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Gotheridge H, Eccles FJR, Murray C, Henderson R, Simpson J. A systematic review of the factors associated with the psychological wellbeing of people with Parkinson's in the COVID-19 pandemic. Disabil Rehabil 2024:1-12. [PMID: 39258822 DOI: 10.1080/09638288.2024.2395460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 07/21/2024] [Accepted: 08/19/2024] [Indexed: 09/12/2024]
Abstract
PURPOSE The lockdown and social distancing measures introduced as a result of the COVID-19 pandemic impacted the ability of people with Parkinson's to engage in normal health management practices. This led to documented reductions in psychological wellbeing. The aim of the present review was to identify factors associated with the psychological wellbeing of people with Parkinson's during the acute stage of the pandemic. MATERIALS AND METHODS Five academic databases (PsycINFO, MEDLINE, Embase, CINAHL, and Web of Science) were searched and 23 articles were identified using pre-defined inclusion and exclusion criteria. The findings are stratified by risk factor and analysed using a narrative synthesis. RESULTS Worsening of motor symptoms, poor motor-related daily living experiences and motor symptoms during "off time" (when symptom suppressing medication has worn off) as well as less physical activity emerged as the most consistent risk factors of worsened or poorer psychological wellbeing. A deviation from pre-pandemic risk factors was identified, with age and gender not identified as consistent risk factors. CONCLUSIONS The implications of this review are not limited to preparing for future pandemics but can also be applied to more common concerns with comparable contextual characteristics such as yearly flu outbreaks, social isolation, and economic uncertainty.
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Affiliation(s)
- H Gotheridge
- Division of Health Research, Lancaster University, Lancaster, UK
| | - F J R Eccles
- Division of Health Research, Lancaster University, Lancaster, UK
| | - C Murray
- Division of Health Research, Lancaster University, Lancaster, UK
| | - R Henderson
- Division of Health Research, Lancaster University, Lancaster, UK
| | - J Simpson
- Division of Health Research, Lancaster University, Lancaster, UK
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2
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Li Y, Luo X, Zhang A, Ying F, Wang J, Huang G. The potential of arts therapies in Parkinson's disease rehabilitation: A comprehensive review. Heliyon 2024; 10:e35765. [PMID: 39229526 PMCID: PMC11369473 DOI: 10.1016/j.heliyon.2024.e35765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/02/2024] [Accepted: 08/02/2024] [Indexed: 09/05/2024] Open
Abstract
Background and purpose Parkinson's disease (PD) causes a decline in motor function, cognitive decline, and impacts the mental health of patients. Due to the high cost and side effects of conventional treatments, the medical community has begun to explore safer and more cost-effective alternative therapies. In this context, arts therapies have gained increasing attention as innovative treatments. This review plans to explore the role and potential of various arts therapies in the rehabilitation of PD patients by analyzing existing literature and case studies. Methods This review comprehensively searched the literature in several databases, including PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure, to assess the effectiveness of different arts therapies in the rehabilitation of patients with PD. Results From 3440 articles screened, 16 met the inclusion criteria. These studies included a variety of therapies, including music, meditation, yoga, art, dance, theatre, video games and play therapy. These different types of arts therapies had a positive impact on the motor, psychological and cognitive rehabilitation of PD patients, respectively. Conclusion The existing literature highlights the great potential of arts therapies in the rehabilitation of people with PD, further confirming the efficacy of arts therapies in enhancing the motor, psychological and cognitive rehabilitation process of people with PD. In addition, this review identifies research gaps in the use of color therapy in PD rehabilitation and highlights the need for further exploration of various arts therapies modalities.
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Affiliation(s)
- Yiyuan Li
- Faculty of Humanities and Arts, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau, 999078, China
| | - Xuexing Luo
- Faculty of Humanities and Arts, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau, 999078, China
| | - Aijia Zhang
- Faculty of Humanities and Arts, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau, 999078, China
| | - Fangtian Ying
- Faculty of Humanities and Arts, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau, 999078, China
- Zhejiang University, Hangzhou, 310027, China
| | - Jue Wang
- State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau, 999078, China
- Faculty of Chinese Medicine, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau, 999078, China
- Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health, Guangzhou, Guangdong, China
| | - Guanghui Huang
- Faculty of Humanities and Arts, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau, 999078, China
- Zhuhai M.U.S.T. Science and Technology Research Institute, Zhuhai, Guangdong, China
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3
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Eccles FJR, Garner IW, Murray CD, Doyle C, Simpson J. The joint impact of symptom deterioration and social factors on wellbeing for people with Parkinson's during the covid-19 pandemic in the UK. J Neurol Sci 2023; 452:120768. [PMID: 37611512 DOI: 10.1016/j.jns.2023.120768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 07/28/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
The covid-19 pandemic and associated restrictions have had significant consequences for those living with chronic conditions such as Parkinson's. The restrictions in access to healthcare as well as reductions in social care, family support and community activities have led to decreases in physical and mental wellbeing. However, not everyone has been equally affected and the predictors of distress are currently being investigated worldwide. Here we use data from a UK survey conducted by the charity Parkinson's UK during Summer 2021 to look at physical and social predictors of wellbeing of people with Parkinson's. Specifically, we aimed to look at the combined effects of worsening physical symptoms, social isolation and loneliness on psychological wellbeing when controlling for age, gender and disease duration. The data from 612 participants were analysed using multiple regression analyses and showed that worsened physical symptoms, loneliness and social isolation each independently predicted wellbeing thus showing the impact of both physical symptoms and social factors. Improved access to healthcare and physical activity is needed to help improve physical health. However, addressing the social needs of people with Parkinson's is also important, and not only during a pandemic. Additional interventions may be needed to reduce social isolation and loneliness as there may be added barriers for people with Parkinson's which need to be considered.
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Affiliation(s)
- Fiona J R Eccles
- Division of Health Research, Faulty of Health and Medicine, Lancaster University, Lancaster LA1 4AT, UK.
| | - Ian W Garner
- Division of Health Research, Faulty of Health and Medicine, Lancaster University, Lancaster LA1 4AT, UK
| | - Craig D Murray
- Division of Health Research, Faulty of Health and Medicine, Lancaster University, Lancaster LA1 4AT, UK
| | - Cathal Doyle
- Parkinson's UK, 215 Vauxhall Bridge Road, London SW1V 1EJ, UK
| | - Jane Simpson
- Division of Health Research, Faulty of Health and Medicine, Lancaster University, Lancaster LA1 4AT, UK
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4
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Blundell EK, Grover LE, Stott J, Schrag A. The experience of Anxiety for people with Parkinson's disease. NPJ Parkinsons Dis 2023; 9:75. [PMID: 37198166 DOI: 10.1038/s41531-023-00512-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/13/2023] [Indexed: 05/19/2023] Open
Abstract
Anxiety is a common non-motor symptom of Parkinson's disease (PD) associated with increased disability and reduced quality of life. However, anxiety is poorly understood, underdiagnosed, and undertreated. To date, little research has explored how anxiety is experienced by patients themselves. This study explored the experience of anxiety for people with Parkinson's (PWP) to inform future research and interventions. Semi-structured interviews with 22 PWP (aged 43-80, 50% female) were conducted and analysed using inductive thematic analysis. Four main themes were extracted: conceptualising anxiety; anxiety and the body; anxiety and social identity; and coping with anxiety. Sub-themes revealed inconsistent perceptions: anxiety was in body and mind, part of disease and human nature, part of self-identity and a threat to it. The symptoms described were diverse. Many perceived their anxiety as more incapacitating than motor symptoms or capable of amplifying them, and described that anxiety restricted their lifestyle. All perceived anxiety as connected to PD, and ultimately persistent: dominant aspirations were coping and acceptance rather than cures, with medications strongly resisted. Findings highlight the complexity and high importance of anxiety for PWP. Implications for therapeutic approaches are discussed.
