Management of catatonia in Parkinson’s disease with comorbid bipolar disorder: A case report and review of literature

Table 1 Differentiating depression from parkinsonian symptoms

Clinical profile of depressive disorders in PD	Shared symptoms of depressive disorders and PD	Discriminating symptoms of depressive disorders and PD	Diagnosing depressive disorder in PD
Persistent and pervasive low mood, sadness, and tearfulness	Lowered mood	Motor features	Low mood, anhedonia, and apathy are the most sensitive indicators of depressive disorders in PD
Dysphoria, irritability	Anhedonia	Downcast look, low mood, reduced or preserved mood reactivity, and agitation in depressive disorder	Neurovegetative symptoms are less effective in distinguishing patients with PD with or without depressive disorders
Preserved mood reactivity	Apathy	Bradykinesia, rigidity, tremor, stooped posture, shuffling gait, and masked facies in PD[18]	The presence of typical melancholic symptoms may help differentiate patients with PD with or without depressive disorders
Anxiety and panic attacks	Diminished emotional expression - lack of facial expressions, flat mood	Psychomotor slowing	A focus on mood and cognitive symptoms rather than neurovegetative symptoms helps in the diagnosis of depressive disorder in PD[18,19]
Anhedonia - diminished enjoyment	Anxiety	Similarities between parkinsonian motor symptoms, psychomotor slowing, negative symptoms and depressive symptoms in major schizophrenia, depressive, and bipolar disorder are evident	An inclusive approach that takes into account neurovegetative symptoms regardless of their possible aetiology is recommended for the diagnosis of depressive disorder in PD[10,30]
Apathy - reduced interest, loss of initiative	Autonomic symptoms	Despite these similarities, motor symptoms of parkinsonism are not correlated with negative and depressive symptoms in schizophrenia and mood disorders	-
Pessimism	Loss of energy, fatigue, tiredness	Motor symptoms of PD are not strongly associated with psychomotor slowing in schizophrenia and mood disorders	The motoric state, wearing on or off, s should be considered while diagnosing depressive disorders in PD[15,31]
Hopelessness	Slowing and retardation	A total score of ≥ 4 on the Simpson-Angus Scale is a clinically meaningful and reliable method for distinguishing parkinsonian from depressive symptoms[35]	The presence of coexisting cognitive impairment should be noted[30]
Mental slowing	Loss of appetite, weight loss	-	-
Diminished concentration	Insomnia, hypersomnia	-	-
Memory impairment	Mental slowing	-	-
Loss of energy, fatigue, tiredness	Diminished concentration	-	-
Slowing and retardation	Memory impairment[7,9,10,19,30]	-	-
Mild symptom severity	-	-	-
Present during wearing-off periods	-	-	-
Relative absence of self-blame, guilt, reproach, and low self-esteem	-	-	-
Frequent suicidal ideations but very few suicide attempts	-	-	-
Relative lack of psychotic symptoms[3,18,19,36,37]	-	-	-

PD: Parkinson’s disease.