Neuropsychiatric Complications of Parkinson Disease Treatments: Importance of Multidisciplinary Care

Taylor, Jacob; Anderson, William S.; Brandt, Jason; Mari, Zoltán; Pontone, Gregory M.

doi:10.1016/j.jagp.2016.08.017

Cited by 30 publications

(21 citation statements)

References 49 publications

(57 reference statements)

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“…The study characteristics of 8 randomized, controlled trials (RCTs) included in the quantitative meta‐analysis and 19 other experimental studies included in the systematic review are presented in Table . The remaining 10 articles included in our systematic review were nonexperimental (ie, review articles or descriptions of care models) and are detailed separately in Supplementary Table 1 …”

Section: Resultsmentioning

confidence: 99%

Integrated Care in Parkinson's Disease: A Systematic Review and Meta‐Analysis

et al. 2020

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Background Quality of life in Parkinson's disease (PD) is affected by motor and nonmotor symptoms, necessitating an integrated care approach. Existing care models vary considerably in numerous domains. The objectives of this study were to perform a systematic review and meta‐analysis of PD integrated care models and develop recommendations for a representative model. Methods We conducted a systematic review of published integrated care models and a meta‐analysis of randomized, controlled trials examining integrated care versus standard care. The primary outcome was health‐related quality of life using a validated PD scale. We evaluated levels of care integration using the Rainbow Model of Integrated Care. Results Forty‐eight publications were identified, including 8 randomized, controlled trials with health‐related quality of life data (n = 1,149 total PD patients). Qualitative evaluation of individual care model integration guided by the Rainbow Model of Integrated Care revealed frequent clinical and professional integration, but infrequent organizational and population‐based integration elements. Meta‐analysis of randomized, controlled trials revealed significant heterogeneity (I2 = 90%, P < 0.0001). Subgroup analysis including only outpatient care models (n = 5) indicated homogeneity of effects (I2 = 0%, P = 0.52) and improved health‐related quality of life favoring integrated care, with a small effect size (standardized mean difference [SMD], −0.17; 95% CI, −0.31 to −0.03; P = 0.02). Conclusions Outpatient integrated PD care models may improve patient‐reported health‐related quality of life compared with standard care; however, because of variable methodological approaches and a high risk of bias related to inherent difficulties in study design (eg, blinding of participants and interventionists), generalizability of these results are difficult to establish. The Rainbow Model of Integrated Care is a promising method of evaluating elements and levels of integration from individual patient care to population health in a PD context. © 2020 The Authors. Movement Disorders published by Wiley Periodicals, LLC. on behalf of International Parkinson and Movement Disorder Society.

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Section: Resultsmentioning

confidence: 99%

Integrated Care in Parkinson's Disease: A Systematic Review and Meta‐Analysis

et al. 2020

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“…Additional risk factors include pre‐existing rigidity and AIDS. Treatment of psychosis in patients with Parkinson's disease is complex, and reviewed elsewhere.…”

Section: Specific Adverse Effectsmentioning

confidence: 99%

Management of common adverse effects of antipsychotic medications

2018

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The benefits of antipsychotic medications are sometimes obscured by their adverse effects. These effects range from relatively minor tolerability issues (e.g., mild sedation or dry mouth) to very unpleasant (e.g., constipation, akathisia, sexual dysfunction) to painful (e.g., acute dystonias) to disfiguring (e.g., weight gain, tardive dyskinesia) to life-threatening (e.g., myocarditis, agranulocytosis). Importantly, adverse effect profiles are specific to each antipsychotic medication and do not neatly fit into first- and second-generation classifications. This paper reviews management strategies for the most frequent side effects and identifies common principles intended to optimize net antipsychotic benefits. Only use antipsychotics if the indication is clear; only continue antipsychotics if a benefit is discernible. If an antipsychotic is providing substantial benefit, and the adverse effect is not life-threatening, then the first management choice is to lower the dose or adjust the dosing schedule. The next option is to change the antipsychotic; this is often reasonable unless the risk of relapse is high. In some instances, behavioral interventions can be tried. Finally, concomitant medications, though generally not desirable, are necessary in many instances and can provide considerable relief. Among concomitant medication strategies, anticholinergic medications for dystonias and parkinsonism are often effective; beta-blockers and anticholinergic medications are useful for akathisia; and metformin may lead to slight to moderate weight loss. Anticholinergic drops applied sublingually reduce sialorrhea. Usual medications are effective for constipation or dyslipidemias. The clinical utility of recently approved treatments for tardive dyskinesia, valbenazine and deutetrabenazine, is unclear.

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“…In many scientific reports, there are also descriptions of the correlation between the occurrence of anxiety and depression and PD treatment. The preliminary test results require further analysis and cooperation of the whole therapeutic team [13]. In a study carried out by Tokuchi et al [14] the group of respondents consisted of 288 patients diagnosed with Alzheimer's disease and 189 patients with Parkinson's disease (mean age, 74.6±5.9 and 73.0±8.7 years respectively).…”

Section: Discussionmentioning

confidence: 99%

Nursing Problems of Patients with Parkinson’s Disease — Case Report

Biercewicz

Filipska

Rybka

et al. 2016

PNIN

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Introduction. Parkinson's disease is considered to be one of degenerative disorders of the central nervous system. It is classified as an incurable, progressive disease leading to significant deficits in self-care. It is regarded, just after Alzheimer's disease, as a disease of the elderly, which relates to the central nervous system (CNS). The mechanisms being the basis of this disease have not been completely understood. Case Report. The case study refers to a 72-year-old woman diagnosed with Parkinson's disease and comorbid dizziness. This work has presented nursing diagnosis and the nursing process. There have been defined patient's problems, the purpose of the care and its implementation by planning activities. There has been also made an assessment, which is a comparison of the results of the care obtained with the objectives assumed. This work is a description of the case of a theoretical patient. Discussion. One of the most important persons taking care of a patient with PD is the nurse. In the proces of hospital treatment hospital nurse becomes the closest person to the patient. Therefore, she is required to maintain a professional therapeutic contact with the patient. The role of the nurse is primarily to motivate the patient to take actions which will lead to a slowdown in the progress of the disease (ie. encouragement to participate in activities with a therapist, to talk to a psychologist, exercise with a physiotherapist). The patient described has a problem with low self-esteem and a critical attitude towards herself. It is difficult for her to establish contacts and maintain relationship with another person. Such signals should be noticed by the nurse. The nurse is required to respond adequately to the aforementioned symptoms. Conclusions. Parkinson's disease is defined as a primary degenerative process of the extrapyramidal system. In its course it is characterised by a slow and degenerative process. The patient described by us is fully aware of her state of health as well as of the nature of the disease. This involves a significant decrease of mood, apathy and fear. She cannot accept her condition and the developing deficit of self-care resulting from the progress of the disease. In the case of our patient after discharge from hospital there was recommended further therapy with a psychologist and participation in classes conducted by an occupational therapist and a physiotherapist.

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Neuropsychiatric Complications of Parkinson Disease Treatments: Importance of Multidisciplinary Care

Cited by 30 publications

References 49 publications

Integrated Care in Parkinson's Disease: A Systematic Review and Meta‐Analysis

Integrated Care in Parkinson's Disease: A Systematic Review and Meta‐Analysis

Management of common adverse effects of antipsychotic medications

Nursing Problems of Patients with Parkinson’s Disease — Case Report

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