Other Emotional Changes To Parkinsons People
Denial: Patients who are suffering from Parkinsons disease in the initial phase are in the phase of denial. Anxiety and anger towards the disease further complicate the problem.
Fatigue: Parkinsons disease can lead to the transformation of simple movements into an arduous task like standing up and walking around. Because of this, patients become less interested in surrounding and socialization.
Anxiety: Fear of Progression of disease and associated complications makes the patient anxious. Keeping in touch with the strict time schedule of medication in Parkinsons disease patient makes them further anxious as the effect of previous medication begins to wear off.
Why Are Spirituality And Spiritual Wellbeing Important
Spirituality is of increasing interest to psychiatrists and other healthcare professionals because of the potential health benefits spiritual wellbeing can bring.
By spiritual wellbeing we generally mean ‘a sense of good health as a whole person and as a unique individual’. This is a process of growth and development, often over a long period of time, as we learn to feel at ease with who we are and to fulfil our potential as individuals, as human beings. Good spiritual health can bring with it a sense of inner peace and comfort.
There are a wide range of spiritual practices and activities which can promote and enhance wellbeing, such as belonging to a faith community, symbolic or ritual practices, meditation, prayer, retreat, pilgrimage, reading scripture, playing or listening to sacred music, Tai Chi, yoga, group activities which involve the fellowship of participants, and engaging with and enjoying the arts and nature.
Some of the recognised benefits of engaging in such practices are:
- an awareness and fostering of values such as patience, honesty, kindness, hope, wisdom, joy and creativity
- enhanced confidence and self-esteem
- improved relationships
- a new sense of optimism about life, together with a sense of inner peace and acceptance of problems we face in life
- faster recovery from illness or bereavement.
Anxiety And Parkinsons Disease
Anxiety is another common mood disorder of PD and is characterized by excessive nervousness or worry over several months. Patients with generalized anxiety disorder may experience symptoms such as:
- Restlessness, feeling wound-up or on edge
- Difficulty controlling the worry
- Sleep problems, such as difficulty falling or staying asleep, or restless or unsatisfying sleep1,3
Anxiety is not linked with disease progression of PD. It may develop before or after a PD diagnosis. It is often experienced along with depression in people with PD, as the disease process of PD changes the chemistry of the brain. Treatment for anxiety may include anti-anxiety medications, psychological counseling, exercise, relaxation techniques, and/or meditation.1
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Mimicking Human Conditions In Animal Models
With the advance of the medical research, it is possible to mimic certain human conditions in selected animals, such as mouse or rat, to study the development of a disease and search for treatment. In addition to being very close to the human physiology, these animal models are reliable and critical to develop new treatment strategy and to understand the pathophysiology of a disease.
In the laboratory of Professor Musa V. Mabandla, we have by exposing pups to early maternal separation once daily, from post-natal day 1 to 14. We thereafter injected these rat models with depressive-like behaviors with a preclinical dose of 6-hydroxydopamine stereotaxically into the medial forebrain bundle to mimic Parkinsonism. This has resulted to a rat model of PD associated with depressive-like behaviors.
We also injected these animal models with Fluvoxamine maleate , an antidepressant widely used for the treatment of psychiatric disorders, to investigate the neuroprotective effects of the drug on a parkinsonian rat model of neurodegeneration.
Our findings show that early maternal separation exacerbated the effects of 6-hydroxydopamine, but FM treatment attenuated neurodegeneration associated with 6-hydroxydopamine toxicity.
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Depression And Parkinsons Disease
Depression can be a disabling symptom of PD, and it may negatively affect a persons long-term outcomes by causing them to withdraw from social situations, avoid activities like exercise, or being more reluctant to seek care. Some people experience depression as an early symptom of PD before the characteristic motor symptoms appear.2
Depression has a variety of symptoms, not all of which are experienced by every patient. Symptoms of depression can also range in severity or vary over time. Common symptoms of depression include:
- Persistent sad, anxious, or empty mood
- Feelings of hopelessness or pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies or activities, especially those which were previously enjoyable
- Difficulty concentrating, remembering, and making decisions
- Difficulty sleeping, early-morning awakening or oversleeping
- Appetite and/or weight changes
- Thoughts of death or suicide
- Restlessness, irritability
- Persistent physical symptoms3
There are many treatment options for depression that work well in people with PD. There are several types of antidepressants, including selective serotonin reuptake inhibitors , tricyclic antidepressants, and selective norepinephrine reuptake inhibitors . Many people also experience relief from their depression through psychological counseling, such as cognitive behavioral therapy. In addition, regular exercise has been shown to ease symptoms of depression.1,4
Contact Our Information And Referral Helpline
The Parkinson Canada Information and Referral Helpline is a toll-free Canada-wide number for people living with Parkinsons, their caregivers and health care professionals. We provide free and confidential non-medical information and referral services. When you have questions or need assistance, our information and referral staff help connect you with resources and community programs and services that can help you. We provide help by phone or email, Monday to Friday, 9:00 a.m. 5:00 p.m. ET.
