (150 mg/day) with bromocriptine (25 mg/day) in early combination with levodopa in Parkinson's disease.  Mov Disord. 2006;  21 500-509
• 14 Millan MJ, Maiofiss L, Cussac D. et al . Differential actions of antiparkinson agents at multiple classes of monoaminergic receptor. I. A multivariate analysis of the binding profiles of 14 drugs at 21 native and cloned human receptor subtypes.  J Pharmacol Exp Ther. 2002;  303 791-804
• 15 Tse KC, Li FK, Tang S. et al . Delusion of worm infestation associated with clarithromycin in a patient on peritoneal dialysis.  Perit Dial Int. 2001;  21 415-416
• 16 Steinert T, Studemund H. Acute delusional parasitosis under treatment with ciprofloxacin.  Pharmacopsychiatry. 2006;  39 159-160
• 17 Hopkinson G. Delusions of infestation.  Acta Psychiatr Scand. 1970;  46 111-119
• 18 Munro A. Delusional hypochondriasis. A description of Monosymptomatic Hypochondriacal Psychosis (MHP).. Toronto: Clarke Institute of Psychiatry Monograph Series, Department of Psychiatry, University of Toronto; 1982
• 19 Dunn J, Murphy MB, Fox KM. Diffuse pruritic lesions in a 37-year-old man after sleeping in an abandoned building.  Am J Psychiatry. 2007;  164 1166-1172
• 20 Robaeys G, De Bie J, Van Ranst M. et al . An extremely rare case of delusional parasitosis in a chronic hepatitis C patient during pegylated interferon alpha-2b and ribavirin treatment.  World J Gastroenterol. 2007;  13 2379-2380
• 21 Fleury V, Wayte J, Kiley M. Topiramate-induced delusional parasitosis.  J Clin Neurosci. 2008;  15 597-599

Correspondence