Thursday, March 23, 2023

Mental Health And Parkinson’s

Do Something Nice For Yourself Every Daydo Not Drop Out Of The Mainstream Of Life

Mental Health and Parkinson’s Disease

Enlist other family members to assist on a regularly scheduled basis Hire aides at home for several hours on a regular basis Participate in exercise programs Participate in education seminars and support groups Consult with a mental health professional Have a home safety evaluation Make use of adult day-care programs

Care partners must be reminded that their health is at stake, and that they are entitled to have some free time to recharge their emotional batteries. Recommendations for alleviating the burden for the primary care partner are listed in Box 2. Care partners should all be encouraged to participate in PD support groups and educational programs, as they will benefit from the advice and experience of others who have had to cope with similar situations. Consultation with a mental health professional is important for care partners who are becoming overwhelmed or depressed.

Family members or friends often say they are willing to pitch in and help the primary care partner without committing to a specific schedule. The assistance of other family members should be arranged on a predictable and regular basis. This might enable the primary care partner to make plans in order to re-engage in the mainstream of life . The assistance of family members on a haphazard basis or only during emergency situations does not ease the ongoing daily burdens for the care partner.

Exacerbation Of Mh Conditions

The medications used to treat PD often cause psychiatric disturbances specifically, psychosis, impulse-control disorders , and mania.

Psychosis: One of the most prominent and best-documented neuropsychiatric symptoms related to antiparkinsonian drug therapy is psychosis. PD-related psychosis is often characterized by visual and auditory hallucinations, illusions, and delusions.4,5 While auditory hallucinations are infrequent, visual hallucinations occur in 20% to 30% of drug-treated PD patients.4-8

The onset of psychosis-related symptoms related to antiparkinsonian drugs may occur soon after initiation or not until after 1 year of therapy.5,9 Early onset of psychosis is more likely in patients with a past medical history of psychiatric illness, and the psychosis resolves after drug discontinuation or dosage reduction.9

The antiparkinsonian medications associated with psychosis include dopaminergics and anticholinergics, amantadine, and monoamine oxidase B inhibitors .5,10-13 Of these, dopaminergics have the highest potential for inducing psychosis in PD patients.14 Levodopa exhibits dose-related psychiatric symptoms in a high proportion of PD patients.5,14,15

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What Are The Treatment Options For Parkinsons Psychosis

Because Parkinsons drugs can cause psychosis, your doctor will likely start by taking you off your medications, one at a time, or adjusting the dose. Changing your medication may make your movement symptoms worse.

Your doctor will keep adjusting your medication. The goal is to get you to a dose that improves your movement without causing hallucinations and delusions.

If changing your medication doesnt work, the next step is to go on an antipsychotic medication. These drugs prevent psychosis symptoms by altering levels of chemicals in your brain.

Older antipsychotic drugs can make Parkinsons movement symptoms worse. Newer drugs, called atypical antipsychotics, are less likely to affect your movement. These drugs are off-label, meaning theyre not approved to treat Parkinsons specifically. They include:

In 2016, the Food and Drug Administration approved pimavanserin . Its the first drug designed specifically to treat Parkinsons disease psychosis. Nuplazid reduces the number of hallucinations and delusions without affecting movement.

Nuplazid and other newer antipsychotic drugs do carry a black box warning. They can increase the risk of death in older people who have psychosis related to dementia. Your doctor will consider this and other risks before prescribing one of these drugs.

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Get Support For Your Mental Health

You can call our free and confidential helpline on 0808 800 0303.

It’s open Monday-Friday 9am-7pm and Saturday 10am-2pm. Our trained advisers can provide support to anyone affected by Parkinson’s.

You can also contact the Mind Infoline on 0300 123 3393, which is open 9am-6pm, from Monday to Friday.

If you need to talk to someone outside of these hours, Samaritans are free to call 24/7 on 116 213.

There are lots of places where you can connect with people who may be experiencing similar issues to you.

