Anxiety is an affliction that is commonly found in patients with Parkinson's disease. Because of different criteria used to diagnose anxiety disorders, no accurate estimation has been determined of the prevalence of the disorder. Most studies give figures between 29% and 75% for the fraction of Parkinsonian patients who have or have had anxiety disorders to accompany the motor disabilities of the disease. (Hegeman Richard, 1996)
Characteristics
Anxiety disorders are characterized by tension, overactivity of the autonomic nervous system, expectation of an impending disaster, and continuous vigilance for danger. They are often accompanied by such autonomic symptoms as palpitations and dry mouth. (Carlson, 1998) Anxiety is frequently seen together with depression. Studies have suggested that 92% of Parkinson's patients who have had an anxiety disorder have also had a depressive disorder. (Hegeman Richard, 1996) There are many different varieties of anxiety disorders that have been observed in conjunction with Parkinson's disease.
- Panic disorder: episodic attacks of severe, unrelenting terror lasting for periods of time between a few seconds and a few hours. Includes physical symptoms such as shortness of breath, clammy sweat, irregular heartbeat, dizziness, faintness, and feelings of unreality.
- Phobia: an intense, irrational fear of a particular stimuli.
- Agoraphobia: intense fear of being in an unprotected place or a place from which escape may be difficult. Fear of open spaces is often a part of agoraphobia.
- Obsessive-compulsive disorder: characterized by recurring thoughts that cannot be suppressed and repeated behaviors that cannot be stopped.
- Social phobia: An intense fear of social situations
Possible Causes
Research has not yet conclusively determined what factors cause anxiety in Parkinsonian patients. It is clear that anxiety disorders occur more often in patients with Parkinson's disease than in patients with other equally debilitating diseases, such as multiple sclerosis, type I diabetes, and rheumatoid arthritis. This suggests that there may be a neurochemical basis for the anxiety, as well as being caused by the trauma of the disease. Also, most studies have shown that patients with anxiety and patients without do not vary in degree of motor incapability. Research has shown that patients with anxiety disorder tend to be younger than most Parkinson's patients and have had the disease for a shorter duration of time. (Stein et. al., 1990) Much research has examined the time of onset of anxiety in comparison with stage of the disease in hopes to separate psychological from biochemical causes. Most studies have found that the debilitating motor symptoms of Parkinson's occur before anxiety does, typically. However, there appears to be a large population of patients whose anxiety disorders precede the motor symptoms and the diagnosis of the disease, also suggesting that there may be a neurochemical reason for the frequency of anxiety in Parkinsonian patients. It should also be noted that anxiety has been known to make treatment more difficult, hinting that anxiety may sometimes be causal of certain symptoms of Parkinson's.
Psychological Causes: Patients with Parkinson's disease often report feelings of embarrassment about their motor impairment. (Hegeman Richard, 1996) Feelings of embarrassment seem to be associated with social phobias. Patients may fear social situations because they feel embarrassed about their disability. Most Parkinsonian patients with social phobia obtained this anxiety disorder after diagnosis. Other studies have shown that anxiety is much greater in patients whose severity of motor disability randomly fluctuates. It has also been shown that for these patients, anxiety is greatest when motor impairment is at a low. It has been hypothesized that this pattern is similar to the patterns of anxiety in laboratory rats exposed to an unpredictable schedule of adversive stimuli. This suggests that anxiety may be a result of fear of a period of reduced motor ability.
Anxiety caused by drugs used in treatment of Parkinson's: Very little evidence has been presented suggesting a link between any commonly used treatment for Parkinson's disease and anxiety disorders. Levodopa therapy has been implicated as a possible culprit behind panic attacks.
Neurobiolgical causes: Disruption of normal functioning of many different neurotransmitter symptoms have been implicated as an origin of anxiety disorders. Abnormalities of norepinephrine levels have the most supporting evidence as the cause of anxious disorders, particularly panic disorders. Systems whose impairments have been shown to cause predisposition for anxiety in the general population have been shown to be impaired in patients with Parkinson's disease. The dorsal ascending noradrenergic pathway, which connects the locus ceruleus to the cerebral cortex, amygdala, hippocampus, and the septum, is impaired in many of those afflicted with Parkinson's disease. Serotonin and GABA systems (two other neurotransmitters in brain) have all been implicated in the search for a biochemical basis for anxiety in Parkinsonian patients. There has been little conclusive evidence demonstrating a link between malfunctions of these systems and anxiety. A possible link between dopaminergic systems and social phobia is being examined. Based on evidence of a correlation between dopamine levels in the cerebrospinal fluid and extroversion, it has been hypothesized that a dopamine defecit in this fluid could cause acute intraversion, or a social phobia. While it remains fairly certain that prevalence of anxiety in patients with Parkinson's is at least partly due to neurochemical processes, it is still very unclear what these processes are and the extent to which they control anxiousness.
