A 51-year-old woman with a 5-year history of PD, commented that she was accumulating an amount of things at home. She invited us to visit her home, so that we could see it. She was taking levodopa/benserazide 500 mg/day, pramipexole 1.5 mg/day, amantadine 200 mg/day, and nortriptyline 25 mg/day (total levodopa-equivalent dose of 850 mg/day). Her motor and non-motor features were the following: Hoehn and Yahr: 2.0, motor UPDRS: 34, and MMSE: 28 (9 years of study). She reported anxiety, which was confirmed in clinical evaluation, and FP, feeling someone behind her at home or even when walking on the street at least twice a week. Those problems had started 1 year before, after prescription of levodopa/benserazide.
At her house, we could find a collection of small purses, some empty and others with more purses inside. We also observed small diaries in which she copied repeated notes and phone numbers (Figure 1). She was unable to throw away flyers and ads distributed in the streets. We diagnosed punding and psychosis, and decided to reduce PD medications.
Two months later, she was on levodopa/benserazide 300 mg/day, pramipexole 1.0 mg/day, and nortriptyline 25 mg/day. There was a substantial improvement in punding behavior (she donated most of the small purses and threw away diaries and flyers). On the other hand, FP persisted in the same pattern. Motor symptoms became worse, and we prescribed entacapone 600 mg/day, with partial improvement.