Perceptions of cause and control of impulse control behaviours in people with Parkinson's disease

More than Just a Brain Disorder: A Five-Point Manifesto for Psychological Care for People with Huntington’s Disease

Huntington’s disease (HD) is a rare and complex condition where affected individuals, family members, caregivers, and clinicians face a number of both long-term and fluctuating challenges. The predominant biomedical framework adopted in HD to date has traditionally viewed it as a brain disorder first and foremost. As a consequence, one of the most challenging aspects of the condition—psychological difficulties and their care—is often not given the emphasis it deserves in everyday clinical practice. Here, we propose a manifesto outlining five points to address the quality, effectiveness, availability, and accessibility of psychological care in HD. These include (1) Listening to People with HD, (2) Reformulating Difficulties Psychologically, (3) Exploring New Interventions, (4) Increasing Psychological Provision, and (5) Learning from Other Conditions. As the search for a cure continues, we hope that this manifesto will create a new impetus towards refining the current approach to psychological difficulties in HD and ultimately improve the quality of life of the tens of thousands of families affected by HD worldwide.

Psychological interventions for people with Parkinson's disease in the early 2020s: Where do we stand?

PURPOSE

To explore the heterogeneity of the literature on psychological interventions for psychological difficulties in people with Parkinson's disease (PD).

METHODS

A scoping review was performed across five major databases (MEDLINE Complete, PsycINFO, CINAHL, Academic Search Ultimate, and Cochrane Library) up to June 2020.

RESULTS

From an initial return of 4911 citations, 56 studies were included, of which 21 were RCTs. A relatively wide range of therapeutic models have been adopted with people with PD, from common therapies such as cognitive behavioural therapy (CBT) and mindfulness, to less frequent approaches, for example, acceptance and commitment therapy (ACT) and psychodrama. The clinical implications of the findings are discussed, and suggestions are provided for future research on intervention studies and key psychological outcomes.

CONCLUSIONS

CBT appears to be effective in treating depression and sleep disorders in people with PD, while psychoeducation programmes alone should be avoided. The use of CBT to improve anxiety, quality of life, and impulse control, as well mindfulness-based interventions, should be undertaken with some caution because of insufficient research and inconsistent results. As we enter the new decade, more high-quality evidence is required for psychological interventions in people with PD in general and to corroborate preliminary positive findings on the adoption of less frequent approaches such as ACT.

PRACTITIONER POINTS

Parkinson's disease is a progressive neurodegenerative condition associated with several psychological difficulties which be targeted by psychological interventions. Currently, cognitive behavioural therapy (CBT) can be recommended to treat depression and sleep disorders in people with Parkinson's, while psychoeducation alone should be avoided. Caution is advised regarding the use of CBT and mindfulness-based interventions to improve anxiety, quality of life, and impulse control. Further evidence is required for less common approaches, such as acceptance and commitment therapy, psychodrama, and EMDR.

Impulsive and compulsive behaviors in Parkinson's disease: Impact on quality of and satisfaction with life, and caregiver burden

INTRODUCTION

To disentangle the association between impulsive and compulsive behaviors (ICBs), health-related quality of life (HRQOL), satisfaction with life (SwL), and caregiver distress in dyads of people with Parkinson's disease (PwP) and caregivers.

METHODS

Data used in this study were obtained from the ongoing Norwegian ParkWest study, a population-based longitudinal cohort study of the incidence, neurobiology and prognosis of PD in Western Norway. One hundred and one dyads of PwP free of dementia and their caregivers were included 5 years after PD diagnosis and inclusion in the ParkWest study. Standardized clinical rating scales were used to evaluate ICBs, HRQOL, SwL and caregiver distress.

RESULTS

Of 101 PwP-caregiver dyads, self-reported ICBs were seen in 33% of PwP and only caregiver-reported ICBs in 12% of PwP. PwP-reported ICBs were associated with poorer HRQOL and SwL, whereas ICBs reported by caregivers only were associated with increased caregiver distress, but not poorer HRQOL or SwL in PwP.