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Affiliation(s)
- Emma K Blundell
- Department of Clinical and Movement Neurosciences, University College London, London, UK
- ADAPT Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Laura E Grover
- Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - Joshua Stott
- ADAPT Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, University College London, London, UK.
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5
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Sistarelli S, Annett LE, Lovatt PJ. Effects of Popping For Parkinson’s dance class on the mood of people with Parkinson’s disease. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2023. [DOI: 10.12968/ijtr.2021.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Background/Aims Depression, low mood and apathy can affect people with Parkinson’s disease, impacting on their quality of life. The aim of this study was to investigate the effects of one Popping For Parkinson’s dance session on the mood of people with Parkinson’s disease. Methods A total of 33 people with Parkinson’s disease, with a mean age of 67.5 years (standard deviation 10.3 years), mean Parkinson’s level of 1.8 (standard deviation 1.6), took part in one Popping For Parkinson's dance class at four different locations: London (UK), Hatfield (UK), New York City (USA) and Turin (Italy). Participants’ mood was measured with the Profile of Mood States questionnaire at four time points: immediately before the dance class, immediately after the dance class, 24 hours after the dance class and 1 week after the dance class. Results Participants’ total mood score and the subscale score of vigour increased, while the subscales of tension, depression, and confusion decreased on the Profile of Mood States, significantly immediately after the dance intervention. However, at 24 hours and 1 week after the dance class, mood scores did not differ significantly compared with baseline measurements. The improvements in mood immediately after the dance class did not differ depending on sex, age, previous dance experience, the location of the dance class, stage of Parkinson’s disease, presence of tremor and deep brain stimulation treatment. Conclusions Participating in a Popping For Parkinson’s dance class boosts mood in the short term, and this improvement lasts less than 24 hours. This finding has implications for the provision of dance classes, suggesting that regular attendance may be necessary for sustained improvements. Further studies are needed to determine whether attending a series of Popping for Parkinson’s classes may have longer-term effects.
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Affiliation(s)
- Simone Sistarelli
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Lucy E Annett
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Peter J Lovatt
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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6
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Eccles FJR, Sowter N, Spokes T, Zarotti N, Simpson J. Stigma, self-compassion, and psychological distress among people with Parkinson's. Disabil Rehabil 2023; 45:425-433. [PMID: 35171069 DOI: 10.1080/09638288.2022.2037743] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE People with Parkinson's disease (hereafter Parkinson's) can experience stigma through the attitudes and actions of others (enacted stigma) and through anticipation of enacted stigma and internalisation of negative stereotypes (felt stigma). Self-compassion may protect against the impact of stigma. This study aimed to investigate the relationships between self-compassion, stigma, and psychological distress among people with Parkinson's. METHODS A total of 130 people with Parkinson's completed questionnaires measuring self-compassion, enacted and felt stigma, and depression, anxiety, and stress. Correlation, mediation, and moderation models were used to investigate relationships between variables. RESULTS All variables correlated significantly in the expected directions. Felt stigma mediated the relationship between self-compassion and the three outcome variables - depression, anxiety, and stress. Self-compassion did not moderate the relationship between enacted stigma and distress and suggested enacted stigma was associated with distress, regardless of levels of self-compassion. CONCLUSIONS Self-compassion and both enacted and felt stigma are important predictors of distress for people with Parkinson's. Part of the relationship between lower self-compassion and psychological distress appears to occur via the internalisation of stigma. These findings may be relevant to the development of individualised and societal interventions with the aim of improving the psychological wellbeing of people with Parkinson's.Implications for rehabilitationSelf-compassion was associated with lower levels of psychological distress (i.e., depression, anxiety, and stress) and self-stigma partially mediated this relationship.Self-compassion did not moderate the relationship between enacted stigma and psychological distress, suggesting enacted stigma increases distress, regardless of self-compassion.The development and assessment of the effectiveness of compassion-focused interventions tailored for people with Parkinson's may be important as well as systemic stigma focused interventions.
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Affiliation(s)
- Fiona J R Eccles
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Natalie Sowter
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Terry Spokes
- Bali Beginnings Addiction Treatment Centre, Sanur, Indonesia
| | - Nicolò Zarotti
- Department of Clinical Psychology, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Jane Simpson
- Division of Health Research, Lancaster University, Lancaster, UK
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7
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Wieringa G, Dale M, Eccles FJR. Adjusting to living with Parkinson's disease; a meta-ethnography of qualitative research. Disabil Rehabil 2022; 44:6949-6968. [PMID: 34592863 DOI: 10.1080/09638288.2021.1981467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Parkinson's disease (PD) is a condition which causes significant difficulties in physical, cognitive and psychological domains. It is a progressive condition which people have to live with for a long time; consequently, there is a need to understand what contributes to individual adjustment. This review aimed to answer the question "how do individuals adjust to PD?" METHOD A systematic search of three databases (MEDLINE, CINAHL and PsycINFO) was carried out of papers documenting the adjustment process when living with PD and the findings were synthesised using a meta-ethnographic approach. RESULTS After exclusion based on eligibility criteria, 21 articles were included and were assessed for quality prior to analysing the data. Three main themes are proposed relating to the process of adjustment: "maintaining a coherent sense of self", "feeling in control" and "holding a positive mindset". Although many of the studies described challenges of living with PD, the results are dominated by the determination of individuals to self-manage their condition and maintain positive wellbeing. CONCLUSION The results highlight the need to empower patients to self-manage their illness, mitigating the effects of Parkinson's disease and supporting future wellbeing.IMPLICATIONS FOR REHABILITATIONIndividual identity disruption impacts on the self-value and sense of self coherence in individuals living with Parkinson's disease.Healthcare professionals should appreciate the complexity of the adjustment process which is related to the ability to maintain a coherent sense of self, to feel in control and to hold a positive mindset.Healthcare professionals should ensure information and knowledge related to self-management is tailored to an individual's understanding and experience of the disease.
