In early November, the Parkinson and Movement Disorder (PMD) Alliance hosted a webinar on psychiatric care for people with Parkinson’s disease (PD). The session featured geriatric neuropsychiatrist Dr. Laura Marsh, who discussed the often untreated psychiatric disorders in PD, and how treating them can improve quality of life. It’s important for the person with PD or their caregiver to advocate for themselves and educate themselves regarding what to look for as signs of possible mental health issues. Many neurologists overlook or under-treat mental health symptoms.
Although medications are very effective, an interdisciplinary approach and treatment plan is considered the most effective. As a geriatric neuropsychiatrist, Dr. Marsh attempts to reduce the number of medications a geriatric patient may take. She offered possible alternatives:
- Be mindful of sleep and diet
- Take part in scheduled meaningful activities and exercise
- Set small, attainable goals to start
- Practice meditation, yoga, or breathing exercises
- Build a support network of friends, support groups, and family
- Take part in therapy
Dr. Marsh also included a “secret sauce” for how a patient may successfully cope with PD. This includes:
- Treat mood disorders
- Anxiety is treated (treated with psychotherapy, sometimes medication)
- Depression (treated with psychotherapy and antidepressants)
- Connect with people
- Join support groups
- Learn about condition
- Get educated
- Be willing to use the right coping strategy at the right time
For more resources on different psychiatric symptoms of PD, please see these Stanford Parkinson’s Community Outreach webpages:
For a recording of this webinar, please see this PMD Alliance YouTube webpage.
See my notes below of the November 8th webinar.
Regards,
– Joëlle Kuehn
“Integrating Psychiatric and Mental Health into Medical Care” – Webinar Notes
Speaker: Laura Marsh, MD, geriatric neuropsychiatrist, Baylor College of Medicine, Houston, Texas
Webinar Host: PMD Alliance
Webinar Date: November 8, 2021
Summary by: Joëlle Kuehn, Stanford Parkinson’s Community Outreach
Even psychiatrists don’t know how to best take care of PD patients with mental health issues, and it is taking more time to begin to get a group of mental health clinicians who really know about Parkinson’s disease and know about movement disorders so that they are comfortable working with PD patients, and PD patients are working with them.
How to know when someone has mental health non-motor symptoms (apathy, depression, anxiety) of PD?
- Important to remember how frequently psychiatric problems occur in individuals with PD
- Know there are things people can do to keep their health as good as possible
- The “whole health” approach to care, which looks at many aspects, is best
- What we call a “healthcare system” has largely been a disease care system:
- We are used to caring for people who are sick
- What we want to do is take an approach where we focus on how to live with the condition, and how to prevent potential complications
- The pandemic has shown us that we all need to take better care of ourselves: Eating better, getting enough sleep, exercising
- Remembering that mental health conditions occur:
- But in PD you are especially vulnerable because of the nature of the brain disorder
- Brain has systems that help regulate mood and thinking, so depending on where in the brain you might have more or less parkinsonian pathology, you might have anxiety, apathy, depression, or thinking trouble, or trouble with executive function
- Being aware of all those possibilities of what can happen and working with someone to understand what it is
- The most important thing patients can do is be able to talk to their clinicians and say what kind of problem they are having ‘
Mental health and PD:
- Mental health aspect of PD is under-identified, although common
- Depending on how patients explain the symptoms, they may not be able to clearly express what they need and so mental illnesses may be undiagnosed
- There is also a stigma with mental illness
- How to help patients to come to doctors and get the help they need:
- What words to use: blue, anxious, agitated, etc.
- Remember what your usual self is, and look at what is different or changed (can’t enjoy certain things anymore, don’t enjoy things anymore, feeling guilty about things you don’t usually feel guilty about, feeling more tired or fatigued than normal, can’t concentrate or think as easily as you could)
- People have a tendency to “explain away” why they are feeling different:
- “Oh it’s because I have PD”
- “Oh I’m that way because my wife is burdened by my care”
- There is always an explanation/excuse, but it’s sometimes good to consider that it may be a serious mood disorder where the brain’s ability to rally is diminished
Diagnosing mental health disorders:
- Depression or anxiety may precede PD diagnosis, due to this, it isn’t always known if it is related to PD
- These things often don’t get diagnosed because neurologist often focus on the movement disorder’s movement symptoms
- There is a movement in the medical field of comprehensive and interdisciplinary care where different individuals will work together, to help avoid mental health issues being untreated
- Creates new focus on quality of life
- We don’t have as robust treatments for non-motor symptoms of PD, as we do for the motor symptoms
- If they aren’t addressed by the clinician, patients don’t feel like they are thriving
- Something patients can do is look for clinics where they have interdisciplinary care so you can ensure doctors are considering things
- When you start off having PD, it is good to know what all the possible symptoms are. If you know about possible symptoms, the patient can be more aware of any changes that may be caused by symptoms. Know what to look for
- Important to identify things because they are treatable, and treating issues allows you to function better
Things to do to avoid taking medication:
- Healthy living in general is especially important if you have a mood disorder
- Be mindful of sleep and diet
- Educate yourself about your condition: Learn about PD, mood, anxiety, coping skills
- Have scheduled meaningful activities and attend them. Sometimes when people are depressed they don’t want to get out of the house but trying to get that momentum going to try to attend scheduled activities every week will help
- Activities could be as basic as seeing your clinicians, or support groups
- Scheduling exercise and doing it
- Try to think about one thing at a time
- Set small, attainable goals and work your way up
- Breathing exercises or meditation or yoga:
- Critical for health in general
- Breathing helps with parasympathetic nervous system
- Helpful if you are anxious
- Can use it in any moment
- Helps you recalibrate where your brain is
- Affects brain neurochemistry
- See family members: Recognize who your support people are
- Cognitive behavioral therapy
- Problem-solving therapy
- Think proactively about what you need to do to keep yourself as safe as possible. Treat constipation, urinary tract infections, and keep people from falling
In the geriatric world, we try to take people off of medications. Important when you go to the doctor to take in your current list of medicines, in the bottles, even over the counter medications.
Hallucinations / psychosis:
- Hallucinations: perception of seeing, hearing, smelling, feeling something touch you that isn’t there
- People with PD might experience minor hallucinations – might see a shadow, or feel the presence of someone near them even when no one is there
- If these minor hallucinations happen, check medication and urine
- Tell your doctor about even minor hallucinations
- Anxiety medications, benadryl, valium, can make things worse
- Reducing and managing some medications can help
- Different medications can help with psychosis
- Also important to educate the family:
- How to cope with a loved one with hallucinations
- How to respond: as calmly as possible
- How to connect with them
Depression:
- Antidepressants are very effective
- Sometimes it’s only when you get on enough of antidepressants that it works, you need to be patient about finding the right dosage, don’t give up if the first attempt doesn’t work
- Get to a level where you can carry out daily live
- Important to get to the right doctor, identify the problem, speak up about it, getting on right combination of pills (or off the pills, or on the pills)
What is the “secret sauce” for a patient that is successful in how they deal with PD:
- When mood disorders are treated:
- Anxiety is treated (treated with psychotherapy, sometimes medication)
- Depression (treated with psychotherapy and antidepressants)
- Connect with people
- Join support groups
- Learn about condition
- Get educated
- Be willing to use the right coping strategy at the right time