How Are Cognitive Problems Treated

Mental Health

Much remains to be learned about the basic biology that underlies cognitive changes in PD. Researchers work towards the development of diagnostic tests to identify people who seem to be at greatest risk for cognitive changes and to differentiate cognitive problems in people with PD from those that occur in another disorder related but different known as dementia with Lewy bodies.

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What Are Parkinsons Delusions

Delusions are thoughts that arent grounded in reality. Theyre not as common as hallucinations, affecting only about 8 percent of people with Parkinsons disease. But they are harder to treat.

The most common delusions involve paranoia for example, the feeling that people are out to get you, or that your partner is cheating on you. Having these thoughts can lead to aggressive or even dangerous behavior.

Youll start with a visit to your doctor for an evaluation. Your doctor may diagnose you with this condition if you:

  • have had symptoms like hallucinations and delusions for at least 1 month
  • dont have another condition that could be causing these symptoms, like dementia, delirium, major depression, or schizophrenia

Not everyone with Parkinsons disease will develop psychosis. Youre more likely to have this if you:

There are two possible causes of Parkinsons psychosis:

  • changes in levels of brain chemicals like serotonin and dopamine from the disease itself
  • changes in levels of these chemicals from medications that treat Parkinsons disease

Dopamine is a chemical that helps your body move smoothly. People with Parkinsons disease have lower than normal levels of dopamine, which causes their body to move stiffly.

Drugs that treat Parkinsons improve movement by increasing dopamine levels. Yet they can sometimes cause psychosis as a side effect.

Anxiety As An Early Warning Sign

It may be that anxiety disorders that are diagnosed as much as two decades before Parkinsons disease may be a harbinger of the disease, says Gregory Pontone, M.D., director of the Johns Hopkins Movement Disorders Psychiatry Clinic. Parkinsons disease, like Alzheimers disease, has what experts call a long approach, he says, and anxiety may be part of that long approach.

One theory is that the anxiety that comes before Parkinsons results from the same underlying changes in brain chemistry and circuitry. Others believe that Parkinsons disease and anxiety share a common genetic risk factor. Either way, taking a closer look at the link can help doctors understand the causes of Parkinsons and treat patients with the disease.

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Emergency Shelter And Housing

Acquired Immune Deficiency Syndrome Addictions Anger Antisocial Personality Disorder , Psychopathy, and Conduct Disorder Anxiety Autism and Autism Spectrum DisordersB Developmental, Intellectual Delay and Disabilities Domestic Violence Eating Disorders including Anorexia and Bulimia Elimination Disorders Fetal Alcohol and Fetal Alcohol Spectrum Disorders Firesetting Infant and Early Childhood Mental Health Insomnia Oppositional behaviours including oppositional defiant disorder Overweight and Obesity Pandemic , Disasters and Related Emergencies Parenting Post-Traumatic Stress Disorder , Trauma and AbuseR School Refusal Self-harm including Self-cutting Sensory Processing Disorders and Self-Regulation Problems Separation and Divorce Social Skills and Life Skills Somatoform Disorders Technology Issues, including Internet, Cellphone, Social Media Addiction Tourette Syndrome and Tic Disorders

There are various shelters that people can use when they have no place to go.

Emergency shelters are places for people to live temporarily when they don’t have a place to stay. Emergency shelters are primarily meant for those fleeing an abusive relationship, sexual abuse or domestic violence. Some shelters limit their clientele by gender or age.

Risk Of Parkinsons Disease In Patients With Psychiatric Disorders

Mental Health for Parkinson’s Care Partners

The influence of mental illness early in life on the subsequent risk of PD and its clinical picture remain obscure. Several studies have identified certain psychiatric illnesses, particularly anxiety, depression and schizophrenia as risk factors for PD. Anxiety has been suggested to be one of the earliest manifestations of PD in several case-control and cohort studies.

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Causes Of Parkinsons Disease

Parkinsons disease is caused by a loss of nerve cells in part of the brain called the substantia nigra. This leads to a reduction in a chemical called dopamine in the brain.