CONCLUSIONS

ICBs have adverse effects on HRQOL, SwL and caregiver distress. These findings underpin the need for proper identification and management of ICBs in PwP.

Illness perceptions in people newly diagnosed with glaucoma and ocular hypertension

Background/aims

To determine whether self-reported illness perceptions in newly diagnosed patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT) are more negative compared with peers who have lived with their diagnosis for more than 2 years.

Methods

A cross-sectional study of 58 newly diagnosed patients with POAG and OHT recruited at their first clinic visit. Electronic patient records were used to identify similar patients (n=58, related by age and severity of visual field loss) who had their diagnosis for >2 years. All participants completed the Brief Illness Perception Questionnaire (BIPQ), EQ5D general health measure and Type D Personality Scale (DS14).

Results

Average BIPQ scores were similar for people newly diagnosed with POAG and POAG diagnosed >2 years and were no different to newly diagnosed OHT and OHT diagnosed >2 years POAG (p=0.46). An analysis correcting for personality type (DS14) and general health (EQ5D) indicated newly diagnosed patients with POAG to have marginally better illness perceptions on individual BIPQ items quantifying impact on life in general, experience of symptoms and ‘understanding’ of their condition (all p<0.01). In contrast, patients with POAG with a diagnosis >2 years understood better their condition to be long-term (p<0.01).

Conclusions

Some illness perceptions differed between newly diagnosed people and patients living with their diagnosis for >2 years. Illness perception for people with manifest glaucoma and at risk of glaucoma (OHT) were similar; the latter might benefit from an intervention at diagnosis that highlights the better prognosis for OHT compared with POAG.

Impulse control disorders in Parkinson's disease: Predominant role of psychological determinants

OBJECTIVES

Impulse Control Disorders (ICDs) in Parkinson's disease (PD) have previously almost exclusively been considered to result from anti-parkinsonian medication. However, this biomedical perspective has failed to achieve a full understanding of the phenomenon and it is argued that a failure to consider psychological factors is a critical omission.

DESIGN

The present study examined the predictive relationship between ICDs in PD and a range of psychological measures, whilst controlling for a number of biomedical determinants.

MAIN OUTCOME MEASURES

One hundred participants with idiopathic PD completed questionnaires that assessed demographic and clinical characteristics, psychological measures and the presence of ICDs (QUIP-RS).

RESULTS

Increased use of a 'negative' coping strategy, stronger illness identity, more emotional illness representations and stress were found to be significant predictors of ICDs, and different psychological predictors were associated with different ICDs. Medication was not found to predict ICDs in the presence of psychological factors, either when total treatment levels were considered or when agonist dose was considered alone.

CONCLUSIONS

This study provides the first quantitative evidence of a predominant predictive relationship between psychological factors and ICDs in PD. The results suggest that psychological interventions may have useful therapeutic role to play for ICDs in PD.

Psychiatric Conditions in Parkinson Disease: A Comparison With Classical Psychiatric Disorders

Psychiatric conditions often complicate the outcome of patients affected by Parkinson disease (PD), but they differ from classical psychiatric disorders in terms of underlying biological mechanisms, clinical presentation, and treatment response. The purpose of the present review is to illustrate the biological and clinical aspects of psychiatric conditions associated with PD, with particular reference to the differences with respect to classical psychiatric disorders. A careful search of articles on main databases was performed in order to obtain a comprehensive review about the main psychiatric conditions associated with PD. A manual selection of the articles was then performed in order to consider only those articles that concerned with the topic of the review. Psychiatric conditions in patients with PD present substantial differences with respect to classical psychiatric disorders. Their clinical presentation does not align with the symptom profiles represented by Diagnostic and Statistical Manual for Mental Disorders and International Classification of Diseases. Furthermore, psychiatry treatment guidelines are of poor help in managing psychiatric symptoms of patients with PD. Specific diagnostic tools and treatment guidelines are needed to allow early diagnosis and adequate treatment of psychiatric conditions in comorbidity with PD.

