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Psychiatric Care in Parkinson’s Disease

QUELHAS, ROSA, MD

Journal of Psychiatric Practice®: March 2013 - Volume 19 - Issue 2 - p 118–141
doi: 10.1097/01.pra.0000428558.94329.6d
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Objective. Parkinson’s disease (PD) is a degenerative and disabling disease in which medical providers focus mainly on ameliorating problems in day-to-day functioning. This review summarizes current knowledge about the efficacy and tolerability of psychopharmacological agents in the treatment of depression, anxiety, psychosis, and insomnia in patients with PD. Recommended or promising nonpharmacological interventions are also reviewed. Method. Studies were identified using computerized searches, with further references obtained from the bibliographies of the reviewed articles. Result. Findings in the research literature provide growing evidence concerning the antidepressant treatment of patients with PD. Psychoeducational interventions for managing depression and anxiety symptoms also appear promising. Music therapy has proven to be particularly effective for patients with PD. Psychosis is common in patients with PD. When psychosis is induced by antiparkinson drugs, a dose reduction can be considered, but it is seldom successful. Patients with PD do not generally tolerate conventional antipsychotic medications, justifying evaluation of newer atypical agents in this population. Cholinesterase inhibitors have also become increasingly important in the treatment of PD in recent years. Finally, insomnia is a very frequent complaint in patients with PD and may also contribute to the development of depression. Patients should be encouraged to improve sleep hygiene and use behavioral interventions. Definitive trials of treatments for sleep disorders in this population are also warranted. Conclusion. Therapeutic approaches to the treatment of PD and its associated psychiatric symptoms must be individualized and may involve a combination of antiparkinson drugs, psychopharmacological treatment, and/or psychotherapeutic interventions. (Journal of Psychiatric Practice 2013;19:118–141)

QUELHAS: Pedro Hispano General Hospital, Matosinhos’ Local Health Unit (ULSM), Matosinhos, Portugal.

The author declares no conflicts of interest.

Please send correspondence to: Rosa Quelhas, MD, Rua Dr. Eduardo Torres, 4454-509 Matosinhos, Portugal. rosaquelhas@gmail.com

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.