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Ect And Parkinson’s Disease

Ect In The Treatment Of Patients With Neurological And Somatic Disease

ECT: Disrupting the Stigma Around An Essential Treatment Option
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How Is Depression Treated In People With Parkinsons Disease

Depression must be treated differently in people who have Parkinsons disease. Many people can be treated with a type of antidepressant called serotonin reuptake inhibitors . However, some other Parkinsons symptoms may worsen from SSRI use in a very small number of people.

SSRIs shouldnt be taken if youre currently taking selegiline . This is a commonly prescribed medication to control other symptoms of Parkinsons.

If both are taken at once, it could cause serotonin syndrome. Serotonin syndrome occurs when theres excessive nerve cell activity, and it can be fatal. Symptoms can include:

  • confusion, disorientation, or hallucinations
  • digestive issues like diarrhea or nausea
  • rapid heartbeat, or tachycardia
  • overactive reflexes, or hyperreflexia

Some medications used to treat other symptoms of Parkinsons, like dopamine agonists, may have an antidepressant effect. These appear to be particularly helpful in those who experience periods when their medication isnt effective. This is also known as on-off motor fluctuation.

Depression Anxiety And Psychosis In Parkinson’s Disease

Parkinson’s disease is associated with depression, demoralization, anxiety, and psychosis. Depression in Parkinson’s disease is overlooked because of the overlap between motor and mental slowing. Treatment includes psychotherapy, pharmacotherapy, and electroconvulsive therapy. Several of the newer antidepressants are effective in patients with Parkinson’s disease, as is electroconvulsive therapy. Anxiety is common in patients with Parkinson’s disease and can interfere with their response to treatment. Psychosis can occur with any of the drugs used to treat Parkinson’s disease. Some of the atypical neuroleptics, as well as electroconvulsive therapy, can be helpful.

Parkinson’s disease is commonly associated with psychiatric morbidity, but fortunately, many effective treatments are available.

Introduction

Parkinson’s disease is commonly associated with psychiatric morbidity, which includes depression, anxiety, and dopaminergic psychosis. These compound the patient’s predicament. Fortunately a variety of effective treatments is available. This article reviews the diagnosis and symptoms of depression, anxiety, and psychosis in Parkinson’s disease, and offers strategies for effective management.

Depression

Symptoms and differential diagnosis

Diagnosis

Treatment

Psychological support

Pharmacotherapy

Electroconvulsive therapy

Anxiety

Psychosis

Table. Parkinson’s disease medication, side effects, and management

Medication

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Extraction Of The Outcome Measures

The data were collected using a semi-structured form for each study by one of the authors and checked by another investigator. Discrepancies were resolved by consensus and a third author consulted if necessary. The following variables were extracted: mean and SD of the motor section of the UPDRS for baseline and after treatment for the active and placebo group mean and SD for the follow up period evaluation study design demographic and clinical characteristics baseline motor UPDRS and Hoehn and Yahr stage TMS parameters and ECT parameters .

For the studies with more than one active group , we considered each group as one study in the quantitative analysis. This approach was used for the following three studies: Mally et al , de Groot et al and Lefaucheur et al .

Parkinsons Disease And Electroconvulsive Therapy: A Nursing Perspective

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    Electroconvulsive Therapy Intervention For Parkinsons Disease

    Dr. Narang is Assistant Professor with the University of Minnesota and Staff Physician and Lead ECT Psychiatrist at Regions Hospital, Minneapolis-St. Paul, Minnesota Dr. Glowacki is a first year family medicine resident at John Peter Smith hospital, Fort Worth Texas and Dr. Lippmann is Professor of Psychiatry at University of Louisville School of Medicine, Louisville, Kentucky.Innov Clin Neurosci. 2015 12:2528.

    Funding: No funding was received for the preparation of this manuscript.

    Financial Disclosures: The authors have no conflicts of interest relevant to the content of this article.

    Key words: Electroconvulsive therapy, ECT, Parkinsons disease, motor symptoms, on-off phenomenon

    Effectiveness Of Electroconvulsive Therapy In Parkinsonian Symptoms: A Case Series

    Drs. Grover, Somani, Sahni, Mehta, Choudhary, Chakravarty, and Rabha are with the Post Graduate Institute of Medical Education and Research, Chadigarh in Chandigarh, India.

    Innov Clin Neurosci. 2017 15:2327.

    FUNDING: No funding was provided for the preparation of this article.

    DISCLOSURES: The authors report no conflicts of interest relevant to this article.