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Ratings Of Affective Pictures
One explanation for the attenuated startle effect is that negative pictures were viewed as less aversive or arousing by the Parkinson’s disease group. To address this possibility, we examined subjective ratings of the pictures. shows the mean valence and arousal ratings across the unpleasant, pleasant and neutral pictures. These ratings were analysed in separate Group × Affect ANCOVAs, using age and gender as covariates. Results of the valence analysis revealed a significant main effect for Affect . Both the Parkinson’s disease and the control groups rated the pictures with unpleasant contents as more negative than the neutral pictures . In turn, neutral pictures were rated as more negative than pleasant pictures . There were no differences between the disease and control groups in these valence ratings (i.e. non-significant Group effect and non-significant Group × Affect interaction .
Table 2
For arousal ratings, a significant main effect for Affect occurred. As expected, both types of emotional pictures were rated as more arousing than the neutral pictures . There were no differences in arousal ratings between the pleasant and unpleasant pictures . As shown in , the main effect for Affect was moderated by a Group × Affect interaction . Post hoc comparisons indicated that the PD patients rated the unpleasant/aversive pictures as less arousing than the controls . The two groups did not differ in their arousal ratings of neutral or pleasant pictures .
Data Reduction And Analyses
The startle data were reduced offline using custom software that eliminated trials with unstable baselines. Each trial was scored for amplitude during the 21130 ms interval following white noise onset. Trials that failed to reach peak during this interval were rejected. Rejections accounted for 14.2% of all trials and were equally distributed across subjects groups and affect conditions. Each trial was also scored for latency, in milliseconds , between the onset of the white noise burst and the time of the peak amplitude. Average blink amplitude was computed separately for the left and right eyes. Because preliminary analyses revealed no significant differences between left and right eye startle eyeblinks, these two values were averaged and a composite startle eyeblink score was used in subsequent analyses.
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Depression May Be An Early Symptom Of Parkinsons
Depression is one of the most common, and most disabling, non-motor symptoms of Parkinsons disease. As many as 50 per cent of people with Parkinsons experience the symptoms of clinical depression at some stage of the disease. Some people experience depression up to a decade or more before experiencing any motor symptoms of Parkinsons.
Clinical depression and anxiety are underdiagnosed symptoms of Parkinsons. Researchers believe that depression and anxiety in Parkinsons disease may be due to chemical and physical changes in the area of the brain that affect mood as well as movement. These changes are caused by the disease itself.
Here are some suggestions to help identify depression in Parkinsons:
- Mention changes in mood to your physician if they do not ask you about these conditions.
- Complete our Geriatric Depression Scale-15 to record your feelings so you can discuss symptoms with your doctor. Download the answer key and compare your responses.
- delusions and impulse control disorders
Diagnosis Of Parkinsons Disease
A number of disorders can cause symptoms similar to those of Parkinson’s disease. People with Parkinson’s-like symptoms that result from other causes are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinson’s, certain medical tests, as well as response to drug treatment, may help to distinguish them from Parkinson’s. Since many other diseases have similar features but require different treatments, it is important to make an exact diagnosis as soon as possible.
There are currently no blood or laboratory tests to diagnose nongenetic cases of Parkinson’s disease. Diagnosis is based on a person’s medical history and a neurological examination. Improvement after initiating medication is another important hallmark of Parkinson’s disease.
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Other Typical Symptoms Of Parkinson’s
Tremor is an uncontrollable movement that affects a part of the body. A Parkinsons tremor typically starts in the hand before spreading to affect the rest of the arm, or down to the foot on the same side of the body.
There is no cure for a tremor, but there are ways to manage the symptom with support from a specialist or Parkinsons nurse.
Slowness of movement also known as bradykinesia may mean that it takes someone with Parkinson’s longer to do things. For example, they might struggle with coordination, walking may become more like a shuffle or walking speed may slow down.
Everyday tasks, such as paying for items at a check-out or walking to a bus stop, might take longer to do.
Parkinsons causes stiff muscles, inflexibility and cramps. This can make certain tasks such as writing, doing up buttons or tying shoe laces, hard to do. Rigidity can stop muscles from stretching and relaxing. It can be particularly noticeable, for example, if you struggle to turn over or get in and out of bed.
Symptoms and the rate at which they develop will vary from person to person. The most important thing to do if youre worried you have Parkinsons is to speak to your GP.
How Are These Mental Health Problems Treated
Your doctor will first want to check if your hallucinations, delusions, or paranoia are caused by other medical conditions. They’ll check for imbalances in chemicals in your blood that help send nerve signals.
They may also check to see how well your kidney, liver, or lungs are working, as well as test for certain infections. All of these issues could cause mental health problems.
Other medications that you may be using, including over-the-counter drugs, could also play a role in your mental health. Tell your doctor about all the medicines you take, including herbs and supplements.
