A matter of motion or an emotional matter? Management of depression in Parkinson’s disease

The prevalence of anxiety and depression in palliative care patients with cancer in Western Australia and New South Wales

OBJECTIVES

To examine the prevalence and predictors of depression and anxiety in palliative care patients with cancer in Western Australia and New South Wales.

DESIGN, SETTING AND PARTICIPANTS

A descriptive study of 266 consecutive patients at a range of inpatient and outpatient settings including home care, hospices, and private and tertiary care hospitals in WA and NSW from 1 March to 30 June 2002.

MAIN OUTCOME MEASURES

Self-reported anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) at a cut-off score of > or = 8 on each subscale (depression and anxiety) for possible cases, and of > or = 11 for probable cases; a cut-off score of > or = 19 was used for probable combined depression and anxiety.

RESULTS

Patients included 200 in WA and 66 in NSW. For the whole sample, 45.8% of patients were possibly depressed and 22.7% probably depressed; 36.9% were possibly anxious and 19.8% probably anxious. About 25% of patients had probable combined depression and anxiety. Logistic regression analyses indicated that past anxiety in the family predicted probable depression, while age, marital status and past depression predicted probable anxiety. Age and past depression predicted probable combined depression and anxiety.

CONCLUSIONS

These findings underscore the need for routine screening for anxiety and depression in palliative care settings, including questions about past personal and family history of anxiety and depression, and the need for a range of interventions and support services.

Suicidal thoughts in patients with Parkinson's disease treated by deep brain stimulation of the subthalamic nuclei: two case reports and review of the literature

BACKGROUND

Deep brain stimulation (DBS) of the subthalamic nuclei (STN) can result in depression despite the obvious motor improvement.

CASE PRESENTATIONS

Two patients with serious life-threatening depressive episodes are described. In the first case, the trigger for depression was a slight adjustment of the left stimulating electrode's contact. In the second case, reducing both the dopaminergic therapy and the voltage of DBS resulted in the manifestation of depressive symptoms.

CONCLUSIONS

DBS-induced depression possibly has pathogenetic differences from ordinary Parkinson's disease depression. The STN region seems to be a sensitive zone that influences emotions.

Does dopamine dysfunction drive depression?

OBJECTIVE

To examine the evidence that dopamine (DA) dysfunction contributes to melancholic depression.

METHOD

Database (EMBASE, PsychLit and MEDLINE) searches using relevant key words were conducted and citations were scrutinized.

RESULTS

In this paper, we assume that the definition of melancholia is contingent upon the presence of psychomotor disturbance (PMD). In melancholic depression PMD comprises both a cognitive and motor component and DA is found to be important in both. DA neurotransmission modulates cognition in particular in attention, adaptation and motivational processes and has a pivotal role in motor function.

CONCLUSION

DA is a credible aetiological candidate for the PMD in melancholic depression. However, melancholia needs first to be characterized both clinically and in terms of its pathophysiology. In this regard, illnesses such as bipolar depression and Parkinson's disease warrant consideration as they provide suitable models of both the cognitive and motor aspects of PMD, and hold the necessary markers to better define melancholia.

Measurement of psychological distress in palliative care

Research investigating the psychological distress of palliative care patients has contributed to our understanding of the needs and experiences of individuals approaching death. This paper aims to provide a brief review of such measurement of psychological distress in palliative care, focusing on established psychiatric and psychological research tools, and quantitative research methods. This includes clinical screening and diagnostic assessment instruments used to identify key distress-related symptoms and the presence of common clinical syndromes, such as depression, anxiety, delirium, as well as the broader psychological dimensions of suffering, such as existential concerns, spirituality, hope and demoralisation. There are important considerations in undertaking psychological research in palliative care, such as maintaining a balance between the methods and measurements that will address key research questions, and sensitivity to the range of physical and emotional demands facing individuals at the point of receiving palliative care. The clinical application of psychological and psychiatric research tools and methods can aid the detection of psychological distress, aid the thorough assessment of the psychological dimension of the patients' illness and care, aid the identification of individuals who would benefit from specific psychotherapeutic or pharmacologic interventions, and the evaluation of response to treatments.