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Psychological Symptoms and Treatments of Parkinson's Disease This article will educate you about the psychology of Parkinson's disease, and includes information concerning common psychological symptoms of PD, information regarding their possible origins and treatment, and information about daily activities that may make it easier for you to cope with this disease. Anxiety Characteristics Anxiety disorders are characterized by tension, over activity of the autonomic nervous system, expectation of an impending disaster, and continuous vigilance for danger. They are often accompanied by such autonomic symptoms as palpitations and dry mouth. Anxiety is frequently seen together with depression. Studies have suggested that 92% of Parkinson's patients who have had an anxiety disorder have also had a depressive disorder. There are many different varieties of anxiety disorders that have been observed in conjunction with Parkinson's disease. Panic disorder: episodic attacks of severe, unrelenting terror lasting for periods of time between a few seconds and a few hours. Includes physical symptoms such as shortness of breath, clammy sweat, irregular heartbeat, dizziness, faintness, and feelings of unreality. Possible Causes Research has not yet conclusively determined what factors cause anxiety in Parkinsonian patients. It is clear that anxiety disorders occur more often in patients with Parkinson's disease than in patients with other equally debilitating diseases, such as multiple sclerosis, type I diabetes, and rheumatoid arthritis. This suggests that there may be a neuro-chemical basis for the anxiety, as well as being caused by the trauma of the disease. Also, most studies have shown that patients with anxiety and patients without do not vary in degree of motor incapability. Research has shown that patients with anxiety disorder tend to be younger than most Parkinson's patients and have had the disease for a shorter duration of time. Much research has examined the time of onset of anxiety in comparison with stage of the disease in hopes to separate psychological from biochemical causes. Most studies have found that the debilitating motor symptoms of Parkinson's occur before anxiety does, typically. However, there appears to be a large population of patients whose anxiety disorders precede the motor symptoms and the diagnosis of the disease, also suggesting that there may be a neuro-chemical reason for the frequency of anxiety in Parkinsonian patients. It should also be noted that anxiety has been known to make treatment more difficult, hinting that anxiety may sometimes be causal of certain symptoms of Parkinson's. Psychological Causes Patients with Parkinson's disease often report feelings of embarrassment about their motor impairment. Feelings of embarrassment seem to be associated with social phobias. Patients may fear social situations because they feel embarrassed about their disability. Most Parkinsonian patients with social phobia obtained this anxiety disorder after diagnosis. Other studies have shown that anxiety is much greater in patients whose severity of motor disability randomly fluctuates. It has also been shown that for these patients, anxiety is greatest when motor impairment is at a low. It has been hypothesized that this pattern is similar to the patterns of anxiety in laboratory rats exposed to an unpredictable schedule of aversive stimuli. This suggests that anxiety may be a result of fear of a period of reduced motor ability. Anxiety caused by drugs used in treatment of Parkinson's: Very little evidence has been presented suggesting a link between any commonly used treatment for Parkinson's disease and anxiety disorders. Levodopa therapy has been implicated as a possible culprit behind panic attacks. Neuro-Biolgical Causes Disruption of normal functioning of many different neurotransmitter symptoms have been implicated as an origin of anxiety disorders. Abnormalities of norepinephrine levels have the most supporting evidence as the cause of anxious disorders, particularly panic disorders. Systems whose impairments have been shown to cause predisposition for anxiety in the general population have been shown to be impaired in patients with Parkinson's disease. The dorsal ascending noradrenergic pathway, which connects the locus ceruleus to the cerebral cortex, amygdala, hippocampus, and the septum, is impaired in many of those afflicted with Parkinson's disease. Serotonin and GABA systems (two other neurotransmitters in brain) have all been implicated in the search for a biochemical basis for anxiety in Parkinsonian patients. There has been little conclusive evidence demonstrating a link between malfunctions of these systems and anxiety. A possible link between dopaminergic systems and social phobia is being examined. Based on evidence of a correlation between dopamine levels in the cerebrospinal fluid and extroversion, it has been hypothesized that a dopamine deficit in this fluid could cause acute introversion, or a social phobia. While it remains fairly certain that prevalence of anxiety in patients with Parkinson's is at least partly due to neuro-chemical processes, it is still very unclear what these processes are and the extent to which they control anxiousness. Treatment There are a variety of available treatments for those who suffer anxiety. Very little research has been done to suggest an optimal course of treatment for those afflicted. The following classes of drugs are available for treatment: Tricyclic Antidepressants Depression Depression is a common psychological symptom of Parkinson's disease, occurring in 40% to 50% of patients with Parkinson's Disease. It is the most common psychological problem occurring with Parkinson's. Depression is seen more often in Parkinsonian patients than in patients with similarly chronic, debilitating diseases, suggesting that it may have a biochemical cause in addition to a psychological cause. Characteristics The following are characteristics of depression. For diagnosis, the DSM IIIR requires that five of the symptoms must be present and that one of them must be depressed mood. Depressed mood (anhedonia) Depressed patients are unable to experience pleasure and lose appetite for food or sex. Pacing and crying are two behavioral symptoms of depression. Constipation and decreased salivation are two physiological effects of depression. 