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Letters   |    
Punding as a Transient Symptom in a Patient With an Early-Onset Form of Dementia
Matheus Oliveira, M.D., M.S.; João R. Oliveira, M.D., Ph.D.; José E. Gomes da Cunha, M.S.
The Journal of Neuropsychiatry and Clinical Neurosciences 2013;25:E08-E10. doi:10.1176/appi.neuropsych.11120356
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The authors declare no conflicts of interest.

Dept. of Neurosurgery Hospital do Servidor Público Estadual de São Paulo São Paulo, Brazil
Neuropsychiatric Department and Keizo Asami Laboratory Federal University of Pernambuco (UFPE) Recife, Pernambuco, Brazil

Correspondence: Matheus Fernandes de Oliveira; e-mail: mafernoliv@yahoo.com.br

Copyright © 2013 American Psychiatric Association

Extract

To the Editor: Punding is characterized by a peculiar stereotyped behavior, with complex, excessive, non–goal-oriented, repetitive patterns of engagement in various tasks. Even though often described as related to dopaminergic dysregulation neurotransmission, especially in parkinsonian patients, punding may be more complex than just dopaminergic stimulation, involving the brainstem serotonergic system and other neurotransmitters, thus explaining its genesis in seemingly unrelated neuropsychiatric disorders.1,2

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FIGURE 1. Imaging Study of the Subject at Onset of Symptoms, in 2007 [left] and at Follow-Up, in 2010 [right]

Although the modalities of studies are different (tomography, left, and magnetic resonance, right), there is a notable increase in cortical atrophy and dilation of ventricles from one study to the other, suggesting evolution of dementia disease.

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References

Fasano  A;  Petrovic  I:  Insights into pathophysiology of punding reveal possible treatment strategies.  Mol Psychiatry 2010; 15:560–573
[CrossRef] | [PubMed]
 
Evans  AH;  Katzenschlager  R;  Paviour  D  et al:  Punding in Parkinson’s disease: its relation to the dopamine dysregulation syndrome.  Mov Disord 2004; 19:397–405
[CrossRef] | [PubMed]
 
Ávila  A;  Cardona  X;  Bello  J  et al:  Impulse-control disorders and punding in Parkinson’s disease: the need for a structured interview.  Neurologia 2011; 26:166–172
[CrossRef] | [PubMed]
 
Silveira-Moriyama  L;  Evans  AH;  Katzenschlager  R  et al:  Punding and dyskinesias.  Mov Disord 2006; 21:2214–2217
[CrossRef] | [PubMed]
 
Fasano  A;  Ricciardi  L;  Pettorruso  M  et al:  Management of punding in Parkinson's disease: an open-label prospective study.  J Neurol 2010; [E-pub ahead of print]
 
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