Often the medications used to treat Parkinson’s disease can cause mental health problems. Your doctor may suggest you switch to a different drug or change your dose. If changing your Parkinson’s medication causes your Parkinson’s symptoms to get worse, your doctor may recommend you stick with it but take antipsychotic drugs at the same time.
There’s a chance that an antipsychotic medicine you take is making your Parkinson’s worse. If that happens, you have alternatives. The medication pimavanserin was approved by the FDA to specifically treat psychosis that goes along with Parkinson’s disease. Other drugs, such as olanzapine , quetiapine , and clozapine can control hallucinations at low doses without making your Parkinson’s symptoms worse.
If you feel depressed or notice any mental health problems, talk to your doctor right away. There’s likely a remedy that will make you feel better.
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Emotional And Spiritual Well Being
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Parkinsons is generally thought of as a physical condition but it commonly affects the mind and emotional wellbeing too.
Mood changes are thought to affect around 50% of people with Parkinsons, in particular anxiety and depression. There is increasing acceptance that your state of mind and how you feel will influence how Parkinsons affects you, including the severity of symptoms. Stress for example is directly related to tremor if you are stressed tremor tends to worsen whereas if you are relaxed it generally reduces.
Feeling down, anxious or depressed can certainly affect quality of life so keeping a positive attitude and finding ways to cope with such feelings will play a big part in how you live well with Parkinsons. Whilst it is easy to feel overwhelmed and simply accept the way you feel, there are lots of things you can do to take control of your feelings, look after your emotional wellbeing and influence how Parkinsons affects you.
One Of The Most Difficult Neurological Disorder Symptoms Of Parkinsons
Why might this be important to families challenged by PD? Because the biggest source of conflict in families occurs when loved ones fail to recognize that a person with brain changes is not the same person who existed at an earlier time in life. Human beings greatly value continuity in personality but by expecting the person to be the same as they once were, loved ones are unfair to the person with brain insult. This person could no more return to an earlier personality state than he or she can will away tremors or rigidity. Energy expended in any way other than coming to terms with this new person is fruitless. There is actually some fascinating research in this area and it is likely to be a topic for a great deal more discussion in future blogs.
Because of the greater likelihood for executive dysfunction and dementia, personality change is easier to see among individuals with more advanced PD. Motivation is frequently affected, resulting in apathy that diminishes how actively an individual interacts with other people and with the world . Thinking or cognition changes can cause the person to process information more slowly and with less focus and concentration . A previously methodical, consistent individual often becomes increasingly chaotic in their response to their environment . One easily becomes less interested and hopeful about the future .
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Emotional Aspects Of Parkinsons
It is important to examine the various emotions that a person living with Parkinsons disease can undergo in living daily with the condition. The emotional factors that affect your loved one can be both internal and external. Some changes that occur can be directly due to the disease process, which causes an alteration in brain chemistry. Other emotional changes are influenced by external factors and the persons reaction to those factors.
Having a chronic neurological condition is stressful, and people react to stress in different ways. Some see it as a challenge and others see it as a problem. Parkinsons disease has a significant impact on family and friends and can create many emotions. These emotions include:
DENIAL/DISBELIEF
Denial, a feeling of shock and disbelief is a common reaction, especially at the time of initial diagnosis and early in the disease process. Since PD can have a subtle onset before an actual diagnosis is made, people often attribute symptoms to other causes. People also sometimes report a general feeling of uneasiness or an anxious, depressed feeling prior to diagnosis. When a diagnosis is finally made, it can come partially as a relief, but there is often shock and fear of the future.
DEPRESSION
Depression is one of the most common reactions to Parkinsons disease, occurring in roughly 50 percent of clients. Some doctors feel that depression may actually be part of the disease process. PD medications can also cause depression in some patients.
Handling Hallucinations And Delusional Thinking
Maybe your loved one is suddenly speaking to people who arent present. This disturbing development, known as psychosis, can happen for a few reasons: It may be part of the neurodegenerative process, explains Dr. Pontone. Or it can be a side effect of PD drugs, most commonly those that work by increasing dopamine. Thats because too much dopamine in the brain helps with motor symptoms but can trigger psychosis. Its also possible that a person who has Parkinsons disease could have another primary reason for psychosis, he says, such as severe depression, lack of sleep, and even schizophrenia.
In some cases, certain PD drugs actually play a role in the development of psychosis, specifically those that boost dopamine or deplete acetylcholine . That said, dopamine medications are not the stand-alone cause, because most patients on medication do not have psychosis, says Pontone.
When hallucinations are drug-induced, sometimes the medication can be switched to something less likely to cause this troubling side effect. But, more often than not, the original drug is paired with an antipsychotic medication such as Clozapine or Nuplazid . In most cases, you dont want to remove the dopamine drug unless you have no other choice, explains Dr. Pantone. Because youre almost certainly going to compromise their movement. Modifying the dosage, or the timing, often helps reduce psychosis while still aiding motor symptoms, says Dr. Pontone.
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