In Parkinson’s Disease (PD) pain is one of the most common and perhaps unexpected symptoms. Up to 75 percent of PD victims suffer from pain ranging from the intensity of slight discomfort to stinging pain. But this symptom is also one of the most under-recognized and therefore undertreated of all. Parkinson’s Disease is largely known to be a movement disorder. But that is just the headline that everyone keeps talking about. Under the table, there is a huge aspect of many non-motor symptoms which only the patients experience and neurologists try to put forward. But due to the lack definite evidence, many of the additional factors related to the mental health are often ignored in Parkinson’s Disease. PD is mainly known as physical disorder that may lead to mental side effects but that is not the story.
There are many studies and research surveys that state a serious connection between psychotic disorders and cognitive decline of mental health with PD. In terms of risk factors, various demographics, clinical and treatment related variables are seen to be connected with higher risk of psychotic morbidity. Random trials in approaching the treatment procedure suitable for each person from switching medication to fluctuating the “On” and “Off” phase of doses often lead to certain psychotic disturbances in patients like depression, anxiety and sleeping sickness.
Risk OF PD In Psychiatric Disorder Patients
It is now believed that PD is highly influenced by psychiatric disorders. Many studies show that people who have a history of mental illness like anxiety, depression or schizophrenia are more prone to Parkinson’s Disease than others. The connection of history even lines up with family genes and is influenced by even 3 generation gaps. Anxiety and obsessive compulsive disorder are suggested to be of the most influencing ones for PD according to many case control and cohort studies.
Depression In PD
Depression is one of the most common mental disturbances associated with Parkinson’s Disease. It is noted be both because of and a reason for onset of PD. PD and depression follow a vicious cycle of influencing each other but most of the patients experience both at some time in life. The surveys state that people with depression 3.24 times more likely to develop Parkinson’s Disease than normal people.
Anxiety
Anxiety is also prevalent in patients suffering from Parkinson’s Disease with a range of 19% to 67%. Based on studies conducted through general questionnaires and rating scales, it was found that both of them are connected and influence each other highly. The fluctuation of motor symptoms due to on and off periods of medication in PD patients often triggers anxiety disorder. Change of lifestyle and acceptance of PD also plays an important role in defining
the intensity of anxiety in the PD patients.
There is no effective evidence to prove that anti anxiety medications help patients suffering from PD. However, they influence the intensity and reduce the duration of anxiety attacks to some extent.
Psychosis In PD
Psychosis is not generally considered as a primary symptom of Parkinson’s Disease but there are cases of psychosis in patients before the medications is started especially Levodopa. In fact, many medical professionals state that the occurrence of Psychosis in PD patients is mainly when the disorder is left untreated for long periods of time. PD constitutes an atypical feature in getting influenced by psychotic disorders but heavily influences them in PD patients.
Cognitive Deficits In PD
Dementia is quite common in the patients during the later stages of PD. Along with this cognitive impairment of lesser severity is also common ranging from low cognitive impairment (LCI) to mild cognitive impairment (MCI). Patients with earlier history of dementia have higher chances of developing Parkinson’s Disease especially the male gender.
Sleep Disorder In PD
Sleeping disorders are seen in almost every other Parkinson’s Disease patient and is likely to put a negative impact on the quality of their life. It can be classified into daytime manifestation, bladder problems leading to disruption in sleep, nocturnal sleep disturbance, sleep related movement disorders and parasomnias. Patients who sleep excessively in the daytime tends to lose sleep at night which triggers many mental disorders including sleep disorder. However, people with a history of sleep disorder do not show signs of developing PD. But the medications drastically affect the production of Dopamine in Sleep Disorder patients which can trigger Parkinson’s Disease. 50% of patients suffering from sleep disorders in PD develop permanent insomnia.
Anhedonia In PD
Even though Anhedonia is taken to be a symptom of depression in Parkinson’s Disease patients. Anhedonia is the inability to feel the pleasure in pleasurable areas of the body. Studies state that it is one of the direct characteristics of Parkinson’s Disease as it is directly linked to the dysfunction of Dopamine levels in mesolimbic area. It is found that Anhedonia exists ranging from 7% to 45.7 % depending on the duration of the disease.
Apathy In PD
Apathy is a mental and psychological behavior that Parkinson’s Disease patients develop over time. It is termed as “reduced interest and participation in normal purposeful behavior, lack of initiative with problems in initiation or sustaining an activity to completion, lack of concern or indifference and a flattening of affect”. Prevalence of apathy increases in the patients based on the age of PD. Another result of the studies suggests that apathy is also a side effect of Deep Brain Stimulation procedure too.
Impulsive Compulsive Disorders In PD
Many studies report high rate of Impulsive-Compulsive Disorder in PD patients. These disorders arise from aberrant or excessive Dopamine receptor stimulation. Once triggered the ICD stay for lifetime and can only be controlled with medication and therapy to some extent. Almost 35% of PD patients develop ICD after a certain progression age of PD.
Dopamine Dysregulation Syndrome
A very few number of patient may develop addiction to Dopamine drugs. This addiction often affects the off medication phase and causes mood swings, higher depressive symptoms and OCD. This addiction is known as Dopamine Dysregulation Syndrome. People who experiment in their dosage quantity and frequency on higher levels are at higher risks of increased alcohol intake too.
Suicidal Behavior
Even though PD patients tend to grow habitual to the condition and accept the changes in their lifestyle, many factors if neglected may lead to suicidal behavior and disconnection from normal living sense. Suicidal behavior includes suicidal ideations, suicidal gestures, attempted suicide and completed suicide. As compared to other aspects, this one is still quite low in numbers as the cases are negligible.
