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Parkinson’s: Why it’s more than just a Movement Disorder?

The Mental Health Aspects Generally Ignored About Parkinson’s

The first description of Parkinson’s disease comes from James Parkinson who identified the characteristic features of the disease, through his own practice and other cases observed throughout London. It is the second most common chronic neurodegenerative condition which is observed in the elderly over 60 years. Globally, the incidence of the disease varies in different countries and is suggested at a rate of 1%. It is believed that the Chinese, African and Japanese populations have a significantly lower occurrence of Parkinson’s disease compared to the west. The disease is characterised by resting tremors, rigidity, bradykinesia, and the depigmentation of the substantia nigra. Although Parkinson’s disease is based on the presence of motor features, it’s just the tip of the ‘iceberg’. Along with the typical motor symptoms which are observed with Parkinson’s, the condition also exhibits many non-motor symptoms, along with behavioral issues. Cognitive decline as well as psychiatric disturbances like impulse control, depression, and psychosis are present. In addition, difficulties in sleep, autonomic failures, and pain could be present. It is seen that depressive disorders like anxiety, cognitive decline, fatigue, and difficulty sleeping could be associated with poor-health-related quality of life in persons having Parkinson’s disease. During the latter stages of the disease, a person loses independence and needs the help of a caregiver. Psychiatric comorbidity is common and disabling with Parkinson’s.

The Risk of Parkinson’s in patients having psychiatric disorders

It is seen that patients who show psychiatric illnesses like anxiety, depression, and schizophrenia have a risk of having Parkinson’s disease. Anxiety is seen as one of the earliest manifestations of Parkinson’s disease.

Depression and Parkinson’s Disease

Clinical research shows that depression is commonly reported in subjects who have Parkinson’s. It is believed that the relationship between depression and Parkinson’s disease follows a vicious cycle. It is noteworthy to understand that patients with depression have a higher prevalence of Parkinson’s disease than the general public. A clinical trial using retrospective data from 23180 participants has reported that patients who have depression are 3.24 times more likely to have Parkinson’s disease than the control subjects. Results from another study have shown that lifetime prevalence of depression caused a 9.2% higher chance of having Parkinson’s.

Anxiety Disorder and Parkinson’s Disease

Patients who have Parkinson’s disease have been shown to have anxiety disorders. It is observed through clinical trials that clinically significant anxiety symptoms are higher for those who have Parkinson’s disease. There are many ways anxiety is associated with Parkinson’s disease. Primary anxiety could lead to Parkinson’s disease. In addition, anxiety secondary to other psychiatric comorbidities can be caused by the use of antiparkinsonian medications like levodopa. Also, anxiety can be caused secondary to the fluctuation of motor symptoms to the impairment and limitations caused by Parkinson’s. The most common anxiety disorders in patients with Parkinson’s disease are panic disorders, generalised anxiety disorder, and social phobia. Studies have also shown that left-sided lesions have a higher correlation with high anxiety levels. Some of the other risk factors for anxiety disorder include being female, the young onset of Parkinson’s disease, more depressive symptoms, poor sleep, gait dysfunction, motor fluctuations, morning dystonia, and symptom clustering.

Psychosis and Parkinson’s Disease

Psychosis is not considered a main symptom of idiopathic Parkinson’s disease. However, there are reports that psychosis is present in patients who have Parkinson’s disease from the pre-levodopa era. It is believed however that psychotic symptoms in an untreated Parkinson’s disease patient are an atypical feature, which casts doubt on the diagnosis.

Sleep disorders in Parkinson’s disease

Studies show that Parkinson’s can have a significant negative impact on the quality of sleep and life. Patients who have Parkinson’s disease have sleep-related problems and it is classified as nocturnal sleep disturbances, sleep-related movement disorders, and parasomnias. Restless leg syndrome is seen and sleep disorders can lead to the development of Parkinson’s disease in later life.

Suicidal Behaviour in Parkinson’s disease

Suicidal behavior includes having suicidal ideations, gestures, and attempted suicide. The risk of death through suicide is seen to be higher in subjects who have Parkinson’s disease. Results from a longitudinal study of 8 years have reported that the death in patients with Parkinson’s disease is 5.3 times higher than expected. Thus, the risk factors for suicidal ideations include depression, anxiety as well as the duration of illness, and a history of impulse control disorder.

In conclusion, Parkinson’s disease should not just be limited to being a motor disorder. This clearly shows that in addition to the motor symptoms, individuals who suffer from Parkinson’s disease have a high prevalence of non-motor symptoms and psychiatric manifestations which can impair the quality of life. More studies are needed to evaluate the efficacy of various psychotropics and psychological treatments in managing the psychiatric manifestations of Parkinson’s disease.

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