Psychiatric Care in Parkinson’s Disease

Quelhas, Rosa

doi:10.1097/01.pra.0000428558.94329.6d

Cited by 10 publications

(9 citation statements)

References 209 publications

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“…For instance, although Parkinson's disease is usually associated with motor symptoms such as bradykinesia, rest tremor, muscular rigidity, and postural instability, a large proportion of affected individuals also exhibit cognitive impairment and psychiatric symptoms [50]. Studies show that almost 25.2 to 40% of Parkinson's disease patients suffer from depression, up to 43% have anxiety disturbances, 32 to 42% exhibit apathy, 5.6 to 11.1% experience mania or hypomania, 15% have symptoms of impulse control disorders [51,52], up to 75% complain of insomnia [53], 8 to 40% experience psychosis [54], and as many as 78.2% develop dementia [55]. Some of these disorders such as depression, anxiety disorders, apathy, and cognitive impairment might be due to the degeneration of brain structures leading to complex brain signalling disturbances caused by Parkinson's disease itself [51,56,57], whereas others such as mania/hypomania, impulse control disorders, and psychosis might, to a greater degree, result from dopaminergic medication used to treat motor symptoms [52,53].…”

Section: Discussionmentioning

confidence: 99%

“…Some of these disorders such as depression, anxiety disorders, apathy, and cognitive impairment might be due to the degeneration of brain structures leading to complex brain signalling disturbances caused by Parkinson's disease itself [51,56,57], whereas others such as mania/hypomania, impulse control disorders, and psychosis might, to a greater degree, result from dopaminergic medication used to treat motor symptoms [52,53]. Most of these disorders are associated with multiple risk factors, and their onset and progression are determined by a combined effect of genetic susceptibility, neural degeneration, neurotransmitter dysregulation, co-existing psychiatric disorders, and medication dosage and regime [54,58,59]. Hence, changes in PIAAAS following DBS should not only be attributed to the DBS target structure, surgical trajectory, and stimulation parameter, but should also take into account patient history, disease attributes, and other forms of treatment adaptations such as medication adjustments.…”

Section: Discussionmentioning

confidence: 99%

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Deflating the “DBS causes personality changes” bubble

2018

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The idea that deep brain stimulation (DBS) induces changes to personality, identity, agency, authenticity, autonomy and self (PIAAAS) is so deeply entrenched within neuroethics discourses that it has become an unchallenged narrative. In this article, we critically assess evidence about putative effects of DBS on PIAAAS. We conducted a literature review of more than 1535 articles to investigate the prevalence of scientific evidence regarding these potential DBS-induced changes. While we observed an increase in the number of publications in theoretical neuroethics that mention putative DBS-induced changes to patients' postoperative PIAAAS, we found a critical lack of primary empirical studies corroborating these claims. Our findings strongly suggest that the theoretical neuroethics debate on putative effects of DBS relies on very limited empirical evidence and is, instead, reliant on unsubstantiated speculative assumptions probably in lieu of robust evidence. As such, this may reflect the likelihood of a speculative neuroethics bubble that may need to be deflated. Nevertheless, despite the low number of first-hand primary studies and large number of marginal and single case reports, potential postoperative DBS changes experienced by patients remain a critical ethical concern. We recommend further empirical research in order to enhance theoretical neuroethics work in the area. In particular, we call for the development of better instruments capable of capturing potential postoperative variations of PIAAAS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Deflating the “DBS causes personality changes” bubble

2018

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“…It is also theorized that the effects of combined physical activity and cognitive training therapies may be additive [92]. Music and art therapies have been shown to improve emotional well-being, quality of life, and motor function in PD [93], though specific evidence for its usefulness for cognitive impairment is sparse. Such creative therapies have been hypothesized to stimulate production of dopamine and serotonin.…”

Section: Treating Dementia and Cognitive Impairment In Pdmentioning

confidence: 99%

Treatment of Psychosis and Dementia in Parkinson’s Disease

Goldman

Holden

2014

Curr Treat Options Neurol

108

103

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Opinion Statement Parkinson’s disease (PD) has been increasingly recognized as having a multitude of non-motor symptoms including psychosis, cognitive impairment and dementia, mood disturbances, fatigue, apathy, and sleep disorders. Psychosis and dementia, in particular, greatly affect quality of life for both patients and caregivers and are associated with poor outcomes. Safe and effective treatment options for psychosis and dementia in PD are much needed. Antipsychotics with dopamine-blocking properties can worsen parkinsonian motor features and have been associated with increased morbidity and mortality in elderly, dementia patients. For treating PD psychosis, a first step would be eliminating confounding variables, such as delirium, infections or toxic-metabolic imbalances, followed by simplifying parkinsonian medications as tolerated. If additional treatment is warranted after such interventions, clozapine or quetiapine can be implemented at the low dose levels typically needed by PD patients. Although quetiapine is easy-to-use in clinical settings, does not require blood count monitoring like clozapine, and is anecdotally beneficial, it remains “investigational” in evidence-based medicine reviews. Though not currently available, the novel 5-HT2a inverse agonist, pimavanserin has shown promise in the treatment of PD psychosis. Current treatments for PD dementia are mostly derived from those utilized in Alzheimer’s disease, focusing mainly on cholinesterase inhibitors and memantine, a NMDA receptor antagonist. Rivastigmine, the only approved medication for PD dementia, is a reasonable first choice. Other cholinesterase inhibitors and memantine have not yet achieved recommendation status in evidence-based medicine reviews but are well tolerated in studies of PD dementia patients. At present, there are no approved treatments for mild cognitive impairment in PD, but rasagiline, a selective MAO-B inhibitor, and atomoxetine, a serotonin norepinephrine reuptake inhibitor, have been recently studied. Non-pharmacological interventions, including cognitive therapy, physical activity, music and art therapy and non-invasive brain stimulation techniques, may be promising options for PD cognitive impairment but await rigorous study.

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“…Chen and Marsh recommend first adjusting the pramipexole dose and then adding tricyclic antidepressants, SSRI, or other antidepressant agents (e.g. bupropion, desvenlafaxine, duloxetine, milnacipran, mirtazapine, moclobemide, nefazodone, reboxetine, trazodone, and venlafaxine) . However, clinical data on improvement of depression symptoms during that medication are limited .…”

Section: Pharmacological Treatment Of Depression In Pdmentioning

confidence: 99%

Depression in Parkinson's disease: the effectiveness and risk of pharmacotherapy. Clinical review

Dyduch¹,

Załuska

2014

Psychogeriatrics

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Parkinson's disease (PD) is a neurological disease with a heterogeneous pattern of neurological symptoms and concomitant psychiatric syndromes. These syndromes are triggered by alterations to neurotransmission that are likely common for both neurological and psychiatric symptoms. Syndromes such as depression, anxiety, or cognitive impairment can precede motor symptoms of PD and delay its diagnosis. Recently, questions related to aetiological factors and treatment strategies of depression in PD have become a growing concern of PD researchers. This article describes the main features of depression in PD and presents current hypotheses on its aetiology and recommended treatment modes.

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Psychiatric Care in Parkinson’s Disease

Abstract: Therapeutic approaches to the treatment of PD and its associated psychiatric symptoms must be individualized and may involve a combination of antiparkinson drugs, psychopharmacological treatment, and/or psychotherapeutic interventions.

Cited by 10 publications

References 209 publications

Deflating the “DBS causes personality changes” bubble

Deflating the “DBS causes personality changes” bubble

Treatment of Psychosis and Dementia in Parkinson’s Disease

Depression in Parkinson's disease: the effectiveness and risk of pharmacotherapy. Clinical review

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