Posted by Phillipa on August 14, 2008, at 12:46:10
In reply to Re: Social phobia was diagnosed in 50% of PD patients. » Marty, posted by Phillipa on August 14, 2008, at 12:38:42
More related to Parkinsons. Phillipa
PARKINSON'S DISEASE: DEPRESSION, PERSONALITY AND ANXIETY
To the passive observer, people with Parkinson's disease may appear to be depressed (and possibly to the same observer, people who are depressed could look parkinsonian). Appearances can be deceptive and there have been a number of studies into depression in Parkinson's.
Diagnosing depression in Parkinson's can be difficult because many of the symptoms of Parkinson's are also symptoms of depression. Many people with Parkinson's have weight loss, sleep disturbance, fatigue and slowing down and these are also things doctors are looking for in diagnosing depression.
It has been suggested to doctors that they ignore these signs in someone with Parkinson's and look for other symptoms such as decreased concentration and feelings of worthlessness as symptoms of depression. It has also been suggested that doctors who see signs such as sleep disturbance and fatigue should take into account that this could be depression, particularly as these symptoms will sometimes respond to antidepressants.
Sleep disturbances are a major symptom of depression and studies have shown that Parkinson's patients with major depression had more sleep disturbance and also more pain than people who were not depressed.
Other studies have shown that while anxiety and depression occur together with sleep problems, they do not contribute to changes in quality of sleep. This would seem to indicate that it is the disease itself that is that major cause of disturbed sleep, rather than depression or anxiety.
It is clear that many people with Parkinson's do suffer from depression, even though the mechanism may be in doubt. Studies have shown that people with Parkinson's have higher levels of depression than people with similar levels of disability from another cause, and that levels of depression are not related to the severity of Parkinson's symptoms. This seems to support the idea that the depression can be a part of the disease itself.
The fact that about 20 per cent of people diagnosed with Parkinson's suffer from depression prior to being diagnosed would also seem to indicate that the depression is part of the disease process rather than a result of diagnosis or living with Parkinson's. Other studies show higher levels of depression just after diagnosis and in the late stages of the condition, indicating that some people may suffer from depression as a reaction to having Parkinson's and some of the difficulties it creates.
The number of people with Parkinson's who are depressed is generally accepted at being about 40 per cent. One recent study of 105 consecutive patients with Parkinson's showed 21 per cent with major depression and 20 per cent with minor depression. Another study of 247 consecutive patients showed 25.5 per cent with major depression, and 17 per cent minor.
Most of these studies are of clinic patients and community-based studies tend to show lower levels. One study of 245 patients living in the community showed 7.7 per cent with major depression and 45.5 per cent with mild symptoms.
Who gets depressed, when and why is another topic for debate, and researchers do not seem to come up with clear answers. There does not seem to be a relationship between current age, the duration of Parkinson's and mood changes and there is no clear picture relating depression to age of onset. One study found that in people with early onset Parkinson's, depression was related to cognitive (thinking) problems and depression in later onset linked with difficulties in activities of daily living (ADL). Another study found that depression in younger onset patients was related to difficulties in ADL only.
A number of studies have shown that depression can affect the cognitive functions in Parkinson's. The area of the brain associated with motivation, prediction and reward has more dopamine cells damaged in people who suffer from major depression than would be expected. It also seems that the cognitive difficulties associated with Parkinson's are of a particular type and that the degree of depression influences the amount rather than the character of this cognitive impairment.
Major depression in Parkinson's is also associated with a decline in normal functioning in daily tasks, so treating depression can help people improve their ability to cope with daily life.
The type of depression suffered by those with Parkinson's seems to be different from a 'normal' depression: greater anxiety, more sadness, pessimism, irritability and ideas of suicide, less guilt, self punishment, feeling of failure, hallucinations and delusions and actual suicide.
A number of drugs are used to treat depression in Parkinson's but there have been very few studies which have examined their effectiveness. Different antidepressants have been used successfully, although up to 30 per cent of patients with depression could be resistant to antidepressants. An analysis of the medications used to treat more than 2,000 people with Parkinson's indicated that the selective serotonin reuptake inhibitors (SSRIs) were used 51 per cent of the time, tricyclic antidepressants 41 per cent of the time and other medications 8 per cent. Drugs for depression are also used in combination with various Parkinson's medications. Some Parkinson's medications also have some antidepressant effects.
The 'Parkinson's personality'
Over the years, some researchers have developed the theory that there is a distinctive Parkinson's personality; a person who is 'introverted, industrious, rigidly moral, serious, stoic, non-impulsive, over-controlled, less talkative and flexible, cautious and depressed'. The existence of this personality type is still, however, speculative.The concept of this distinctive Parkinson's personality has less credibility when people who have been diagnosed with Alzheimer's and Parkinson's have been shown to have similar personality traits, suggesting that these traits could be in part an adaptation to a chronic neurological condition.
Other researchers have found that people with Parkinson's have less 'novelty seeking' behaviour (described as rigid, stoic, slow tempered, frugal, orderly and persistent). This type of behaviour seems to be linked to dopamine related mechanisms, which would seem to indicate that if there are these personality traits, they may be related to the disease process itself.
Other studies have been unable to find a link between novelty seeking and depression in Parkinson's, but there does seem to be a link between depression and harm avoidance, which is a behaviour linked to other chemical mechanisms in Parkinson's.
There are several ways to interpret these studies linking personality and Parkinson's and at this stage it is hard to prove or disprove any of them. Here are some of the theories.
A particular personality type causes or contributes to the onset of Parkinson's.
Parkinson's causes a personality type.
Particular personality types and Parkinson's occur in common at-risk populations.
The personality seen in Parkinson's is a manifestation of depression.
Anxiety and Parkinson's
Anxiety is common in Parkinson's, affecting up to 40 per cent of people, and is often related to self consciousness about the symptoms, particularly tremor. It can take the form of a generalised anxiety, a panic disorder or a social phobia. Generally anxiety symptoms occur after the diagnosis of Parkinson's, but in some people it can be the first symptom.Anxiety is often associated with depression. One study showed that of those patients with anxiety, 92 per cent also had depression and in another study of people with Parkinson's and depression, 67 per cent also had a diagnosed anxiety disorder. The drugs most commonly used to treat anxiety in Parkinson's are the benzodiazepines.
Some people with Parkinson's experience a condition called akathisia, a term used to describe an inner restlessness and an inability to keep still. This is found frequently in Parkinson's and should not be confused with anxiety.
Reference: 'Psychiatric Manifestations of Parkinson's Disease'. Vladimir S. Kostic, Institute of Neurology, CCS, Belgrade, Yugoslavia. Seminar presentation at the 5th International Congress of Parkinson's Disease and Movement Disorders, New
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