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Affiliation(s)
- Gina Wieringa
- Faculty of Health and Medicine, Division of Health Research, Furness College, Lancaster University, Lancaster, UK
| | - Maria Dale
- Leicestershire Partnership NHS Trust, Mill Lodge, Leicestershire, UK
| | - Fiona J R Eccles
- Faculty of Health and Medicine, Division of Health Research, Furness College, Lancaster University, Lancaster, UK
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8
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Rawlings GH, Thompson AR, Armstrong I, Novakova B, Beail N. Cognitive and behavioral processes predict anxiety and depression in patients with pulmonary hypertension. Pulm Circ 2022; 12:e12174. [PMID: 36532313 PMCID: PMC9749075 DOI: 10.1002/pul2.12174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Emotional and psychological difficulties cannot fully be explained by disease-related factors in people with pulmonary hypertension (PH). This study examined the relationship between anxiety, depression, demographic, objective and subjective PH factors, and self-reported cognitive and behavioral processes, which have been associated with mood in clinical and nonclinical samples. This is a secondary analysis of baseline data from 77 adults with PH who took part in a randomized controlled trial of a self-help intervention targeting anxiety in PH. Participants completed self-report measures including: demographic (age, gender, ethnicity, education, employment) and clinical questionnaire (PH diagnosis, functional class, years since diagnosis), depression (PHQ-9), anxiety (GAD-7), health-related quality of life (emPHAsis-10), dyspnea (D12), and cognitive and behavioral processes (CBP-Q) scale. Data were analyzed using correlational and regression analyses. Overall, 70% and 63% of participants scored above the clinical cut off for anxiety and depression, respectively. Demographics were not associated with anxiety or depression. PH-related factors were correlated with depression but not anxiety. A multiple regression analysis suggested dyspnea and cognitive processes significantly predicted anxiety whereas behavioral processes were not a unique predictor. In contrast, dyspnea and behavioral processes predicted depression whereas cognitive processes did not. While a body of evidence exists demonstrating people with PH are more likely to experience anxiety and depression, less is known about factors that cause and maintain these disorders. Findings highlight the significance of subjective factors that could be a target for screening and psychological treatments for emotional difficulties, such as cognitive behavioral therapy.
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Affiliation(s)
| | - Andrew R. Thompson
- South Wales Clinical Psychology Training ProgrammeCardiff and Vale University Health Board and Cardiff UniversityCardiffUK
- Clinical Psychology UnitUniversity of SheffieldSheffieldUK
| | - Iain Armstrong
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire HospitalSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Barbora Novakova
- Health and Wellbeing Service, Sheffield IAPTSheffield Health and Social Care NHS Foundation TrustSheffieldUK
| | - Nigel Beail
- Clinical Psychology UnitUniversity of SheffieldSheffieldUK
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9
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Rider JV, Longhurst JK, Lekhak N, Navalta JW, Young DL, Landers MR. Psychological Factors Associated With Fear of Falling Avoidance Behavior in Parkinson's Disease: The Role of Depression, Anxiety, and Catastrophizing. J Geriatr Psychiatry Neurol 2022; 36:215-224. [PMID: 35977708 DOI: 10.1177/08919887221119974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to examine the relationship between psychological factors (depression, anxiety, and catastrophizing) and fear of falling avoidance behavior (FFAB) among individuals with Parkinson's disease (PD). METHODS A secondary analysis of cross-sectional data from 59 individuals with PD using hierarchical multiple regression. RESULTS Disease severity (Movement Disorder Society - Unified PD Rating Scale) and catastrophizing (Consequences of Falling Questionnaire (CoF)) explained approximately 48.2% of the variance in the FFAB Questionnaire scores (P < .001). Catastrophizing was the only significant psychological variable (P < .001). The damage to identity subscale of the CoF was significant in the final model (P < .001). CONCLUSIONS Catastrophizing about the consequences of falls explained the largest portion of variability in FFAB after controlling for disease severity. Catastrophizing about the immediate consequences of falling may play a prominent role in FFAB and may be a potential treatment target for mitigating FFAB.
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Affiliation(s)
- John V Rider
- School of Occupational Therapy, College of Health and Human Services, Touro University Nevada, Henderson, NV.,Department of Physical Therapy, School of Integrated Health Sciences, University of Nevada, Las Vegas, NV
| | - Jason K Longhurst
- Department of Physical Therapy and Athletic Training, Saint Louis University, MO
| | | | - James W Navalta
- Department of Kinesiology and Nutrition Sciences, School of Integrated Health Sciences, University of Nevada, Las Vegas, NV
| | - Daniel L Young
- Department of Physical Therapy, School of Integrated Health Sciences, University of Nevada, Las Vegas, NV
| | - Merrill R Landers
- Department of Physical Therapy, School of Integrated Health Sciences, University of Nevada, Las Vegas, NV
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10
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Di Rosa E, Mapelli D, Ronconi L, Macchia E, Gentili C, Bisiacchi P, Edelstyn N. Anxiety predicts impulsive-compulsive behaviours in Parkinson's disease: Clinical relevance and theoretical implications. J Psychiatr Res 2022; 148:220-229. [PMID: 35134729 DOI: 10.1016/j.jpsychires.2022.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/13/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
Patients with Parkinson's disease (PD) often present symptoms of anxiety, depression and apathy. These negative affect manifestations have been recently associated with the presence of impulsive compulsive behaviours (ICBs). However, their relation with the use of dopamine replacement therapy (DRT), a renewed risk factor for ICBs, is still not fully understood. Elucidating the role of these different ICBs predictors in PD could inform both prevention/intervention recommendations as well as theoretical models. In the present study, we have analysed data collected in 417 PD patients, 50 patients with Parkinsonian symptoms but with scan without evidence of dopaminergic deficit (SWEDD), and 185 healthy controls (HC). We examined each patient's clinical profile over a two-year time window, investigating the role of both negative affect and DRT on ICBs. Results confirmed the presence of higher levels of anxiety in both the clinical groups, and of higher level of ICBs in SWEDD patients, respect to both PD and HC. Mixed model analyses revealed a statistically significant association between anxiety and ICBs in the SWEDD patients who did not take any DRT. Findings suggest the independence between anxiety and DRT in ICBs development, and provide new evidence for the motivational opponency theoretical framework.
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Affiliation(s)
- Elisa Di Rosa
- Department of General Psychology, University of Padua, Padua, Italy; School of Psychology, Keele University, Staffordshire, UK.
| | - Daniela Mapelli
- Department of General Psychology, University of Padua, Padua, Italy
| | - Lucia Ronconi
- Department of General Psychology, University of Padua, Padua, Italy
| | - Eleonora Macchia
- Department of General Psychology, University of Padua, Padua, Italy
| | - Claudio Gentili
- Department of General Psychology, University of Padua, Padua, Italy; Padua Neuroscience Centre, University of Padua, Padua, Italy; Centro di Ateneo dei Servizi Clinici Universitari Psicologici, University of Padua, Padua, Italy
| | - Patrizia Bisiacchi
- Department of General Psychology, University of Padua, Padua, Italy; Padua Neuroscience Centre, University of Padua, Padua, Italy
| | - Nicky Edelstyn
- School of Psychology, Keele University, Staffordshire, UK
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11
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Macchi ZA, Miyasaki J, Katz M, Galifianakis N, Sillau S, Kluger BM. Prevalence and Cumulative Incidence of Caregiver-Reported Aggression in Advanced Parkinson Disease and Related Disorders. Neurol Clin Pract 2022; 11:e826-e833. [PMID: 34992965 DOI: 10.1212/cpj.0000000000001110] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/22/2021] [Indexed: 01/08/2023]
Abstract
Objective To estimate the point prevalence and cumulative incidence of caregiver-reported aggressive behaviors among people living with advanced Parkinson disease and related disorders (PDRDs) and secondarily examine variables associated with aggression. Methods Caregivers from a clinical trial of outpatient palliative care for PDRD were surveyed about patient aggression at baseline and every 3 months over 12 months. Baseline responses were used for point prevalence. Cumulative incidence was calculated using responses from caregivers with no reported baseline aggression and available data at all other time points. Measures of disease severity, quality of life, mood, and caregiver burden were included in correlation and relative risk models, adjusting for age, sex, and diagnosis. Results Of 170 caregivers, 31 (18.2%) reported physical aggression, and 18 (10.6%) reported sexual aggression. Twelve-month cumulative incidence for physical and sexual aggression was 21.1% (23/109) and 16.0% (19/119), respectively. Physical aggression cumulative incidence was associated with patient depression (r = 0.37), patient-perceived quality of life (r = -0.26), caregiver burden (r = 0.26), caregiver-perceived patient quality of life (r = -0.26), and caregiver anxiety (r = 0.20). Age, sex, cognitive impairment, and dementia were not associated with aggression. No variables were associated with cumulative sexual aggression. Conclusion There was a high prevalence and incidence of aggression in our PDRD cohort. This is an understudied issue in PDRD, and our findings highlight the need for increased awareness among neurologists. Providers should consider assessing for aggression when discussing neuropsychiatric symptoms or screening for caregiver burden. Future research should examine the relationship between aggression and patient and caregiver health outcomes. Trial Registration Information Clinical trial registration number: NCT02533921.
