{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T05:27:27Z","timestamp":1793683647623,"version":"4.5.1"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Psychosis is a frequent comorbidity in Parkinson\u2019s disease (PD) and often complicates the evaluation of motor and behavioral fluctuations. Distinguishing between psychosis-related catatonia and a PD off phenomenon presents a significant diagnostic challenge. We describe the case of a 48-year-old male with PD and depression who was admitted to a psychiatric ward following an episode of aggressive behavior and persecutory delusions. During hospitalization, he developed mutism, rigidity, and immobility \u2013 initially interpreted as catatonia. A Bush\u2013Francis Catatonia Rating Scale score of 16 was documented, but a lorazepam challenge failed to elicit improvement. These symptoms coincided with the tapering of dopaminergic therapy, particularly pramipexole. Neurological consultation on hospital day 11 identified the presentation as a severe PD off state. Restoration of dopaminergic therapy, focusing on extended-release formulations and optimized timing, resulted in marked clinical improvement within 1 week. Dopamine agonists were avoided due to concern for exacerbating psychosis. This case highlights the importance of distinguishing catatonia from PD off states in patients with overlapping motor and psychiatric symptoms. Careful medication history, response to benzodiazepines, and interdisciplinary collaboration are critical to diagnostic accuracy and treatment success.<\/jats:p>","DOI":"10.4103\/ant.ant-d-25-00052","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:01:01Z","timestamp":1785434461000},"page":"162-165","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["When Psychosis Conceals a Motor Crisis: A Misleading Case of Catatonia Unveiling Parkinson\u2019s Disease off Phenomenon"],"prefix":"10.4103","volume":"35","author":[{"given":"Wen-Wen","family":"Tsai","sequence":"first","affiliation":[{"name":"Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei-Hsin","family":"Kao","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuan-Hsien","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng-Hsiang","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"R1-20261103","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1056\/NEJMra2401857","article-title":"Parkinson's disease","volume":"391","author":"Tanner","year":"2024","journal-title":"N Engl J Med"},{"key":"R2-20261103","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1002\/mds.23664","article-title":"Parkinson's disease: The quintessential neuropsychiatric disorder","volume":"26","author":"Weintraub","year":"2011","journal-title":"Mov Disord"},{"key":"R3-20261103","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.1056\/NEJMra2116304","article-title":"Catatonia","volume":"389","author":"Heckers","year":"2023","journal-title":"N Engl J Med"},{"key":"R4-20261103","doi-asserted-by":"crossref","first-page":"S32","DOI":"10.1016\/j.jagp.2022.12.068","article-title":"The dangers of neuroleptic use in Parkinsonian-spectrum illnesses \u2013 Management of emergent hypodopaminergic syndromes and catatonia","volume":"31","author":"Patel","year":"2023","journal-title":"Am J Geriatr Psychiatry"},{"key":"R5-20261103","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00213-014-3807-8","article-title":"Neuroleptic malignant syndrome or catatonia? Trying to solve the catatonic dilemma","volume":"232","author":"Lang","year":"2015","journal-title":"Psychopharmacology (Berl)"},{"key":"R6-20261103","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1002\/mds.27602","article-title":"Update on treatments for nonmotor symptoms of Parkinson's disease-an evidence-based medicine review","volume":"34","author":"Seppi","year":"2019","journal-title":"Mov Disord"},{"key":"R7-20261103","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1007\/s00702-010-0424-5","article-title":"The wearing-off phenomenon and the use of questionnaires to facilitate its recognition in Parkinson's disease","volume":"117","author":"Stacy","year":"2010","journal-title":"J Neural Transm (Vienna)"},{"key":"R8-20261103","doi-asserted-by":"crossref","first-page":"181","DOI":"10.3389\/fpsyt.2014.00181","article-title":"A clinical review of the treatment of catatonia","volume":"5","author":"Sienaert","year":"2014","journal-title":"Front Psychiatry"},{"key":"R9-20261103","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1038\/s41531-023-00541-w","article-title":"To restrict or not to restrict? Practical considerations for optimizing dietary protein interactions on levodopa absorption in Parkinson's disease","volume":"9","author":"Rusch","year":"2023","journal-title":"NPJ Parkinsons Dis"},{"key":"R10-20261103","doi-asserted-by":"crossref","first-page":"e000057","DOI":"10.1136\/bmjno-2020-000057","article-title":"Movement disorders in psychiatric patients","volume":"2","author":"Perju-Dumbrava","year":"2020","journal-title":"BMJ Neurol Open"}],"container-title":["Acta Neurologica Taiwanica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ant.ANT-D-25-00052","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T05:00:34Z","timestamp":1793682034000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ant.ANT-D-25-00052"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":10,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/ant.ant-d-25-00052","relation":{},"ISSN":["1028-768X"],"issn-type":[{"value":"1028-768X","type":"print"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2025-04-19","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-16","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}