Symptoms of insomnia in teenagers8/11/2023 Against medical advice, the dose was increased to 20 mg daily after only 1 week. The initial dose of 10 mg daily was ineffective, and the patient became restless. Citalopram was begun 4 weeks previously for behavioral changes (agitation, hallucinations, repetitive vocalizations, and insomnia). Her current medications included gliclazide, metformin, valsartan, and atorvastatin she was receiving no Parkinson’s disease treatment. An echocardiogram 5 months previously was normal except for grade 1 diastolic dysfunction. She had no history of venous thromboembolism, bleeding, or psychiatric illness. At baseline, she was functional, as evidenced by dependence for both basic and instrumental activities of daily living, and cognitively impaired. Physical activities should also be maintained as much as possible.Īn 86-year-old woman with Parkinson’s disease, hypertension, diabetes mellitus, hyperlipidemia, and osteoporosis presented to our emergency department with altered mental status, reduced oral intake, generalized weakness, and left lower leg swelling. Upon initiating SSRIs in older patients with functional decline and multiple comorbidities, physicians need to evaluate the patient’s risk factors for bleeding or thrombosis. Older adults with Parkinson’s disease are sensitive to adverse effects of psychotropic agents, including SSRIs, which are not recommended first-line agents for behavioral symptoms in PDD. At follow-up, her sodium remained normal, and her cognition and behavior were noticeably improved. After normalization of her sodium, she was discharged on donepezil and apixaban. The patient was treated with hypertonic saline and intravenous heparin. Doppler ultrasound revealed a DVT in the left lower leg. Brain computed tomography showed age-related changes. At presentation, her plasma sodium level was 123 mg/dL. Citalopram was begun 4 weeks previously for behavioral changes and was discontinued 2 days before presentation because of excessive fatigue. Case presentationĪn 86-year-old woman with PDD presented to our emergency department with altered mental status, generalized weakness, and left lower leg swelling. This report describes a patient with PDD who developed deep venous thrombosis (DVT) and hyponatremia after initiating citalopram treatment. The effect of SSRIs on hemostasis is also unclear. Selective serotonin reuptake inhibitors (SSRIs) are widely used for mood disorders and behavioral symptoms in older adults with cognitive impairment, but they have limited efficacy in patients with PDD. Evidence is limited regarding the optimal therapeutic approach for neuropsychiatric symptoms associated with Parkinson’s disease dementia (PDD).
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