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Affiliation(s)
- Zachary A Macchi
- Department of Neurology (ZAM, SS), and Department of Internal Medicine (ZAM), University of Colorado Anschutz, Aurora; Division of Neurology (JM), Department of Medicine, University of Alberta, Edmonton, Canada; Department of Neurology (MK, NG), University of California San Francisco Medical Center; and Departments of Neurology and Medicine (BMK), University of Rochester Medical Center, NY
| | - Janis Miyasaki
- Department of Neurology (ZAM, SS), and Department of Internal Medicine (ZAM), University of Colorado Anschutz, Aurora; Division of Neurology (JM), Department of Medicine, University of Alberta, Edmonton, Canada; Department of Neurology (MK, NG), University of California San Francisco Medical Center; and Departments of Neurology and Medicine (BMK), University of Rochester Medical Center, NY
| | - Maya Katz
- Department of Neurology (ZAM, SS), and Department of Internal Medicine (ZAM), University of Colorado Anschutz, Aurora; Division of Neurology (JM), Department of Medicine, University of Alberta, Edmonton, Canada; Department of Neurology (MK, NG), University of California San Francisco Medical Center; and Departments of Neurology and Medicine (BMK), University of Rochester Medical Center, NY
| | - Nicholas Galifianakis
- Department of Neurology (ZAM, SS), and Department of Internal Medicine (ZAM), University of Colorado Anschutz, Aurora; Division of Neurology (JM), Department of Medicine, University of Alberta, Edmonton, Canada; Department of Neurology (MK, NG), University of California San Francisco Medical Center; and Departments of Neurology and Medicine (BMK), University of Rochester Medical Center, NY
| | - Stefan Sillau
- Department of Neurology (ZAM, SS), and Department of Internal Medicine (ZAM), University of Colorado Anschutz, Aurora; Division of Neurology (JM), Department of Medicine, University of Alberta, Edmonton, Canada; Department of Neurology (MK, NG), University of California San Francisco Medical Center; and Departments of Neurology and Medicine (BMK), University of Rochester Medical Center, NY
| | - Benzi M Kluger
- Department of Neurology (ZAM, SS), and Department of Internal Medicine (ZAM), University of Colorado Anschutz, Aurora; Division of Neurology (JM), Department of Medicine, University of Alberta, Edmonton, Canada; Department of Neurology (MK, NG), University of California San Francisco Medical Center; and Departments of Neurology and Medicine (BMK), University of Rochester Medical Center, NY
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12
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Weintraub D, Aarsland D, Chaudhuri KR, Dobkin RD, Leentjens AF, Rodriguez-Violante M, Schrag A. The neuropsychiatry of Parkinson's disease: advances and challenges. Lancet Neurol 2022; 21:89-102. [PMID: 34942142 PMCID: PMC8800169 DOI: 10.1016/s1474-4422(21)00330-6] [Citation(s) in RCA: 137] [Impact Index Per Article: 68.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 08/21/2021] [Accepted: 09/20/2021] [Indexed: 01/03/2023]
Abstract
In people with Parkinson's disease, neuropsychiatric signs and symptoms are common throughout the disease course. These symptoms can be disabling and as clinically relevant as motor symptoms, and their presentation can be similar to, or distinct from, their counterparts in the general population. Correlates and risk factors for developing neuropsychiatric signs and symptoms include demographic, clinical, and psychosocial characteristics. The underlying neurobiology of these presentations is complex and not well understood, with the strongest evidence for neuropathological changes associated with Parkinson's disease, mechanisms linked to dopaminergic therapy, and effects not specific to Parkinson's disease. Assessment instruments and formal diagnostic criteria exist, but there is little routine screening of these signs and symptoms in clinical practice. Mounting evidence supports a range of pharmacological and non-pharmacological interventions, but relatively few efficacious treatment options exist. Optimising the management of neuropsychiatric presentations in people with Parkinson's disease will require additional research, raised awareness, specialised training, and development of innovative models of care.
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Affiliation(s)
- Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Parkinson's Disease Research, Education and Clinical Center, Corporal Michael J Crescenz Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.
| | - Dag Aarsland
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Centre for Age-Related Disease, Stavanger University Hospital, Stavanger, Norway
| | - Kallol Ray Chaudhuri
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Parkinson's Foundation Centre of Excellence, King's College Hospital, King's College London, London, UK
| | - Roseanne D Dobkin
- Department of Psychiatry, Rutgers University, Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Albert Fg Leentjens
- Department of Psychiatry, and School for Mental Health and Neuroscience, Maastricht University Hospital, Maastricht, Netherlands
| | - Mayela Rodriguez-Violante
- Clinical Neurodegenerative Diseases Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, UCL, London, UK
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Gasiorowska A, Wydrych M, Drapich P, Zadrozny M, Steczkowska M, Niewiadomski W, Niewiadomska G. The Biology and Pathobiology of Glutamatergic, Cholinergic, and Dopaminergic Signaling in the Aging Brain. Front Aging Neurosci 2021; 13:654931. [PMID: 34326765 PMCID: PMC8315271 DOI: 10.3389/fnagi.2021.654931] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/14/2021] [Indexed: 12/12/2022] Open
Abstract
The elderly population is growing worldwide, with important health and socioeconomic implications. Clinical and experimental studies on aging have uncovered numerous changes in the brain, such as decreased neurogenesis, increased synaptic defects, greater metabolic stress, and enhanced inflammation. These changes are associated with cognitive decline and neurobehavioral deficits. Although aging is not a disease, it is a significant risk factor for functional worsening, affective impairment, disease exaggeration, dementia, and general disease susceptibility. Conversely, life events related to mental stress and trauma can also lead to accelerated age-associated disorders and dementia. Here, we review human studies and studies on mice and rats, such as those modeling human neurodegenerative diseases, that have helped elucidate (1) the dynamics and mechanisms underlying the biological and pathological aging of the main projecting systems in the brain (glutamatergic, cholinergic, and dopaminergic) and (2) the effect of defective glutamatergic, cholinergic, and dopaminergic projection on disabilities associated with aging and neurodegenerative disorders, such as Alzheimer's and Parkinson's diseases. Detailed knowledge of the mechanisms of age-related diseases can be an important element in the development of effective ways of treatment. In this context, we briefly analyze which adverse changes associated with neurodegenerative diseases in the cholinergic, glutaminergic and dopaminergic systems could be targeted by therapeutic strategies developed as a result of our better understanding of these damaging mechanisms.
