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Am J Psychiatry 1978; 135:669-675
Copyright © 1978 by American Psychiatric Association
Levodopa-induced psychosis: a kindling phenomenon
C Moskovitz, H Moses 3d and HL Klawans
Of 88 patients with idiopathic Parkinson's disease, without prior psychotic
symptoms, and without significant dementia, nearly half had experienced
vivid dreams, hallucinations, illusions, and nonconfusional as well as
confusional psychoses as side effects of chronic levodopa therapy within
the previous year of treatment. It was found that 61.3% of all
hallucinations were associated with preexistent or concurrent vivid dream
phenomena, that all psychotic states were associated with preexistent or
concurrent vivid dreams and/or hallucinations, and that nonconfusional
psychotic states tended to become confusional. These findings raise the
possibility that chronic levodopa therapy may result in dopaminergic
kindling and support the hypothesis that chronic dopaminergic agonism may,
via such a kindling mechanism, play a role in the development of some types
of psychoses.
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