The experience of Parkinson's disease: a systematic review and meta-ethnography

There has been little attempt to summarise and synthesise qualitative studies concerning the experience and perception of living with Parkinson's disease. Bringing this information together would provide a background to understand the importance of an individual's social identity on their well-being and hope. Three primary aims were identified (a) understanding the importance of social identity and meaningful activities on individuals' well-being, (b) identifying factors and strategies that influence well-being and hope, and (c) establishing a model that relates to an individual's hope and well-being. Three stages were undertaken including a traditional electronic search, a critical appraisal of articles, and a synthesis of studies. Qualitative articles were included that considered the experience of living with Parkinson's disease. Thirty seven articles were located and included in the review. Five themes were identified and the themes were used to inform development of a new model of hope enablement. The current review furthered understanding of how physical symptoms and the experience of Parkinson's disease affect the individual's well-being and hope. Social identity was established as a key factor that influenced an individual's well-being. Being able to maintain, retain, or develop social identities was essential for the well-being and hope of individuals with Parkinson's disease. Understanding the factors which prevent or can facilitate this is essential.

Experiences of apathy in people with Parkinson's disease: a qualitative exploration

PURPOSE

Research has suggested that people with Parkinson's disease (PD) can experience apathy. This study explored the lived experiences of apathy in people with PD.

METHOD

Seven participants with Parkinson's disease who were also described as having apathy were interviewed and the data analysed using interpretative phenomenological analysis.

RESULTS

The findings were understood within three overlapping themes: (1) "The apathy creeps into jobs that I used to be able to do and no longer can do": Reduced motivation in response to the consequences of impairment; (2) "I hate at the end of the day if I've achieved nothing": The (un)acceptability of apathy; (3) "They say 'come on you lazy b*gger, get something done'": The social context of apathy.

CONCLUSIONS

These themes are compared to wider research on apathy, PD and chronic illness. This study offers a view that, for some, apathy may be experienced as a number of behavioural choices influenced by increasing impairment and enacted in a social context. It presents an alternative conceptualisation from one describing apathy as the sole result of an endogenous disease process. As such, a number of therapeutic options are discussed but with the caveat that "apathy" need not always be the focus for intervention. Implications for Rehabilitation Apathy is a term used to denote a decrease in motivation and, although widely used, lacks conceptual clarity. Therefore the personal meaning of the behaviour for the individual within the context of their illness must be considered on assessment. Apathy is a societal as well as personal issue and the therapist also needs to assess the meaning and implications of the behaviour in the individual's social context. Practitioners need to be aware that apathy need not always be a focus for intervention. Discussion around the meaning of the behaviour may be all which is needed. Where individuals do wish to change their behaviours, a number of behavioural and psychological approaches are available. "Third wave" psychological therapies such as compassion- and acceptance-based approaches seem useful although none currently have any evidence base specifically with people with Parkinson's disease.

Reformulating psychological difficulties in people with Parkinson's disease: the potential of a social relational approach to disablism

Research investigating the psychological difficulties experienced by people with Parkinson's disease (PD) is dominated by individualistic neurobiological and psychological perspectives. Therefore, this opinion paper draws on a reformulation of the social model of disability, Thomas' (1999) and (2007) social relational approach to disablism, to offer an alternative way of conceptualising psychological difficulties experienced by people with PD. This opinion paper explores the ways in which socially imposed restrictions and stigma may contribute to psychological difficulties by using Thomas' (2007) concept of psychoemotional disablism. By using the lens of psychoemotional disablism, this paper demonstrates that people with PD can be exposed to stigmatising attitudes and interactions which could contribute to restrictions, feelings of shame, and psychological difficulties such as depression. Accordingly, it is argued that further attention to the link between psychological difficulties and social dimensions of disablism in PD is needed in both research arenas and clinical practice to broaden understandings and interventions for people with PD.