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Affiliation(s)
- Anna Gasiorowska
- Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Malgorzata Wydrych
- Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Patrycja Drapich
- Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Maciej Zadrozny
- Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Marta Steczkowska
- Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Wiktor Niewiadomski
- Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Grazyna Niewiadomska
- Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
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The Relationship Between Anxiety Disorders and Parkinson's Disease: Clinical and Therapeutic Issues. Curr Psychiatry Rep 2021; 23:20. [PMID: 33660146 DOI: 10.1007/s11920-021-01229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW This paper seeks to describe anxiety's different symptomatologic presentations in Parkinson's disease (PD), its longitudinal course and predictors, as well as its motor and non-motor correlates. It also reviews the available screening tools and different treatment modalities. RECENT FINDINGS In PD, longitudinal predictors of anxiety are mostly non-motor non-dopaminergic symptoms. The longitudinal course of anxiety is mainly a stable one. The Parkinson Anxiety Scale and the Geriatric Anxiety Scale are the 2 recommended screening tools. A third of PD patients suffer from an anxiety disorder at any time point. It can precede or follow PD motor symptoms. Anxiety is associated with demographic, disease-related motor and non-motor features. There is a lack of studies evaluating psychotropic treatment of anxiety in PD. Adjustment of dopaminergic treatment is indicated when anxiety is associated with motor fluctuations. DBS can be useful as well as CBT and body-mind interventions.
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15
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Personalized prediction of depression in patients with newly diagnosed Parkinson's disease: A prospective cohort study. J Affect Disord 2020; 268:118-126. [PMID: 32158001 DOI: 10.1016/j.jad.2020.02.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/13/2020] [Accepted: 02/27/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Depressive disturbances in Parkinson's disease (dPD) have been identified as the most important determinant of quality of life in patients with Parkinson's disease (PD). Prediction models to triage patients at risk of depression early in the disease course are needed for prognosis and stratification of participants in clinical trials. METHODS One machine learning algorithm called extreme gradient boosting (XGBoost) and the logistic regression technique were applied for the prediction of clinically significant depression (defined as The 15-item Geriatric Depression Scale [GDS-15] ≥ 5) using a prospective cohort study of 312 drug-naïve patients with newly diagnosed PD during 2-year follow-up from the Parkinson's Progression Markers Initiative (PPMI) database. Established models were assessed with out-of-sample validation and the whole sample was divided into training and testing samples by the ratio of 7:3. RESULTS Both XGBoost model and logistic regression model achieved good discrimination and calibration. 2 PD-specific factors (age at onset, duration) and 4 nonspecific factors (baseline GDS-15 score, State Trait Anxiety Inventory [STAI] score, Rapid Eye Movement Sleep Behavior Disorder Screening Questionnaire [RBDSQ] score, and history of depression) were identified as important predictors by two models. LIMITATIONS Access to several variables was limited by database. CONCLUSIONS In this longitudinal study, we developed promising tools to provide personalized estimates of depression in early PD and studied the relative contribution of PD-specific and nonspecific predictors, constituting a substantial addition to the current understanding of dPD.
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Pontone GM, Dissanayaka N, Apostolova L, Brown RG, Dobkin R, Dujardin K, Friedman JH, Leentjens AFG, Lenze EJ, Marsh L, Mari L, Monchi O, Richard IH, Schrag A, Strafella AP, Vernaleo B, Weintraub D, Mari Z. Report from a multidisciplinary meeting on anxiety as a non-motor manifestation of Parkinson's disease. NPJ Parkinsons Dis 2019; 5:30. [PMID: 31840044 PMCID: PMC6906437 DOI: 10.1038/s41531-019-0102-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/17/2019] [Indexed: 12/14/2022] Open
Abstract
Anxiety is a severe problem for at least one-third of people living with Parkinson's disease (PD). Anxiety appears to have a greater adverse impact on quality of life than motor impairment. Despite its high prevalence and impact on daily life, anxiety is often undiagnosed and untreated. To better address anxiety in PD, future research must improve knowledge about the mechanism of anxiety in PD and address the lack of empirical evidence from clinical trials. In response to these challenges, the Parkinson's Foundation sponsored an expert meeting on anxiety on June 13th and 14th 2018. This paper summarizes the findings from that meeting informed by a review of the existing literature and discussions among patients, caregivers, and an international, clinician-scientist, expert panel working group. The goal is to provide recommendations to improve our understanding and treatment of anxiety in PD.
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Affiliation(s)
- Gregory M. Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Nadeeka Dissanayaka
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
- Department of Neurology, Royal Brisbane & Woman’s Hospital, Brisbane, Australia
| | - Liana Apostolova
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN USA
| | - Richard G. Brown
- Department of Psychology, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Roseanne Dobkin
- Department of Psychiatry, Rutgers University, Robert Wood Johnson Medical School, Piscataway, NJ USA
| | - Kathy Dujardin
- Department of Neurology and Movement Disorders, Lille University Medical Center, Lille, France
| | - Joseph H. Friedman
- Movement Disorders Program, Butler Hospital; Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Albert F. G. Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Eric J. Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
| | - Laura Marsh
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX USA
- Department of Psychiatry, Baylor College of Medicine, Houston, TX USA
| | - Lynda Mari
- Person Holistic Innovation, Las Vegas, NV USA
| | - Oury Monchi
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Irene H. Richard
- Department of Neurology, University of Rochester Medical Center, Rochester, NY USA
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - Antonio P. Strafella
- E.J. Safra Parkinson Disease Program, Toronto Western Hospital & Krembil Research Institute, UHN; Research Imaging Centre, Campbell Family Mental Health Research Institute, CAMH; University of Toronto, Ontario, Canada
| | | | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
- Parkinson’s Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA USA
| | - Zoltan Mari
- Cleveland Clinic Lou Ruvo Center for Brain Health, Movement Disorders Program, Las Vegas, NV USA
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Stutts LA, Speight KL, Yoo S, Little ID. Positive Psychological Predictors of Psychological Health in Individuals with Parkinson's Disease. J Clin Psychol Med Settings 2019; 27:182-189. [PMID: 31127423 DOI: 10.1007/s10880-019-09633-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Parkinson's Disease is associated with depression, anxiety, and stress; however, minimal research has examined positive psychological variables in this population. The present study investigated the relationship between positive psychological variables and psychological health in individuals with Parkinson's Disease. The sample included 140 adults with Parkinson's Disease who completed online surveys on self-compassion, optimism, posttraumatic growth, and psychological health outcomes. Participants reported moderate levels of self-compassion, optimism, and posttraumatic growth. Approximately 50% of participants reported depression and anxiety. Higher self-compassion was a significant predictor of lower depression, anxiety, and stress. Higher optimism was a significant predictor of lower depression and higher life satisfaction. Posttraumatic growth was not a predictor of psychological health. This research suggests that the psychological health of individuals with Parkinson's Disease can be improved, and self-compassion appears to be an important area of focus.
