管理帕金森精神病中的抑郁和焦虑

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这是一个恶毒周期：帕金森氏病（PD）导致抑郁和焦虑，研究表明，这可能导致帕金森氏病精神病的更多和恶化，包括幻觉，妄想和记忆力丧失。反过来，患有PD精神病会使您感到焦虑和沮丧。但是您不必仅仅“与之生活”。那里are您或您所爱的PD的事情可以做到缓解心理健康的斗争，停止，或者至少放慢了循环。这是我们对心理健康与PD精神病之间的关系以及您的医疗团队如何提供帮助的知识。

帕金森的精神病和抑郁链接

Anywhere from 20% to 70% of people with Parkinson’s disease will develop精神病over the course of the disease. It can be caused by natural disease progression or as a result of the dopamine therapy used to treat PD. “The longer you have Parkinson's, the more likely you are to develop psychosis,” says Rodolfo Savica, M.D., Ph.D., a neurologist at Mayo Clinic in Rochester, MN. A hallucination is when you see, hear, feel, or taste something that isn’t there, while a delusion is a false belief. Between episodes, though, people with PD psychosis can be lucid much of the time.

In those intervals of lucidity, people with Parkinson’s psychosis may feel embarrassed by their hallucinations and/or delusions. Realization of their loosening grip on reality can worsen or spark depression, says Dr. Savica. Likewise, the hallucinations and delusions themselves may cause depression; after all, believing that someone is trying to poison you, for example, is scary and stressful. Beyond that, the latest research shows that PD degeneration begins in the brainstem, which contains serotonin and adrenergic neurons, both of which play a big part in regulating mood. Understanding these connections can help you have more empathy with a loved one with PD psychosis.

How Anxiety Impacts Psychosis, and Vice Versa

埃默里大学（Emory University）的一项研究发现，焦虑的严重程度是对他们所拥有的幻觉和妄想的数量和严重程度的重要预测指标。焦虑是否引发精神病，反之亦然，这是研究人员尚未回答的鸡或蛋，但这确实意味着分别治疗焦虑症可能有助于精神病。该协会也可能是一个有用的警告：如果您所爱的PD是一个焦虑的人，他们可能会面临精神病的风险。与您的医生讨论主动治疗焦虑。

For most people, anxiety manifests in an inability to relax, excessive worrying, and restlessness. PD patients have these symptoms, as well, but they may exhibit additional troubling warning signs. One 2020 study found that almost a quarter of people with Parkinson’s will experience PD-specific symptoms including anxiety around driving, eating, and socializing. Why? Typical PD symptoms like drooling, slurred speech, and hand tremors are embarrassing and can make people with Parkinson's dread seeing friends or going out in public. Assure your loved one that no one judges them and encourage them to remain a part of a community—whether it’s a church, a senior center, or a book club—for as long as possible.

Diagnosing Mental Health Issues With PDP

As interconnected as depression, anxiety, and psychosis are in people with Parkinson’s, it’s important not to lump them all together, says Joseph Quinn, M.D., director of the Parkinson’s Center at Oregon Health and Science University in Portland, a Parkinson’s Foundation Center of Excellence. Your doctor will want to assess for and diagnose each condition on its own. “We ask about mood, sleep, appetite, and crying spells as markers of depression,” says Dr. Quinn, “and we ask about hallucinations and delusions as markers of psychosis.” Understanding the nature of the diagnoses will help your loved one get the best care possible.

“It’s helpful to treat one thing at a time,” says Dr. Savica, “so that we can be clearer about whether or not the treatment works.” He says he tries to determine what the most bothersome symptom is for the patient and starts out treating that symptoms first. It might be that hallucinations and delusions are the most upsetting toyou作为照顾者；毕竟，看到您所爱的人与不在那里的人互动，这令人震惊。但是，如果这些情节很少发生，那么不断的抑郁症很有可能使您所爱的人的日常生活变得黯淡，首先应该解决。

找到合适的治疗

PD的一个标志是减少多巴胺，这是涉及控制运动，肾功能，睡眠，动机，学习和愉悦的神经递质。因此，一线治疗是多巴胺激动剂（DA），这些药物模仿神经递质的作用并恢复正常运动和情绪。但是，随着时间的流逝，挽救了您所爱的人生命的同样药物可能会残酷地打开它们。Savica博士说：“多年后，这些药物会引起幻觉，偏执狂，强迫和记忆力丧失。”如果是这样，他以一种全新的非DA毒品方案开始新鲜。“有很多方法可以为患者定制治疗。精神病并不总是最终的。”

神经科医生可能会用抗抑郁药治疗抑郁症和/或焦虑症，但大多数医生也会推荐谈话治疗。Savica博士说，由于精神病的症状通常首先出现在55至65岁之间，并在70岁以上的人中变得更加普遍，因此值得寻找专门研究老年病的心理学家或精神病医生。在一项研究中，老年治疗师接受了认知行为疗法（CBT）的PD患者的抑郁症明显少于那些抑郁症。奎因博士说，一个警告：治疗不会帮助精神病症状，但可以帮助缓解相关的抑郁症和焦虑。

运动的重要性

Exercise of all kinds can be vitally important for all PD patients, says Dr. Savica. Those who exercise a minimum of 2.5 hours a week significantly slow the decline in their quality of life compared to those who don’t. Exercise has also been shown to play a big role in mood. People with PD who exercise more are less likely to experience anxiety or apathy than those who exercise less. Get moving with regular walking, water aerobics, Tai Chi, dance, Pilates, weight training—anything that’s enjoyable enough to stick with it long term.

底线：是的，抑郁症和焦虑是帕金森精神病的统计可能性，但您所爱的人不是统计数据，您有选择。首先呼吁他们的医生评估治疗方案，然后考虑我们概述的哪些疗法和生活方式的增强（也许会寻找温和的水 - 水域课程或每周与朋友的低调午餐）是否可行。它可能需要试用和错误，但是有很大的机会在前进。

Meet Our Writer

Patty Onderko

Patty Onderko是一位作家和编辑，涵盖了20多年来的健康，育儿，心理学，旅行以及更多。她和妻子和两个儿子一起住在纽约布鲁克林。

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