Treatment
There are a variety of available treatments for those who suffer anxiety. Very little research has been done to suggest an optimal course of treatment for those afflicted. The following classes of drugs are available for treatment:
- Tricyclic Antidepressants
- Selective serotonin reuptake inhibitors
- Nonselective monoamine oxidase inhibitors (Risk of hypertension when taken with levodopa)
- Benzodiazepines (Can worsen Parkinsonian symptoms at increased dosages)
- Busiprone
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Anxiety disorders are characterized by tension, overactivity of the autonomic nervous system, expectation of an impending disaster, and continuous vigilance for danger. They are often accompanied by such autonomic symptoms as palpitations and dry mouth. (Carlson, 1998) Anxiety is frequently seen together with depression. Studies have suggested that 92% of Parkinson's patients who have had an anxiety disorder have also had a depressive disorder. (Hegeman Richard, 1996) There are many different varieties of anxiety disorders that have been observed in conjunction with Parkinson's disease.
- Panic disorder: episodic attacks of severe, unrelenting terror lasting for periods of time between a few seconds and a few hours. Includes physical symptoms such as shortness of breath, clammy sweat, irregular heartbeat, dizziness, faintness, and feelings of unreality.
- Phobia: an intense, irrational fear of a particular stimuli.
- Agoraphobia: intense fear of being in an unprotected place or a place from which escape may be difficult. Fear of open spaces is often a part of agoraphobia.
- Obsessive-compulsive disorder: characterized by recurring thoughts that cannot be suppressed and repeated behaviors that cannot be stopped.
- Social phobia: An intense fear of social situations
Possible Causes
Research has not yet conclusively determined what factors cause anxiety in Parkinsonian patients. It is clear that anxiety disorders occur more often in patients with Parkinson's disease than in patients with other equally debilitating diseases, such as multiple sclerosis, type I diabetes, and rheumatoid arthritis. This suggests that there may be a neurochemical basis for the anxiety, as well as being caused by the trauma of the disease. Also, most studies have shown that patients with anxiety and patients without do not vary in degree of motor incapability. Research has shown that patients with anxiety disorder tend to be younger than most Parkinson's patients and have had the disease for a shorter duration of time. (Stein et. al., 1990) Much research has examined the time of onset of anxiety in comparison with stage of the disease in hopes to separate psychological from biochemical causes. Most studies have found that the debilitating motor symptoms of Parkinson's occur before anxiety does, typically. However, there appears to be a large population of patients whose anxiety disorders precede the motor symptoms and the diagnosis of the disease, also suggesting that there may be a neurochemical reason for the frequency of anxiety in Parkinsonian patients. It should also be noted that anxiety has been known to make treatment more difficult, hinting that anxiety may sometimes be causal of certain symptoms of Parkinson's.
Psychological Causes: Patients with Parkinson's disease often report feelings of embarrassment about their motor impairment. (Hegeman Richard, 1996) Feelings of embarrassment seem to be associated with social phobias. Patients may fear social situations because they feel embarrassed about their disability. Most Parkinsonian patients with social phobia obtained this anxiety disorder after diagnosis. Other studies have shown that anxiety is much greater in patients whose severity of motor disability randomly fluctuates. It has also been shown that for these patients, anxiety is greatest when motor impairment is at a low. It has been hypothesized that this pattern is similar to the patterns of anxiety in laboratory rats exposed to an unpredictable schedule of adversive stimuli. This suggests that anxiety may be a result of fear of a period of reduced motor ability.
Anxiety caused by drugs used in treatment of Parkinson's: Very little evidence has been presented suggesting a link between any commonly used treatment for Parkinson's disease and anxiety disorders. Levodopa therapy has been implicated as a possible culprit behind panic attacks.
Neurobiolgical causes: Disruption of normal functioning of many different neurotransmitter symptoms have been implicated as an origin of anxiety disorders. Abnormalities of norepinephrine levels have the most supporting evidence as the cause of anxious disorders, particularly panic disorders. Systems whose impairments have been shown to cause predisposition for anxiety in the general population have been shown to be impaired in patients with Parkinson's disease. The dorsal ascending noradrenergic pathway, which connects the locus ceruleus to the cerebral cortex, amygdala, hippocampus, and the septum, is impaired in many of those afflicted with Parkinson's disease. Serotonin and GABA systems (two other neurotransmitters in brain) have all been implicated in the search for a biochemical basis for anxiety in Parkinsonian patients. There has been little conclusive evidence demonstrating a link between malfunctions of these systems and anxiety. A possible link between dopaminergic systems and social phobia is being examined. Based on evidence of a correlation between dopamine levels in the cerebrospinal fluid and extroversion, it has been hypothesized that a dopamine defecit in this fluid could cause acute intraversion, or a social phobia. While it remains fairly certain that prevalence of anxiety in patients with Parkinson's is at least partly due to neurochemical processes, it is still very unclear what these processes are and the extent to which they control anxiousness.