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Affiliation(s)
| | | | - Seeley Yoo
- Davidson College, PO Box 7135, Davidson, NC, 28031, USA
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18
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Ryan M, Eatmon CV, Slevin JT. Drug treatment strategies for depression in Parkinson disease. Expert Opin Pharmacother 2019; 20:1351-1363. [DOI: 10.1080/14656566.2019.1612877] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Melody Ryan
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Courtney V. Eatmon
- Mental Health Clinical Pharmacy Specialist, Lexington Veterans Affairs Healthcare System, Lexington, KY, USA
| | - John T. Slevin
- Departments of Neurology and Pharmacology and Nutritional Sciences, University of Kentucky College of Medicine, Lexington, KY, USA
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Gison A, Bonassi S, Rizza F, Giaquinto S. Comparison of three scales to evaluate personality traits in Parkinson's disease: which one to use? Eur J Phys Rehabil Med 2018; 55:183-190. [PMID: 30311492 DOI: 10.23736/s1973-9087.18.05240-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Personality traits have gained interest in the field of disability and stress, because they may either prompt or deny compliance. They can also foster motivation and influence outcome. Parkinson disease (PD) is a disabling and stressful condition that requires coping strategies and rehabilitation plans. Three constructs and their relative scales have been a matter of investigation, namely dispositional optimism (DO), locus-of-control (LOC), and sense-of-coherence (SOC). AIM The present study compared the psychometric properties of three constructs in Parkinson's disease (PD). The health-related variables were: emotional distress (ED), quality of life (HR-QoL) and activities of daily living (ADL). The final objective was to provide guidance on scale selection to be implemented in clinical protocols. DESIGN A cross sectional study. SETTING Community-based general physicians. POPULATION Participants with PD (N.=84) from community-based general physicians. METHODS PD patients completed 3 self-report scales, namely Life Orientation Test-Revised (LOT-R, measuring Dispositional Optimism), Internal and External Locus Of Control (LOC-int. LOC-ext) and Sense of Coherence (SOC). All participants had magnetic resonance imaging. The MDS-UPDRS and the Barthel Scale were compiled by the investigator with the assistance of a caregiver. RESULTS LOC-ext was the only scale to be associated with PD severity and disability (P<0.05). A higher level of LOC-ext was also associated with a higher level of ED (P<0.005). LOT-R was inversely associated with ED. Subjects in the highest tertile had a 41% lower ED (P<0.001). SOC was also inversely associated with degree of ED. Subjects in the highest tertile have a 44% lower ED (P<0.01). Moreover, HR-QoL is associated with several parameters, but LOT-R is the one with the strongest association (P<0.001). CONCLUSIONS DO and SOC are predictive of important end-points, namely HR-QoL and ED. DO is even better under this respect. Conversely, those clinicians who are more interested in motor problems may find LOC more suitable. DO may be the most efficient construct to use in PD because of its favorable psychometric properties. CLINICAL REHABILITATION IMPACT DO, LOC and SOC are constructs to be implemented in both research and clinical PD protocols. It is recommended to implement these, because they have predictive value especially when HR-QoL and ED are studied.
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Affiliation(s)
- Annalisa Gison
- Department of Neurological Rehabilitation, IRCCS San Raffaele Pisana, Rome, Italy -
| | - Stefano Bonassi
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy
| | - Federica Rizza
- Department of Neurological Rehabilitation, IRCCS San Raffaele Pisana, Rome, Italy
| | - Salvatore Giaquinto
- Department of Neurological Rehabilitation, IRCCS San Raffaele Pisana, Rome, Italy
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20
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Han EY, Yun JY, Chong HJ, Choi KG. Individual Therapeutic Singing Program for Vocal Quality and Depression in Parkinson's Disease. J Mov Disord 2018; 11:121-128. [PMID: 30086617 PMCID: PMC6182306 DOI: 10.14802/jmd.17078] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 05/15/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Patients with Parkinson's disease (PD) frequently experience depression associated with voice problems. Singing involves the use of similar muscles and the neural networks associated with vocal function and emotional response. The purpose of this study is to enhance vocal quality and depressive symptoms of patients with PD using individual singing program. METHODS The Individual Therapeutic Singing Program for PD (ITSP-PD) was conducted by a certified music therapist. In total, nine PD patients with a subjective voice problem or depression participated in 6 sessions over 2 weeks. We measured the Maximum Phonation Time (MPT) via the Praat test, the Voice Handicap Index (VHI), the Voice-Related Quality of Life (V-RQOL) and the Geriatric Depression Scale (GDS). RESULTS In total, 8 out of 9 patients completed all the sessions; 6 out of 8 patients participated in the follow-up test after 6 months. A statistically significant change in MPT (p = 0.011) was observed between the pre- and post-tests. The VHI (p = 0.035) and the GDS (p = 0.018) were significantly lower in the post-test. In the pre-, post-, and follow-up tests, the MPT (p = 0.030), V-RQOL (p = 0.008), and GDS (p = 0.009) were significantly changed. CONCLUSION The ITSP-PD based on neurological singing therapy for PD showed therapeutic possibility for vocal function and depression in patients with PD. Our findings suggest the need for a randomized study to examine the continuing positive effects of the ITSP-PD over a longer period of time.
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Affiliation(s)
- Eun Young Han
- Department of Music Therapy, Ewha Womans University, Seoul, Korea.,Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ji Young Yun
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hyun Ju Chong
- Department of Music Therapy, Ewha Womans University, Seoul, Korea
| | - Kyoung-Gyu Choi
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
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21
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Simpson J, Chatzidamianos G, Fletcher I, Perpetuo L, Eccles FJR. A new scale measuring adaptive perceived control for people with Parkinson's: Initial construction and further validation. J Neurol Sci 2018; 391:77-83. [DOI: 10.1016/j.jns.2018.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/28/2018] [Indexed: 11/27/2022]
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22
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Broen MPG, Leentjens AFG, Hinkle JT, Moonen AJH, Kuijf ML, Fischer NM, Perepezko K, Bakker A, Pontone GM. Clinical Markers of Anxiety Subtypes in Parkinson Disease. J Geriatr Psychiatry Neurol 2018; 31:55-62. [PMID: 29528763 PMCID: PMC5903060 DOI: 10.1177/0891988718757369] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this work was to investigate marker profiles for proposed anxiety subtypes in Parkinson disease (PD). METHODS We used the persistent anxiety, episodic anxiety, and avoidance behavior subscales of the Parkinson Anxiety Scale as dependent variables in multivariable linear regression analyses using a cross-sectional data set of 311 patients with PD. Independent variables consisted of a range of demographic, psychiatric, and disease-specific markers. RESULTS In the most parsimonious model of persistent anxiety, higher Hamilton Depression Rating Scale scores, a history of anxiety, fewer years of education, lower Mini-Mental State Examination scores, lower Lawton Instrumental Activities of Daily Living scores, female sex, and complications of therapy (higher Unified Parkinson Disease Rating Scale part IV scores) were all associated with more severe persistent anxiety. Markers associated with more severe episodic anxiety included PD-specific disturbances of activities of daily living, complications of therapy, higher Hamilton Depression Rating Scale scores, female sex, and a history of anxiety. Finally, higher Hamilton Depression Rating Scale scores, a history of anxiety, complications of therapy, and longer disease duration were associated with avoidance behavior. After excluding clinically depressed patients with PD, disease severity and longer disease duration were significantly associated with episodic anxiety, but not with persistent anxiety. CONCLUSION Persistent anxiety is mainly influenced by nonspecific markers, while episodic anxiety seems to be more PD-specific compared to persistent anxiety and may be more situational or contextual. These results provide support for possible distinct underlying constructs for anxiety subtypes in PD.
