Differential diagnosis of psychiatric symptoms after deep brain stimulation for movement disorders.

Objectives: The presence of a deep brain stimulator (DBS) in a patient with a movement disorder who develops psychiatric symptoms poses unique diagnostic and therapeutic challenges for the treating clinician. Few sources discuss approaches to diagnosing and treating these symptoms.
Materials and Methods: The authors review the literature on psychiatric complications in DBS for movement disorders and propose a heuristic for categorizing symptoms according to their temporal relationship with the DBS implantation process.
Results: Psychiatric symptoms after DBS can be categorized as preimplantation, intra-operative/perioperative, stimulation related, device malfunction, medication related, and chronic stimulation related/long term. Once determined, the specific etiology of a symptom guides the practitioner in treatment.
Conclusions: A structured approach to psychiatric symptoms in DBS patients allows practitioners to effectively diagnose and treat them when they arise.
(© 2014 International Neuromodulation Society.)