Dopamine plays a vital role in regulating the movement of the body. A reduction in dopamine is responsible for many of the symptoms of Parkinsons disease.

Exactly what causes the loss of nerve cells is unclear. Most experts think that a combination of genetic and environmental factors is responsible.

Management Of Dual Diagnosis Of Parkinsons Disease And A Mental Health Disorder

Jasmine Carpenter, PharmD, BCPS

Adepeju Awodipe, PharmD Candidate 2015Howard University College of PharmacyWashington, DC

Washington, DC

US Pharm. 2015 40:34-38.

ABSTRACT: Mental health disorders are frequently seen in patients with Parkinsons disease , possibly as a result of the complex imbalance of neurotransmitters in both disease states. This imbalance poses various treatment challenges, such as the exacerbation of both disease states and drug interactions between the medications used to treat PD and mental health disorders. Owing to these challenges, mental health disturbances in PD patients often go untreated. By assisting with ruling out causative medications and underlying disease states, simplifying antiparkinsonian regimens, and recommending antipsychotics, the pharmacist can help ensure that both of these disease states are adequately treated.

Parkinsons disease , which impacts millions of people worldwide, is a neurodegenerative disorder involving the deterioration of motor, mental, and functional skills.1 This degenerative decline increases mortality rates and negatively affects patients quality of life. Motor movement disorders are heavily emphasized as cardinal signs of PD however, nonmotor manifestations such as depression, anxiety, and psychosis are major concerns that must be addressed in this patient population.

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Tremors Caused By Medications

In addition to drug-induced parkinsonism, which includes rest tremor and is caused by medications that block the dopamine receptor, there are also a wide variety of medications that do not block the dopamine receptor, but can cause other types of tremors, such as postural and action tremors. So if you have these types of tremors, but without the slowness, stiffness and other PD-like symptoms, you could have drug-induced tremor .

A postural tremor occurs when a body part is held against gravity. Postural tremors occur for example, when the arms are extended, such as when holding a tray. An action tremor occurs when a body part is moving. Action tremors occur for example, when the arm is moving toward the mouth to eat.

Drug-induced tremors typically are symmetric or equal on both sides of the body. The medications that can cause tremor include, but are not limited to, lithium, valproic acid, amiodarone, beta-adrenergic agonists, and selective serotonin reuptake inhibitors . Be attentive to whether a tremor starts after any new medication is started. If it does, discuss this with your doctor.

Kathy: On Anxiety Going It Alone And Being Kind To Yourself

Parkinsons Disease

Anxiety is also the biggest mental health challenge for Kathy , a 72 year old woman with PD diagnosed 4 years ago. Her mental health concerns are deeply influenced by a major external stressor, namely an adult child who is facing an illness of her own. Kathy was always a very active and capable person, and remains so, but PD is starting to cause some physical limitations for her. She wants to help her daughter as much as she can, but has begun to realize that she cant do everything she used to be able to do. This is extremely frustrating, because not only must she accept her limitations, but others around her must do so as well.

She often feels very lonely. She is not married and finds herself shouldering her own physical and mental struggles, as well as those of her daughter, by herself. She is lucky to have some close friends, but they have health challenges of their own to deal with and cant always be there for her. She finds it mildly exasperating to constantly read how important it is for PD patients to surround themselves with supportive family what if you are alone?

She also finds it irritating to read articles about PD that are relentlessly perky about PD. Yes, exercise can be very helpful and can sometimes help keep symptoms at bay. But there is a down-side to PD as well. You should be allowed to feel that and express that. It is also not your fault if your PD worsens it does not mean that you did not do enough.

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Parkinsons Doesnt Just Affect People Physicallyit Can Also Take A Toll On Our Emotions We Asked Clinical Psychologist Louise Marasco About The Mental Impacts Of Pd And How To Manage

Sometimes people with Parkinsons spend so much time concentrating on the physical changes that occur with PD that they neglect to address the mental or emotional impacts of this disease. Stress, anxiety, depression, grief and apathy are common emotions that people with Parkinsons may experience at diagnosis or as the disease progresses.