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Affiliation(s)
- Martinus P. G. Broen
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - A. F. G. Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, the Netherlands
| | - J. T. Hinkle
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A. J. H. Moonen
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, the Netherlands
| | - M. L. Kuijf
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - N. M. Fischer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - K. Perepezko
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A. Bakker
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - G. M. Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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23
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Ghielen I, van Wegen EEH, Rutten S, de Goede CJT, Houniet-de Gier M, Collette EH, Burgers-Bots IAL, Twisk JWR, Kwakkel G, Vermunt K, van Vliet B, Berendse HW, van den Heuvel OA. Body awareness training in the treatment of wearing-off related anxiety in patients with Parkinson's disease: Results from a pilot randomized controlled trial. J Psychosom Res 2017; 103:1-8. [PMID: 29167034 DOI: 10.1016/j.jpsychores.2017.09.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/22/2017] [Accepted: 09/01/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND In Parkinson's disease (PD) patients, fluctuations in symptoms commonly occur after many years of dopamine replacement therapy. The so-called wearing-off phenomenon exists of both motor and non-motor symptoms, such as rigidity and anxiety. Current treatment options are limited and an integrated approach is needed to address the complex interactions between motor and non-motor symptoms. Since wearing-off is eventually inevitable, treatment needs to focus on coping, acceptance and self-efficacy. We developed the body awareness training, named BEWARE, combining physical therapy with acceptance and commitment therapy to help PD patients deal better with wearing-off related anxiety (WRA). METHODS This was an investigator-blinded randomized controlled trial. Forty PD patients with WRA were randomly assigned to the BEWARE or to the treatment as usual (TAU) condition. Assessments were performed prior to and immediately after the treatment period, and at 3-months follow up. The primary outcome was self-efficacy, secondary outcomes focused on mobility, daily functioning, anxiety, depression and quality of life. RESULTS There was no significant improvement in self-efficacy in the BEWARE treatment condition when compared to TAU. However, standing balance and emotional wellbeing showed a significant improvement, and feelings of stigmatization showed a trend-significant decrease in the BEWARE condition. CONCLUSIONS We consider the BEWARE training to be a promising therapeutic approach to address WRA. Improvement points from the participants included 1) less frequent but longer therapy sessions; 2) active involvement of caregivers; and 3) the development of a supportive workbook. The optimized treatment protocol needs further evaluation in a phase III RCT. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02054845.
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Affiliation(s)
- Ires Ghielen
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; Department of Anatomy & Neurosciences, VU University Medical Center, Amsterdam, The Netherlands.
| | - Erwin E H van Wegen
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
| | - Sonja Rutten
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
| | - Cees J T de Goede
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
| | | | - Emma H Collette
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Ingrid A L Burgers-Bots
- Department of Anatomy & Neurosciences, VU University Medical Center, Amsterdam, The Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
| | - Kees Vermunt
- Dutch Parkinson Patient Association (Parkinson Vereniging), Bunnik, The Netherlands.
| | - Bep van Vliet
- Dutch Parkinson Patient Association (Parkinson Vereniging), Bunnik, The Netherlands.
| | - Henk W Berendse
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands; Amsterdam Neuroscience, Amsterdam, The Netherlands.
| | - Odile A van den Heuvel
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; Department of Anatomy & Neurosciences, VU University Medical Center, Amsterdam, The Netherlands; Amsterdam Neuroscience, Amsterdam, The Netherlands.
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24
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Cui SS, Du JJ, Fu R, Lin YQ, Huang P, He YC, Gao C, Wang HL, Chen SD. Prevalence and risk factors for depression and anxiety in Chinese patients with Parkinson disease. BMC Geriatr 2017; 17:270. [PMID: 29166864 PMCID: PMC5700465 DOI: 10.1186/s12877-017-0666-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/14/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Anxiety and depression are common in Parkinson disease and both are important determinants of quality of life in patients. Several risk factors are identified but few research have investigated general and Parkinson's disease (PD)-specific factors comprehensively. The aim of this work was to explore PD-specific and -non-specific risk factors for PD with depression or anxiety. METHODS A cross-sectional survey was performed in 403 patients with PD. Multivariate logistic analysis was used to investigate the prevalence and risk factors for the depression and anxiety in PD. The data of patients included demographic information, medicine history, disease duration, age at onset (AAO), family history, anti-parkinsonism drug, modified Hoehn and Yahr staging (H-Y) stage, scales of motor and non-motor symptoms and substantia nigra (SN) echogenic areas. RESULTS 403 PD patients were recruited in the study. Depression and anxiety were present in 11.17% and 25.81% respectively. Marital status, tumor, higher Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) II score, dyskinesia, higher Hamilton Anxiety Rating Scale (HARS) score and lower the Parkinson's disease sleep scale (PDSS) score were associated with depression in PD. female gender, higher rapid eye movement behavior disorder Questionnaire-Hong Kong (RBD-HK) score, higher Hamilton Deprssion Rating Scale (HAMD) score, higher the scale for outcomes in PD for autonomic symptoms (SCOPA-AUT)score and larger SN echogenic areas were associated with anxiety. Neither depression nor anxiety was related to any anti-parkinsonism drugs. CONCLUSIONS The prevalence of depression and anxiety in the current PD patients was 11.17% and 25.81% respectively. Disease of tumor, currently having no partner, severer motor function, dyskinesia, poorer sleep quality and anxiety were risk factors for PD with depression. Female, depression, rapid eye movement behavior disorder (RBD), autonomic dysfunction and larger SN area were risk factors for PD with anxiety.
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Affiliation(s)
- Shi-Shuang Cui
- Department of Neurology & Co-innovation Center of Neuroregeneration, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 197 RuijinEr Road, Shanghai, 200025 People’s Republic of China
| | - Juan-Juan Du
- Department of Neurology & Co-innovation Center of Neuroregeneration, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 197 RuijinEr Road, Shanghai, 200025 People’s Republic of China
| | - Rao Fu
- Department of Neurology & Co-innovation Center of Neuroregeneration, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 197 RuijinEr Road, Shanghai, 200025 People’s Republic of China
| | - Yi-Qi Lin
- Department of Neurology & Co-innovation Center of Neuroregeneration, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 197 RuijinEr Road, Shanghai, 200025 People’s Republic of China
| | - Pei Huang
- Department of Neurology & Co-innovation Center of Neuroregeneration, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 197 RuijinEr Road, Shanghai, 200025 People’s Republic of China
| | - Ya-Chao He
- Department of Neurology & Co-innovation Center of Neuroregeneration, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 197 RuijinEr Road, Shanghai, 200025 People’s Republic of China
| | - Chao Gao
- Department of Neurology & Co-innovation Center of Neuroregeneration, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 197 RuijinEr Road, Shanghai, 200025 People’s Republic of China
| | - Hua-Long Wang
- Department of Neurology & Co-innovation Center of Neuroregeneration, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 197 RuijinEr Road, Shanghai, 200025 People’s Republic of China
| | - Sheng-Di Chen
- Department of Neurology & Co-innovation Center of Neuroregeneration, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 197 RuijinEr Road, Shanghai, 200025 People’s Republic of China
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Theed R, Eccles F, Simpson J. Experiences of caring for a family member with Parkinson's disease: a meta-synthesis. Aging Ment Health 2017; 21:1007-1016. [PMID: 27802771 DOI: 10.1080/13607863.2016.1247414] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The aim of this qualitative meta-synthesis was to search and then synthesise family caregivers' experiences of providing care to individuals with Parkinson's disease (PD). METHOD A systematic search resulted in the identification of 11 qualitative studies. Noblit and Hare's seven-stage approach was used to provide a higher-order interpretation of how family caregivers' experienced the effects of taking on a caregiving role. RESULTS The process of reciprocal translation resulted in four overarching themes: (1) the need to carry on as usual - 'the caregiver must continue with his life'; (2) the importance of support in facilitating coping - 'I'm still going back to the support group'; (3) the difficult balancing act between caregiving and caregiver needs - 'I cannot get sick because I'm a caregiver'; (4) conflicts in seeking information and knowledge - 'maybe better not to know'. CONCLUSION The themes reflected different aspects of family caregivers' lives that were affected as a result of caring for a relative diagnosed with PD and these raise challenges for more simplistic theories of family caring and appropriate support structures. The findings also highlight several recommendations for clinical practice.
