Objective: To describe the case of a patient with paranoid schizophrenia followed by the onset of the Parkinson’s disease at the 44-year age

Background: Currently comorbidity of Parkinson’s disease and schizophrenic spectrum disorders is still poorly understood. Despite the apparent differences of these disorders, in reality they have a significant overlap in pathogenetic mechanisms and clinical manifestations such as delusions, hallucinations, apathy, affective and anxiety phenomena. The therapy of such patients is problematic due to antiparkinsonian drugs can induce psychotic symptoms and neuroleptics can exacerbate parkinsonian symptoms.

Method: Male patent, 45 years old, with a 10-year history of paranoid schizophrenia. Since childhood, the patient was reclusive, unsociable. He graduated from the institute and successfully worked as a programmer for more than 10 years. A sense of persecution, being inside the experiment, divine purpose appeared at the age of 35 for which he was admitted to a psychiatric hospital and treated with haloperidol up to 15 mg per day with positive effect, no motor side effects were noted. Further for 9 years he did not receive treatment systematically. At the age of 44 he had the intensification of psychotic symptoms and was hospitalized and treated with fluphenazine decanoate 25 mg once in 2 weeks with good antipsychotic effect but with the appearance of pronounced symptoms of parkinsonism: resting tremor with emphasis on the right side, rigidity, bradykinesia. Several therapy regimens including risperidone, olanzapine, lurazidone with amantadine and trihexyphenidyl were used with persistence of parkinsonian symptoms. Only quetiapine in dosage 500 mg/day showed a decrease in the intensity of motor symptoms with preservation of persistent antipsychotic effect

Results: Patient was examined by a neurologist and diagnosed with Parkinson’s disease, mixed form, Hen-Yahr stage 2. Levodopa/benserazide was added to the therapy at a total dosage of 200/50 mg per day. The patient tolerated the drug well, parkinsonian symptoms decreased significantly.

Conclusion: Because of the overlap in clinical manifestations between Parkinson’s disease and schizophrenia, differential diagnosis of these diseases is often extremely difficult. Modern literature suggests that these disorders are etiologically and pathogenetically united, as this clinical example illustrates.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comorbidity-of-schizophrenia-and-parkinsons-disease-a-clinical-case-report/