    ABSTRACT: Depression is a common comorbidity in patients suffering from Parkinsons disease . Available evidence suggests that electroconvulsive therapy is an effective treatment for depression and also improves symptoms of PD. However, literature on usefulness of ECT in parkinsonian symptoms is limited. A review of records of all patients receiving ECT from 2010 to April 2017 in the authors clinic yielded six cases of depression with PD who were treated with ECT. All six patients had improvement in both depression and symptoms of PD following ECT treatment. The improvement achieved with ECT was sustained in four patients. Worsening of PD symptoms 3 to 4 months post-treatment was seen in two patients. ECT appears to be an effective treatment option for management of motoric symptoms in patients with PD, especially those with comorbid psychiatric disorders.

    KEYWORDS: Depression, Parkinsons disease, electroconvulsive therapy

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    Journal Of Medical Cases

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    Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
    Article copyright, the authors Journal compilation copyright, J Med Cases and Elmer Press Inc
    Journal website http://www.journalmc.org

    Case Report

    Volume 5, Number 2, February 2014, pages 89-91

    Electroconvulsive Therapy as an Effective Alternative in Parkinsons Disease Associated Psychosis: A Case Report and Brief Review of the Literature

    Sevda Sarikayaa, Gokben Hizli Sayarb, c, Eylem Oztenb, Gul Eryilmazb

    aBeykoz Kavaclk Medistate Hospital, Istanbul, TurkeybUskudar University, Istanbul, TurkeycCorresponding author: Gokben Hizli Sayar, Uskudar University, Istanbul, Turkey

    Manuscript accepted for publication January 14, 2014Short title: Electroconvulsive Therapy

    Top

    The psychotic symptoms related to Parkinsons Disease are often resistant to antipsychotics, and management of psychotic features is one of the most critical issues in the treatment of PD. We reported a 42-year-old man with PD and medically intractable PD associated psychosis who was significantly benefitted from electroconvulsive therapy.

    Keywords: Electroconvulsive therapy Parkinsons Disease Psychosis

    Introduction Top

    These psychotic symptoms are likely to be induced by high doses of antiparkinsonian drugs, but they also can occur intrinsically . Presence of psychotic symptoms significantly alters prognosis .

    Case Report Top
    Discussion Top
    References

    A Case Of Improved Psychotic Depression And Motor Symptoms In Parkinsons Disease Following Electroconvulsive Therapy

    Electroconvulsive Therapy (ECT): Treating Severe Depression

    S. Ramesh, J. Ratliff

    Category:Parkinsons Disease: Pharmacology and Therapy

    Objective: To describe a case of motoric, affective, and psychotic symptoms improving in PD following ECT.

    Background: Parkinsons disease is a neurodegenerative disease caused by dopaminergic depletion in the basal ganglia. Non-motor features can independently include both depression and psychosis. Electroconvulsive therapy is a treatment for a range of psychiatric conditions, including medication-refractory depression. There is limited data regarding the effect of ECT on motor, depressive, and psychotic symptoms in PD.

    Method: Case Report.

    Both PD and psychotic depression involve changes in dopaminergic transmission and neuronal dopamine response. The effect of ECT on reducing PD symptoms may be mediated through striatal dopamine. Literature suggests that ECT may have effects on release, receptor sensitivity, and other modulatory mechanisms. This case demonstrates that ECT may be effective for the motoric, affective, and psychotic symptoms of PD though the mechanism is likely complex. The literature has few randomized control trials describing this relationship. Additional investigation is warranted.

    To cite this abstract in AMA style:

    Mov Disord.

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    Negative And Positive Effect In Rtms Trials

    Although this meta-analysis shows a favourable effect of TMS on motor function in PD, a positive effect was not observed in every trial. One of the reasons may be the small sample size of these negative studies. In this scenario, the meta-analysis technique is a valuable method to combine the data from small studies in order to provide a conclusion based on an analysis with better power. However, two studies with relatively large sample sizes showed negative results. One explanation for this contradiction might be the interaction of antiparkinson drugs with TMS, as these studies assessed the motor UPDRS after the use of levodopa . This medication might mask the effects of TMS due to a ceiling effect. Therefore, assessment of patients in the off state may provide a more sensitive measure of the benefit of TMS. An alternative explanation is that the variability of the results stems from the wide range of TMS parameters and patient selection criteria used in these studies, that is, the optimal TMS parameters might vary depending on disease duration and severity. Although the meta-regression results failed to show that TMS parameters could significantly account for the variability across studies in motor improvement, the interaction term was not analysed because of lack of power for this type of test.

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