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Letters   |    
Reduction in Parkinson’s Disease Therapy Improved Punding But Not Feeling of Presence
Camila Catherine Aquino, M.D., M.Sc.; Pollyana Celso de Castro, M.D.; Flávia Doná, Ph.D.; Leonardo Medeiros, M.D.; Sonia Maria César Azevedo Silva, M.D., Ph.D.; Vanderci Borges, M.D., Ph.D.; Henriques Ballalai Ferraz, M.D., Ph.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2013;25:E43-E44. doi:10.1176/appi.neuropsych.12070173
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Movement Disorders Section, Dept. of Neurology and Neurosurgery Universidade Federal de São Paulo São Paulo, Brazil

Correspondence: Dr. Aquino; e-mail: c.aquino@unifesp.br

Copyright © 2013 American Psychiatric Association

Extract

To the Editor: There is growing evidence that dopaminergic therapy (DT) used to treat Parkinson’s disease (PD) can cause compulsive behaviors like punding and impulse-control disorders (ICDs).1 Punding is defined as a constellation of complex, sterile, and stereotyped behaviors, including an intense fascination with repetitive manipulations of technical equipment; continual handling, examining, and sorting of common objects; excessive grooming; hoarding; incessant fidgeting at clothes or oneself; pointless driving; and the engagement in extended monologues devoid of rational content.2 Feeling of presence (FP) refers to the vivid sensation that somebody is present nearby when nobody is actually there.3 FP is included in the spectrum of psychosis in PD, which has been also attributed to DT. We report a PD patient who had been experiencing punding and FP for 1 year. After reduction in DT, punding has improved, but FP persisted.

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FIGURE 1. Illustrations of Punding Behavior

[A,B,C]: Collection of small purses; [D]: Diaries with repetitive phone numbers and notes.

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References

Lee  JY;  Kim  JM;  Kim  JW  et al:  Association between the dose of dopaminergic medication and the behavioral disturbances in Parkinson disease.  Parkinsonism Relat Disord 2010; 16:202–207
[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]
 
Fénelon  G;  Soulas  T;  Cleret de Langavant  L  et al:  Feeling of presence in Parkinson’s disease.  J Neurol Neurosurg Psychiatry 2011; 82:1219–1224
[CrossRef] | [PubMed]
 
Fasano  A;  Ricciardi  L;  Pettorruso  M  et al:  Management of punding in Parkinson’s disease: an open-label prospective study.  J Neurol 2011; 258:656–660
[CrossRef] | [PubMed]
 
Zahodne  LB;  Fernandez  HH:  Pathophysiology and treatment of psychosis in Parkinson’s disease: a review.  Drugs Aging 2008; 25:665–682
[CrossRef] | [PubMed]
 
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