A 52-year-old patient with treatment-resistant
paranoid schizophrenia developed severe parkinsonian features after more than 20 years of
antipsychotic drug therapy. The role of this
therapy was thought to have been a contributing factor to the patient's clinical presentation, although
Parkinson's disease could not be ruled out. Originally, parkinsonian symptoms developed acutely and progressed to hand
tremor,
sialorrhea, upper body rigidity, masked
facies, striatal hand,
bradykinesia, and a severe, unsteady,
shuffling gait.
Tremor and rigidity were the only parkinsonian symptoms that responded to
anticholinergic therapy. After converting from a first- to a second-generation
antipsychotic drug, the patient maintained psychiatric stability, with some improvement in motor functioning-most notably decreased upper body rigidity. Our findings are consistent with the literature on
quetiapine therapy in patients with
Parkinson's disease in terms of adequately controlling
psychosis without worsening motor symptoms. The difference, however, was that in most cases reported, psychotic features were the result of
dopamine-enhancing treatments and not
schizophrenia.