We recently spoke with Dr. Louise Marasco, a licensed clinical psychologist at Oregon Health & Science University about managing the impacts that Parkinsons disease has on a persons mental and emotional health.

Brian Grant Foundation: What are some common mental health struggles that people with Parkinsons cope with as their disease progresses?

Louise Marasco: The most common mental health struggle I hear about is what people refer to as anxiety. Depression is certainly prevalent, though I would argue that often times it is more an issue of apathy and/or emotionality, difficulty regulating emotions, rather than clinical depression.

BGF: Whats the difference between depression, apathy and grief in relation to Parkinsons, and how do you treat them?

LM: Great question, and sometimes difficult to tease out. Grief is a normal, expected response to loss. People grieve when they lose loved ones, but they also grieve when they cant work anymore, or play squash or walk without assistance. We do not exactly treat grief, but nurture, support and guide people going through this normal response.

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When To Seek Help For Mental Health Issues

One question that readers may have is when do I seek help for my mental health issues and when do I consider my concerns just to be a normal part of life? There is no one right answer to this question, but as a rule, if the mental health issue that has arisen is interfering with your normal level of function, then it is time to seek out medical advice. Most issues can be improved with counseling, other lifestyle adjustments, changing your PD meds, or adding other medications, so there is no need to struggle in silence.

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How Are Mental Health Problems Treated In Parkinsons Disease

Mental health problems in Parkinson’s disease can be treated with a combination of medication, talking therapy and lifestyle changes. Your doctor may also suggest joining a Parkinsons support group so that you can share your challenges with other PD patients.

Other ways to care for your mental health if you have Parkinson’s include:

Parkinson’s disease and mental health problems are not easily cured. However, there are a variety of treatment options and lifestyle changes that can boost your mental wellbeing and improve your overall quality of life.

What Type Of Exercise Should I Do If I Have Parkinson’s Disease

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Exercise is a planned, structured, repetitive activity that is intended to improve physical fitness. There is no right exercise for people with Parkinsons. Everyones regimen will differ, depending on overall health, symptoms and previous level of activity. Any exercise helps, and a variety of exercise types may provide well-rounded benefits.

Aerobic exercise

Aerobic exercise involves activities that challenge your cardiorespiratory system such as walking, biking, running, and activities in the pool. Participating in aerobic exercise at least three days a week for 30-40 minutes may slow Parkinsons decline.

Strength training

Strength training involves using your body weight or other tools to build muscle mass and strength. Strength training two days per week, starting with low repetition and weight, may be beneficial in Parkinsons disease. A focus on extensor muscles, or muscles in the back of the body, can help with posture.

Flexibility training

Stretching two or more days per week can be beneficial to maintain range of motion and posture. Holding each stretch of major muscle groups for 30 to 60 seconds can improve muscle length.

Balance and agility training

This type of training often combines aerobic exercise, strength training, and flexibility training. Examples include:

  • Tai chi, yoga or Pilates.

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Other Mental Health Problems Linked To Parkinson’s

Some mental health issues are side effects of Parkinson’s treatments, like hallucinations, paranoia, and delusions.

A hallucination happens when you think something is present when it isn’t. For example, you may hear a voice but no one is there. An example of paranoia is when you think someone is following you when they are not. A delusion is when you are convinced something is true, despite clear evidence that proves it’s not.

Symptoms Of Parkinsons Disease

The symptoms of Parkinsons disease usually develop gradually and are mild at first.

There are many different symptoms associated with Parkinsons disease. Some of the more common symptoms are described below.

However, the order in which these develop and their severity is different for each individual. Its unlikely that a person with Parkinsons disease would experience all or most of these.

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Is Parkinsons A Mental Or Physical Disability

Is Parkinsons a Disability? Parkinsons Disease is considered a disability by the Social Security Administration According to the SSAs Blue Book, which is the list of conditions that can qualify for Social Security disability benefits. Parkinsons Disease is located in section 11.06 of the SSAs Blue Book.

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