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Psychiatric Issues in Parkinson's Disease: A Practical Guide

2005 Edition, November 29, 2005

Complete Document

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Active, Most Current

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ISBN: 978-0-203-69843-3
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Product Details:

  • Revision: 2005 Edition, November 29, 2005
  • Published Date: November 29, 2005
  • Status: Active, Most Current
  • Document Language: English
  • Published By: CRC Press (CRC)
  • Page Count: 358
  • ANSI Approved: No
  • DoD Adopted: No

Description / Abstract:


Parkinson's disease (PD) is now the second most common neurodegenerative disease in the elderly. About one million Americans have the illness and it is projected that this number will increase considerably as our population ages. Once rarely discussed in public, the many courageous and well-known individuals who have talked about their own struggles with PD have increased awareness of this disorder. This heightened profile has led to a decrease in stigma and increased support for research on mechanisms and treatment of the disease. With this new emphasis on research comes a greater sense of hope for a cure as well as for better ways to manage PD.

The impact of PD on individuals is as wide-ranging as the clinical manifestations of the disease itself. While it affects nearly all aspects of life for most people, those without PD often fail to appreciate that the disease can make even the most mundane daily activity a challenge. In addition, most discussion of PD focuses on its motor features, such as tremor, slowness, and imbalance. Yet the so-called "non-motor" aspects of the illness, such as depression, anxiety, memory difficulties, sleep disturbances, etc., are often prominent and can cause as much or more difficulty for individuals struggling with the disease.

While we anticipate that a cure for PD will come eventually, we remain faced with the question of what to do now that will ease the burden of the illness. Often, clinicians and patients approach us with the question, "What do I do about . . .?" These questions cover nearly every aspect of PD, from diagnosis and medication to coping and the value of advocacy. In order to understand, treat, or cope with PD, it is important to understand the various manifestations of the illness, particularly the clinical presentations and management of psychiatric disturbances. Accordingly, we hope that clinicians,patients and their families will be helped by the practical approach to understanding and treating PD that you will find in this book.

It is for these reasons that we have gathered together a group of experts on PD to address reducing the burden of the illness. We have found, in our many years of treating individuals with PD, that the impact of the nonmotor aspects and how they relate to the motor aspects is often underappreciated, by both the family and the physician. One goal of this book is to provide our readers with a better understanding of the neuropsychiatric and quality-of-life struggles that affect individuals living with PD. Furthermore, we aim to provide guidance to clinicians from multiple disciplines about managing these problems. While this book is intended for a clinically trained audience, we expect that many patients, families, and other caregivers will benefit from the information provided and use this book as a resource for subsequent discussions with their treating clinicians.

Because many of the motor and psychiatric issues are interrelated, their optimal management requires coordination between those who provide neurological care, psychiatric care, family support, and other services. The book begins, therefore, with chapters that discuss the neurology of PD and the latest treatments for its primary motor features. Subsequent chapters in Section I of the book discuss the motor complications of antiparkinsonian medications and the other non-motor physical symptoms that are common in PD patients, such as constipation, dry skin, and blurred vision. These chapters are intended to serve as a primer on the treatment of the typical motor and associated symptoms of PD from the neurologist's perspective. Such an understanding should enhance co-management of PD by those whose primary focus is on the psychiatric aspects of PD. Sections II and III of the book are devoted to information and guidance on the neuropsychiatric disturbances that can occur in PD. Awareness of these phenomena should facilitate their early identification and suitable interventions.

Section II provides discussions and advice on cognitive impairment and dementia that should help in understanding the common presentations and various manifestations of cognitive difficulties. These chapters will also offer practical advice on management. In Section III, you will find chapters on depression and on anxiety, common problems experienced by those with PD. These problems greatly affect quality of life and attention to them can lessen the burdens of the illness. Our belief, and experience, is that addressing these problems successfully improves all aspects of an individual's and their family's life. There are also chapters devoted to psychosis and to other behavioral disturbances including disinhibition. Problems such as hallucinations, delusions, and gambling often seem completely out of character for the individual with PD, but they are in large part related to the medications used to treat PD. We spend considerable time explaining these problems and offering advice on treatment.

The chapters in Section IV focus on a variety of matters that are less likely to be discussed in medical textbooks of this sort. However, we included these topics because they are integral to patient care and are of great relevance to the long-term management of PD by clinicians, patients and their families. To that end, we provide perspectives and advice on learning to cope with the illness, disability, and the value of rehabilitation. We also discuss the role of nursing homes in the later stages of the illness and pay special attention to the issues faced by caregivers. Lastly, we discuss the value of advocacy. Advocacy groups offer the comfort and collective optimism of a shared purpose and provide opportunities for individuals to become better informed about PD and involved in changing the future for individuals with PD.

Our expectation for this book is that it will help you to better understand and manage the various faces of PD. If you are a clinician, we hope that it will also help you to provide advice and comprehensive guidance to patients and their families, as well as to members of other clinical disciplines involved in the care of these patients. If PD affects you or a loved one, we also hope that this book will, in some way, help to ease your burden.