Objective: To present a new type of Dopamine Dysregulation Syndrome in Parkinson’s Disease.

Background: Dopamine Dysregulation Syndrome (DDS) is a rare neuropsychiatric complication of Parkinson’s Disease (PD) therapy. In Factitious Disorder Imposed on Another (FDIA) someone fabricates or exaggerates features of a disease in another person.

Method: Case Report

Results: We present a case of a 70 year-old woman who was brought to the the Emergency Room with generalized involuntary movements. She had PD for 12 years, and she was under Carbidopa/L-dopa 250/25mg 4 times daily and Ropinirole 8mg daily, with previous control of her disease. She also had a Major Depressive Disorder, treated with antidepressants. The patient and her companion were both beggars. She presented with generalized choreic-ballistic movements and a mild cognitive impairment. Both patient’s and companion’s information was compatible with DDS and she was admitted for clinical improvement, therapeutic adjustment and social support. She reduced Carbidopa/L-dopa dosage (600mg daily), suspended the dopaminergic agonist and started Clozapine 25mg daily which prevented further abnormal movements and motor fluctuations. During the third week, the dyskinetic choreiform movements suddenly returned and were mainly present from lunch and onward through the afternoon, which did not respect the predictable peak dose neither the end of the dose period that would be expected from the scheduled levodopa intakes. In one situation, her companion was seen administering extra Carbidopa/L-dopa pills, which he referred to be for the patient’s clinical benefit. We were also informed by the Hospital’s Social Service support that the patient’s exuberant choreiform dyskinesia was commonly seen in touristic spots. Her companion’s strategy was to give her excessive doses of Carbidopa/L-dopa which he mixed in a glass of water so as to more rapidly induce the dyskinetic movements, hence increasing their chances of receiving money through begging. The diagnosis of FDIA was then made on the companion.

Conclusion: We presented a new type of DDS in PD, without the addictive dimension usually associated to this syndrome which makes therapeutics and prognosis different.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/factitious-disorder-imposed-on-another-mimicking-a-dopamine-dysregulation-syndrome/