Psychiatric complications of deep brain stimulation for Parkinson's disease.
BACKGROUND
The purpose of this article is to review the current literature regarding deep brain stimulation (DBS) of the subthalamic nucleus as a treatment for Parkinson's disease and to bring to the attention of the psychiatric community the possible psychiatric complications of this treatment.


METHODS
A MEDLINE search of English-language publications was conducted using PubMed in July 2003. The search term used was deep brain stimulation. In addition, pertinent references were obtained from the retrieved articles. Reports and studies of psychiatric complications of DBS patients were reviewed and are discussed. A case report is presented of a man who developed hypomanic symptoms shortly after beginning DBS treatment for Parkinson's disease.


RESULTS
There have been an increasing number of reports of postprocedure psychiatric complications, including depression, mania, aggression, and deficits in language. Improvement in symptoms of severe obsessive-compulsive disorder and depression has also been reported.


CONCLUSIONS
As information continues to emerge, psychiatrists will play vital roles in the assessment and continuing care of patients who receive DBS. These findings may also provide the framework to determine which patients are at psychiatric risk from DBS. Symptoms of refractory obsessive-compulsive disorder have been noted to improve with DBS, which has led researchers to begin studying its effectiveness for this condition.
University of Wisconsin Psychiatric Institute and Clinics, Madison. spiasecki@hfmhealth.org
Shelley D
SD
Piasecki
James W
JW
Jefferson
D001714:Bipolar Disorder / Q000209:etiology; D003866:Depressive Disorder / Q000209:etiology / Q000628:therapy; D004599:Electric Stimulation Therapy / Q000009:adverse effects* / Q000379:methods; D004567:Electrodes, Implanted; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000209:etiology*; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000523:psychology / Q000628:therapy; D010300:Parkinson Disease / Q000523:psychology / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D013238:Stereotaxic Techniques; D020531:Subthalamic Nucleus / Q000502:physiology*; D016896:Treatment Outcome