67% of those who have had a depressive disorder also have had an anxiety disorder. Causes There are many variables in patients with Parkinson's disease that have been found to be related to severity or existence of depression. It has proved difficult to determine whether the depression is responsible for these factors or these factors are causing the depression. The following are some factors that have been found to be correlated with amount of depression in Parkinsonian patients: Early onset of disease Most of these factors make psychological sense; the worse the disability is, and the more deleterious the effects it has on one's life, the more intense the depression will be. However, the last factor is hard to account for when considering psychological factors alone. This, and the fact that Parkinsonian patients experience depression of a greater intensity than similarly devastating conditions, suggest that there is a physiological root to the depression in addition to a psychological one. Depression often pre-dates recognizable motor symptoms by several years. Recent research has suggested what this physiological cause may be. Abnormal activity of the neurotransmitter serotonin has been implicated as a villain in the depression found in patients with Parkinson's. Research has found that patients with Parkinson's and depression have lower serotonin levels in brain, lower levels of certain metabolites of serotonin (5-hydroxyindoleacetic acid), and less serotonin binding sites in comparison to patients with Parkinson's who are not depressed. Levodopa levels have not been found to correlate with depression in Parkinsonian patients. Degeneration of dopamine-secreting neurons in the ventral tegmental area has been found to correlate with depressive symptoms. Dopamine appears only to play a minor role in depression in Parkinson's disease. Treatments Serotonin precursors have been found to alleviate depression in some patients with Parkinson's Psychosis Psychosis is a very difficult symptom to deal with for both Parkinsonian patients and those who care for them. It occurs in 10% to 15% of all patients with Parkinson's disease. It drastically reduces the quality of life for those afflicted. It also results in increased trauma for caregivers, an earlier transfer to a nursing home, and shorter lifespan. Characteristics of Psychoses Visual hallucinations Possible Causes Many risk factors have been identified with psychoses. The older a patient is and the further advanced the disease is, the more likely psychoses are to occur. Cognitive impairment is also correlated with psychosis. Atrophy of the nucleus basalis and cortical cholinergic deficiencies are neuro-anatomical precursors to psychoses. Levels of acetylcholine, a neurotransmitter, appear to be the main culprit in occurrence of psychoses. Dopaminergic drugs and deficiency in acetylcholine may work together to bring about psychosis. Treatment of Psychoses Until recently, treatment for psychoses was nearly impossible in Parkinsonian patients. This is because the drugs that were commonly used to treat psychosis caused Parkinsonian symptoms themselves. A decision had to be made about whether the psychosis or the Parkinsonism was least desirable. Today, a new drug has been discovered that treats the psychoses involved in Parkinson's Disease without exacerbating the other disabilities caused by the disease. This new drug is clozapine. Clozapine is an atypical antipsychotic drug that provides much relief for victims of Parkinson's. Its side effects, which include sedation and agranulocytosis, must be very carefully monitored. This drug is also very costly, although it may save money in the long run by reducing costs of care for these patients. Coping With Parkinson's Disease: What the Patient Can Do Unfortunately, Parkinson's disease has no cure and cannot reverse in its course. Fortunately, there are things that the patient can do to dramatically increase their quality of life. By making practices such as those included below a habit, one may be able to remain healthy, active, happy, and safe for a very long time. Visit Your Doctor Regularly Parkinson's disease has a variety of interacting symptoms and affects that can make the effects of the disease vary as much as the weather. Often, it is difficult for the patient to determine what is happening, and they may have much health-related concern. Regular visits to the doctor means increased responsiveness to health conditions and improved state of mind. It will ensure that you will receive the best and most responsive health care possible. Remember that you and your doctor share a common goal: to improve your long-term health. Exercise Exercising muscles can keep one strong and flexible. Exercise can also make a person feel very good about him or her self and give them a sense of accomplishment. Sometimes, it is even fun. When designing a regular exercise program, it is important to keep a couple of things in mind. First of all, include exercises that will increase your cardiovascular fitness, such as walking, jogging, or swimming, depending on your capability. Secondly, choose activities that are enjoyable, so that you will keep up with it every day. Always stretch before you exercise. Breathing exercises are very helpful, as are exercises of the face and jaws. Do not over exert your muscles and rest when is needed. Exercise will usually lessen the debilitating motor symptoms of Parkinson's, such as tremor and muscle stiffness. It also improves one's health by contributing to a good body weight and improving sleep. It is important to consult with your doctor before starting an exercise program. Maintain a Healthy Diet Excess body weight is often a secondary symptom of Parkinson's that contributes