مقاله انگلیسی درمان بهینه افسردگی و اضطراب در بیماری پارکینسون
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ABSTRACT
Depression and anxiety are highly prevalent and have major adverse effects on function and quality of life in Parkinson’s disease (PD). Optimal management requires that motor symptoms and psychiatric symptoms be simultaneously addressed. While there is fairly robust evidence for the treatment of motor symptoms, there are no completed randomized controlled trials to guide pharmacological treatment of anxiety in PD and no nonpharmacologic interventions have proven efficacious. Several high-quality trials for depression in PD suggest a number of antidepressants and cognitive behavioral therapy may help, but there is no data on rates of recurrence, comparative efficacy, or augmentation strategies. In order to address the gaps in knowledge, the authors provide a summary of the current evidence for treating depression and anxiety in PD and offer an algorithm that extends beyond the current literature based on clinical experience working in a multidisciplinary specialty centerCASE VIGNETTE M r. P is a 72-year-old married male with a 7- year history of Parkinson’s disease (PD). He had no history of anxiety, major depression, or psychotic illness prior to PD. For the first 6 years he was treated with a combination of the dopamine agonist pramipexole and one tablet of carbidopa-levodopa three times per day. However, he developed an impulse control disorder (hypersexuality) and visual hallucinations last year and pramipexole was tapered off. He is currently treated with carbidopa-levodopa 25/100 mg two tablets 4 times per day. Over the past two months he has stopped attending his current events group and no longer goes to his exercise classes—he often feels too fatigued to participate anyway. He sometimes skips or postpones his appointments with his neurologist, saying, “what’s the point they don’t have a cure.”