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Affiliation(s)
- Rachael Theed
- a Division of Health Research , Lancaster University , Lancaster , United Kingdom
| | - Fiona Eccles
- a Division of Health Research , Lancaster University , Lancaster , United Kingdom
| | - Jane Simpson
- a Division of Health Research , Lancaster University , Lancaster , United Kingdom
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26
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Qamar MA, Sauerbier A, Politis M, Carr H, Loehrer PA, Chaudhuri KR. Presynaptic dopaminergic terminal imaging and non-motor symptoms assessment of Parkinson's disease: evidence for dopaminergic basis? NPJ Parkinsons Dis 2017; 3:5. [PMID: 28649605 PMCID: PMC5445592 DOI: 10.1038/s41531-016-0006-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/04/2016] [Accepted: 11/25/2016] [Indexed: 02/08/2023] Open
Abstract
Parkinson's disease (PD) is now considered to be a multisystemic disorder consequent on multineuropeptide dysfunction including dopaminergic, serotonergic, cholinergic, and noradrenergic systems. This multipeptide dysfunction leads to expression of a range of non-motor symptoms now known to be integral to the concept of PD and preceding the diagnosis of motor PD. Some non-motor symptoms in PD may have a dopaminergic basis and in this review, we investigate the evidence for this based on imaging techniques using dopamine-based radioligands. To discuss non-motor symptoms we follow the classification as outlined by the validated PD non-motor symptoms scale.
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Affiliation(s)
- MA Qamar
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
| | - A Sauerbier
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
| | - M Politis
- Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - H Carr
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
| | - P A Loehrer
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - K Ray Chaudhuri
- National Parkinson’s Foundation International Center of Excellence, King’s College London and King’s College Hospital NHS Foundation Trust, London, UK
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27
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Lutz SG, Holmes JD, Ready EA, Jenkins ME, Johnson AM. Clinical Presentation of Anxiety in Parkinson's Disease: A Scoping Review. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2016; 36:134-47. [PMID: 27618849 DOI: 10.1177/1539449216661714] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Up to 40% of all individuals with Parkinson's disease (PD) are estimated to experience anxiety that interferes with daily functioning. This article describes research regarding the presentation of anxiety in PD and the influence anxiety has on participation in this population. A scoping review identified 1,635 articles, of which 49 met the inclusion criteria. This review identified that anxiety in PD is often associated with a range of clinical correlates related to demographic and clinical characteristics (age, gender, disease stage, duration, progression), motor symptoms (tremor, bradykinesia, dystonia, freezing of gait, symptom severity), treatment-related complications (on/off fluctuations, on with dyskinesia, unpredictable off), and non-motor symptoms (sleep abnormalities, fatigue, cognitive impairment, depression). These findings can be used to increase clinicians' awareness toward the specific clinical correlates linked to anxiety in PD so that mental health concerns can be detected and addressed more readily in practice.
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Affiliation(s)
- Sara G Lutz
- School of Occupational Therapy, The University of Western Ontario, Canada Graduate Program in Health and Rehabilitation Sciences, The University of Western Ontario, Canada
| | - Jeffrey D Holmes
- School of Occupational Therapy, The University of Western Ontario, Canada Graduate Program in Health and Rehabilitation Sciences, The University of Western Ontario, Canada
| | - Emily A Ready
- School of Occupational Therapy, The University of Western Ontario, Canada Graduate Program in Health and Rehabilitation Sciences, The University of Western Ontario, Canada
| | - Mary E Jenkins
- Clinical Neurological Sciences, The University of Western Ontario, Canada Graduate Program in Health and Rehabilitation Sciences, The University of Western Ontario, Canada
| | - Andrew M Johnson
- School of Health Studies, The University of Western Ontario, Canada Graduate Program in Health and Rehabilitation Sciences, The University of Western Ontario, Canada
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28
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Sadeghi Bahmani D, Gerber M, Kalak N, Lemola S, Clough PJ, Calabrese P, Shaygannejad V, Pühse U, Holsboer-Trachsler E, Brand S. Mental toughness, sleep disturbances, and physical activity in patients with multiple sclerosis compared to healthy adolescents and young adults. Neuropsychiatr Dis Treat 2016; 12:1571-9. [PMID: 27390520 PMCID: PMC4930238 DOI: 10.2147/ndt.s111208] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is the most common chronic autoimmune demyelinating and inflammatory disease of the central nervous system, afflicting both the body and mind. The risk of suffering from MS is 2.5-3.5 times greater in females than in males. While there is extant research on fatigue, depression, and cognitive impairment in patients with MS during its clinical course, there is a lack of research focusing on sleep, psychological functioning, and physical activity (PA) at the point of disease onset. The aims of the present study were therefore, to assess the markers of mental toughness (MT) as a dimension of psychological functioning, sleep disturbances (SD), and PA among patients at the moment of disease onset and to compare these with the corresponding values for healthy adolescents and young adults. METHODS A total of 23 patients with MS at disease onset (mean age =32.31 years; 91% females), 23 healthy adolescents (mean age =17.43 years; 82% females), and 25 healthy young adults (mean age =20.72 years; 80% females) took part in the study. They completed questionnaires covering sociodemographic data, MT, SD, and PA. RESULTS Patients with MS had similar scores for MT traits as those in healthy adolescents and healthy young adults, and equivalent levels of moderate-intensity PA and SD as young adults. MS patients reported lower levels of vigorous PA compared to both healthy adolescents and young adults. CONCLUSION The pattern of the results of the present study suggests that the onset of MS is not associated with poor MT, poor sleep, or reduced moderate-intensity PA. Lower levels of vigorous PA were observed in MS patients. Low levels of vigorous PA may lead to decreased cardiorespiratory fitness in patients with MS and, in the long run, to reduced cardiovascular health and degraded psychological functioning.
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Affiliation(s)
- Dena Sadeghi Bahmani
- Psychiatric Clinics of the University of Basel, Center for Affective, Stress and Sleep Disorders
| | - Markus Gerber
- Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland
| | - Nadeem Kalak
- Psychiatric Clinics of the University of Basel, Center for Affective, Stress and Sleep Disorders
| | - Sakari Lemola
- Department of Psychology, University of Warwick, Coventry
| | - Peter J Clough
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Pasquale Calabrese
- Division of Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Vahid Shaygannejad
- Department of Neurology and Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Uwe Pühse
- Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland
| | - Edith Holsboer-Trachsler
- Psychiatric Clinics of the University of Basel, Center for Affective, Stress and Sleep Disorders
| | - Serge Brand
- Psychiatric Clinics of the University of Basel, Center for Affective, Stress and Sleep Disorders; Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland
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