Psychiatric aspects of Parkinson's disease - An Update
ABSTRACT In patients with Parkinson's disease (PD) disturbances of mental state constitute some of the most difficult treatment challenges of advanced disease, often limiting effective treatment of motor symptoms and leading to increased disability and poor quality of life. This article provides an update on the current knowledge of these complications and the use of old and new drugs in their management. Mental state alterations in PD include depression, anxiety, cognitive impairment, apathy, and treatment-related psychiatric symptoms. The latter range from vivid dreams and hallucinations to delusions, manic symptoms, hypersexuality, dopamine dysregulation syndrome and delirium. While some of these symptoms may be alleviated by anti-parkinsonian medication, especially if they are off-period related, treatment-related phenomena are usually exacerbated by increasing the number or dosage of antiparkinsonian drugs. Elimination of exacerbating factors and simplification of drug regimes are the first and most important steps in improvement of such symptoms. However, the advent of atypical antipsychotics such as clozapine has dramatically helped the management of treatment-related psychiatric complications in PD. In patients with dementia associated with PD cognitive functioning and behavioural problems appear to respond to cholinesterase inhibitors, such as rivastigmine or donepezil. Depression is a common problem in early as well as advanced PD, and selective serotonin reuptake inhibitors, reboxetine, and tricyclic antidepressants have been reported to be effective and well tolerated antidepressants. Randomised, controlled studies are required to assess the differential efficacy and tolerability of antidepressants in patients with PD, including the newer antidepressants with serotonergic and noradrenergic properties.
SourceAvailable from: Silvia Ríos-Romenets[Show abstract] [Hide abstract]
ABSTRACT: To determine effects of Argentine tango on motor and non-motor manifestations of Parkinson's disease. Randomized control trial. Forty patients with idiopathic Parkinson's disease. Movement disorder clinic and dance studio. Two randomized groups: group (N=18) with 24 partnered tango classes, and control self-directed exercise group (N=15). The primary outcome was overall motor severity. Secondary outcomes included other motor measures, balance, cognition, fatigue, apathy, depression and quality of life. On the primary intention-to-treat analysis there was no difference in motor severity between groups MDS-UPDRS-3 (1.6 vs.1.2-point reduction, p=0.85). Patient-rated clinical global impression of change did not differ (p=0.33), however examiner rating improved in favor of tango (p=0.02). Mini-BESTest improved in the tango group compared to controls (0.7±2.2 vs. -2.7±5.9, p=0.032). Among individual items, tango improved in both simple TUG time (-1.3±1.6s vs. 0.1±2.3, p=0.042) and TUG Dual Task score (0.4±0.9 vs. -0.2±0.4, p=0.012), with borderline improvement in walk with pivot turns (0.2±0.5 vs. -0.1±0.5, p=0.066). MoCa (0.4±1.6 vs. -0.6±1.5, p=0.080) and FSS (-3.6±10.5 vs. 2.5±6.2, p=0.057) showed a non-significant trend toward improvement in the tango group. Tango participants found the activity more enjoyable (p<0.001) and felt more "overall" treatment satisfaction (p<0.001). We found no significant differences in other outcomes or adverse events. Argentine tango can improve balance, and functional mobility, and may have modest benefits upon cognition and fatigue in Parkinson's disease. These findings must be confirmed in longer-term trials explicitly powered for cognition and fatigue. Copyright © 2015 Elsevier Ltd. All rights reserved.Complementary Therapies in Medicine 02/2015; 23(2). DOI:10.1016/j.ctim.2015.01.015 · 2.22 Impact Factor
Turk Uroloji Dergisi 11/2012; 38(4):205-210. DOI:10.5152/tud.2012.043
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ABSTRACT: Psychosis in Parkinson Disease (PDP) is a common clinical problem and presents a pharmacological therapeutic conundrum. Many patients with PDP require anti-parkinsonian drugs for motor control, but the use of these medications has been associated with worsening of the psychotic symptoms. Differences from other psychotic disorders include the association with the use of anti-parkinsonian drugs, and the common presentation with visual hallucinations. Understanding of the pathophysiology of this phenomenon in PD has grown over the last few decades with the realization that the dopaminergic system is not the sole player. This has led to pharmacological research beyond antipsychotics. In this article we review the general management of PDP, the available evidence for the pharmacological management of PDP, and the medications profile and safety. Useful tables, practical recommendations and treatment algorithm are proposed.Current Drug Therapy 09/2012; 7(3):151-163. DOI:10.2174/157488512803988094