Treatment
There are a variety of available treatments for those who suffer anxiety. Very little research has been done to suggest an optimal course of treatment for those afflicted. The following classes of drugs are available for treatment:
- Tricyclic Antidepressants
- Selective serotonin reuptake inhibitors
- Nonselective monoamine oxidase inhibitors (Risk of hypertension when taken with levodopa)
- Benzodiazepines (Can worsen Parkinsonian symptoms at increased dosages)
- Busiprone
Back to Home Page
Back to Psychology
Research has not yet conclusively determined what factors cause anxiety in Parkinsonian patients. It is clear that anxiety disorders occur more often in patients with Parkinson's disease than in patients with other equally debilitating diseases, such as multiple sclerosis, type I diabetes, and rheumatoid arthritis. This suggests that there may be a neurochemical basis for the anxiety, as well as being caused by the trauma of the disease. Also, most studies have shown that patients with anxiety and patients without do not vary in degree of motor incapability. Research has shown that patients with anxiety disorder tend to be younger than most Parkinson's patients and have had the disease for a shorter duration of time. (Stein et. al., 1990) Much research has examined the time of onset of anxiety in comparison with stage of the disease in hopes to separate psychological from biochemical causes. Most studies have found that the debilitating motor symptoms of Parkinson's occur before anxiety does, typically. However, there appears to be a large population of patients whose anxiety disorders precede the motor symptoms and the diagnosis of the disease, also suggesting that there may be a neurochemical reason for the frequency of anxiety in Parkinsonian patients. It should also be noted that anxiety has been known to make treatment more difficult, hinting that anxiety may sometimes be causal of certain symptoms of Parkinson's.
Psychological Causes: Patients with Parkinson's disease often report feelings of embarrassment about their motor impairment. (Hegeman Richard, 1996) Feelings of embarrassment seem to be associated with social phobias. Patients may fear social situations because they feel embarrassed about their disability. Most Parkinsonian patients with social phobia obtained this anxiety disorder after diagnosis. Other studies have shown that anxiety is much greater in patients whose severity of motor disability randomly fluctuates. It has also been shown that for these patients, anxiety is greatest when motor impairment is at a low. It has been hypothesized that this pattern is similar to the patterns of anxiety in laboratory rats exposed to an unpredictable schedule of adversive stimuli. This suggests that anxiety may be a result of fear of a period of reduced motor ability.
Anxiety caused by drugs used in treatment of Parkinson's: Very little evidence has been presented suggesting a link between any commonly used treatment for Parkinson's disease and anxiety disorders. Levodopa therapy has been implicated as a possible culprit behind panic attacks.
Neurobiolgical causes: Disruption of normal functioning of many different neurotransmitter symptoms have been implicated as an origin of anxiety disorders. Abnormalities of norepinephrine levels have the most supporting evidence as the cause of anxious disorders, particularly panic disorders. Systems whose impairments have been shown to cause predisposition for anxiety in the general population have been shown to be impaired in patients with Parkinson's disease. The dorsal ascending noradrenergic pathway, which connects the locus ceruleus to the cerebral cortex, amygdala, hippocampus, and the septum, is impaired in many of those afflicted with Parkinson's disease. Serotonin and GABA systems (two other neurotransmitters in brain) have all been implicated in the search for a biochemical basis for anxiety in Parkinsonian patients. There has been little conclusive evidence demonstrating a link between malfunctions of these systems and anxiety. A possible link between dopaminergic systems and social phobia is being examined. Based on evidence of a correlation between dopamine levels in the cerebrospinal fluid and extroversion, it has been hypothesized that a dopamine defecit in this fluid could cause acute intraversion, or a social phobia. While it remains fairly certain that prevalence of anxiety in patients with Parkinson's is at least partly due to neurochemical processes, it is still very unclear what these processes are and the extent to which they control anxiousness.
Treatment
There are a variety of available treatments for those who suffer anxiety. Very little research has been done to suggest an optimal course of treatment for those afflicted. The following classes of drugs are available for treatment:
- Tricyclic Antidepressants
- Selective serotonin reuptake inhibitors
- Nonselective monoamine oxidase inhibitors (Risk of hypertension when taken with levodopa)
- Benzodiazepines (Can worsen Parkinsonian symptoms at increased dosages)
- Busiprone
Back to Home Page
Back to Psychology
There are a variety of available treatments for those who suffer anxiety. Very little research has been done to suggest an optimal course of treatment for those afflicted. The following classes of drugs are available for treatment:
- Tricyclic Antidepressants
- Selective serotonin reuptake inhibitors
- Nonselective monoamine oxidase inhibitors (Risk of hypertension when taken with levodopa)
- Benzodiazepines (Can worsen Parkinsonian symptoms at increased dosages)
- Busiprone
Back to Home Page
Back to Psychology
Back to Psychology