ReviewPsychosis, apathy, depression and anxiety in Parkinson's disease
Introduction
Psychiatric symptoms are common in Parkinson's disease, occur at higher prevalence than in age-matched controls and have significant impact on quality of life (Barone et al., 2009, Chaudhuri et al., 2006, Gallagher and Schrag, 2008, Gallagher et al., 2010). They include depressive disorders, anxiety, apathy, psychosis and impulse control disorders (ICD) and dopamine dysregulation syndrome (DDS). We here review the prevalence, pathophysiology, diagnosis and treatment of the affective disturbances, apathy and psychosis.
Section snippets
Prevalence
Establishing the prevalence of disorders of mood, motivation and anxiety in PD is complicated by the symptomatic overlap between the somatic features of the neuropsychiatric and underlying movement disorder, differences in the phenomenology of these disorders in PD (dPD) and the general population, frequently coexisting cognitive problems, psychiatric side effects of dopaminergic medication, the presence of motor and non-motor fluctuations and the different diagnostic frameworks available
Depression, anxiety and apathy
Clinically, a number of factors have been associated with depression in PD. These include younger age of symptom onset, longer disease duration, increased motor severity, motor complications (fluctuations and dyskinesias), disease stage (Hoehn and Yahr), disability (Schwab and England), dopaminergic medication (higher Levodopa equivalent dose), and motor subtype (particularly postural instability gait difficulty, PIGD) (Dissanayaka et al., 2011). Other associations include co-existing
Depression
Diagnostic frameworks for depression include DSM criteria for major, minor or subsyndromal depression and the International Statistical Classification of Diseases and Related Health Problems (criteria for a mild, moderate or severe depressive episode. DSM-IV-R diagnosis of major depression requires one or more of the two core criteria (depressed mood, loss of interest or pleasure), and a total of five or more symptoms including significant weight change, insomnia or hypersomnia, psychomotor
Depression
Pharmacological agents used for depression in general psychiatry practice, including tricyclic antidepressants (TCA), the tricyclic-related drugs (e.g. trazodone), the selective serotonin reuptake inhibitors (SSRIs), the serotonin and noradrenaline reuptake inhibitor venlafaxine, the selective noradrenaline reuptake inhibitor reboxetine, the presynaptic alpha-2 adrenoreceptor antagonist mirtazapine and the noradrenaline–dopamine reuptake inhibitor (NDRI) bupropion may all have a role in
Conclusion
Depression, anxiety, apathy and psychosis are important non motor symptoms in PD. The pathophysiology of these disorders is likely to relate to widespread brainstem and cortical neuronal loss and LB deposition, with involvement of different neurotransmitter systems, including dopaminergic, serotonergic, cholinergic and adrenergic transmission. The pathology of affective disorders in PD may be distinct from depression, anxiety and apathy in non-PD subjects, and there are particular challenges in
References (141)
- et al.
Double-blind, randomized, placebo controlled trial on the effect of 10 days low-frequency rTMS over the vertex on sleep in Parkinson's disease
Sleep Med.
(2010) - et al.
Dopamine agonists in the treatment of early Parkinson's disease: a meta-analysis
Parkinsonism Relat. Disord.
(2009) - et al.
Reality monitoring and visual hallucinations in Parkinson's disease
Neuropsychologia
(2003) - et al.
Pramipexole for the treatment of depressive symptoms in patients with Parkinson's disease: a randomised, double-blind, placebo-controlled trial
Lancet Neurol.
(2010) - et al.
Nonmotor fluctuations in Parkinson's disease: clinical spectrum and classification
J Neurol Sci.
(2010) - et al.
Social support plays a role in depression in Parkinson's disease: a cross-section study in a Chinese cohort
Parkinsonism Relat. Disord.
(2008) - et al.
Factors associated with depression in Parkinson's disease
J. Affect. Disord.
(2011) - et al.
Validation of diagnostic criteria for apathy in Parkinson's disease
Parkinsonism Relat. Disord.
(2010) - et al.
Management of hallucinations and psychosis in Parkinson's disease
Am. J. Geriatr. Pharmacother.
(2010) - et al.
An open study of repetitive transcranial magnetic stimulation in treatment-resistant depression with Parkinson's disease
Clin. Neurophysiol.
(2007)