to the debilitating motor symptoms of Parkinson's. Lack of appetite caused by depression, digestive problems, and/or inactivity are factors that can cause one's body weight to change beyond healthy levels. Excess weight makes controlling one's body more difficult and energy-consuming. Exercise, coupled with a healthy diet, can make one healthier, happier, and more mobile. As with all people, it is important to consume adequate carbohydrates, vitamins, and minerals, while avoiding excess fat. If digestive problems are experienced, you may want to cut food into small portions or use a blender when possible. Sometimes, an excess of proteins may adversely affect absorption of medication. It is important to find out from your doctor how dietary considerations will affect you medication's effectiveness. Physical Therapy Many patients with Parkinson's disease have improved their condition through physical therapy programs. A physical therapist can design the ideal exercise program and can provide the motivation needed to continue on this program. Usually, physical therapy sessions can either be scheduled at a medical institution or in the home. Therapy and Counseling Many of the psychological effects of Parkinson's disease that are not chemical in nature can be at least partially alleviated by individual counseling and/or group therapy. Effective counseling and therapy has been effective in experimental situations for reducing the severity of the following psychological problems associated with the disease: Depression Note: This is only a list of symptoms that therapy has been shown by studies to be effective in improving. It does not imply that therapy and counseling will have no effect on other psychological symptoms. Group Seminars Properly designed group seminars have been shown to be beneficial in reduction of many psychological symptoms of Parkinson's. In a study reported by Ellgring, patients who attended group seminars aimed at increasing certain skills involved with living with Parkinson's had improved their relaxation skills, were better at achieving their goals, and showed an increase in self-motivation. Many patients learned to accept their disease through group counseling. The most substantial improvement in attendees of these seminars was in their enhanced ability to cope with social situations. The seminars encouraged many patients to not be embarrassed about their condition and to avoid fewer social settings. There were no personal characteristics measured that were found to affect the usefulness of group therapy. It appeared to be effective for most types of people. Topics of the effective seminars included coping with social situations, education about stress and disease, increasing activity, motivation, and independence, and changing attitude about the affliction. The means through which the positive results were achieved were cognitive restructuring, social training, role play, relaxation training, and teaching transfer of seminar education into daily activities. The seminars studied were two hours in duration and were roughly bi-monthly. The most effective group size was found to be between five and six members. Individual Counseling A study on the efficacy of individual counseling was reported by the same authors as the previously discussed study on group counseling. The type of individual counseling studied did not appear to be as effective as group counseling. In the individual counseling, patients were given the opportunity to discuss any matter they chose. Merely discussing the problems with a counselor appeared to be better than nothing, but only mildly. It is important to not belittle the impact proper individual counseling can have on a patient based on this study alone, however. It is possible that only the kind of counseling that was studied had limited effectiveness, and that other methods of counseling may yield more positive results. The narrow focus of this particular study should not be enough to discourage one from seeking counseling. If desired, individual counseling should be strongly considered. Marriage Counseling The relationship between a patient and his or her spouse has a very substantial effect on the psychology of the patient, as well as the spouse. Patients with a stable, healthy partnership are those that show the least depression. Single patients with Parkinson's suffer from depression far less than do patients that are in difficult or troubled relationships. It is for this reason that marriage counseling may be a very effective method for improving the psychological condition of the sufferer. The negative effects of Parkinson's, both somatic and psychological, can cause difficulties in a previously mutually satisfying relationship. A spouse may have a hard time accepting all of the additional responsibilities that come with taking care of a patient with Parkinsons disease. This can cause resentment on both parts. Adverse psychological effects, especially depression and dementia, can severely fray communications and relations between the pair. The spouse may not be able to properly cope with the changes in the patient's comportment. The patient may feel resentment, inadequacy, or guilt at the prospect of becoming dependent upon his or her spouse for assistance with activities of daily life. Effective marriage counseling improves the quality of the marriage, and the psychological state of the patient and the patient's spouse, by improving the communications between the pair. Please Consider Partnering With PDASD to Improve Quality of Life Your investment helps support programs and services that improve the quality of life for families affected by Parkinson's, and provides funding for medical research seeking more effective treatments and a cure.
See how your gift gives hope and strength to families facing the daily challenges of Parkinson's. Click on the Many Faces of Parkinson's to see how our programs and services maximize self-sufficiency for Parkinson's patients and provide support for their families. The Parkinson's Disease Association of San Diego Exists to Improve |
