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Depression and Anxiety in Persons with Parkinson's Disease With and Without “On–Off” Phenomena

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Abstract

“On–off” phenomena in Parkinson's disease (PD) are unpredictable motor fluctuations associated with long-term levodopa use. Mood fluctuations have been found to coincide with the motor fluctuations in that depression and anxiety increase while the person with PD is in the “off” state. What has been relatively unexplored is whether those persons with PD who have “on–off” phenomena differ psychologically in fundamental ways from those who do not have “on–off” phenomena. In the present study, depression and anxiety symptoms were assessed in 36 persons with PD (n = 14 with “on–off” phenomena, n = 22 without “on–off” phenomena). All those with “on–off” phenomena were assessed in their “on” state. Those persons with PD with “on–off” phenomena had significantly higher levels of anxiety than those without “on–off” phenomena. However, both groups, regardless of “on–off” status, were mildly depressed. Neurobiological interpretations of the results implicate the locus coeruleus in the pathogenesis of both “on–off” phenomena and anxiety, whereas psychological interpretations of the results involve the issues of learned helplessness and control over health symptoms in PD.

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REFERENCES

  • Antonini, A., Schwarz, J., Oertel, W., Pogarell, O., & Leenders, K. (1997). Long–term changes of striatal dopamine D2 receptors in patients with Parkinson's disease: A study with positron emission tomography and [11C] raclopride. Movement Disorders, 12, 33–38.

    Google Scholar 

  • Beck, A., Ward, C., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 41, 561–571.

    Google Scholar 

  • Brown, R., & MacCarthy, B. (1990). Psychiatric morbidity in patients with Parkinson's disease. Psychological Medicine, 20, 77–87.

    Google Scholar 

  • Brown, R., MacCarthy, B., Gotham, A., Der, G., & Marsden, C. (1988). Depression and disability in Parkinson's disease: A follow–up of 132 cases. Psychological Medicine, 18, 49–55.

    Google Scholar 

  • Brown, R., Marsden, C., Quinn, N., & Wyke, M. (1984). Alterations in cognitive performance and affect–arousal state during fluctuations in motor function in Parkinson's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 47, 454–465.

    Google Scholar 

  • Charney, D., & Deutch, A. (1996). A functional neuroanatomy of anxiety and fear: Implications for the pathophysiology and treatment of anxiety disorders. Critical Reviews in Neurobiology, 10, 419–446.

    Google Scholar 

  • Cummings, J. (1993). The neuroanatomy of depression. Journal of Clinical Psychiatry, 54, 14–20.

    Google Scholar 

  • Dooneief, G., Mirabello, E., Bell, K., Marder, K., Stern, Y., & Mayeux, R. (1992). An estimate of the incidence of depression in idiopathic Parkinson's disease. Archives of Neurology, 49, 305–307.

    Google Scholar 

  • Drevets, W., Videen, T., Price, J., Preskorn, S., Carmichael, S., & Raichle, M. (1992). A functional anatomical study of unipolar depression. The Journal of Neuroscience, 12, 3628–3641.

    Google Scholar 

  • Erdal, K. (in press). Depressive symptom patterns in patients with Parkinson's disease and other older adults. Journal of Clinical Psychology.

  • Folstein, M., Folstein, S., & McHugh, P. (1975). Mini–mental state. Journal of Psychiatric Research, 12, 189–198.

    Google Scholar 

  • Gallagher, D., Breckenridge, J., Steinmetz, J., & Thompson, L. (1983). The Beck Depression Inventory and research diagnostic criteria: Congruence in an older population. Journal of Consulting and Clinical Psychology, 51, 945–946.

    Google Scholar 

  • Gallagher, D., Nies, G., & Thompson, L. (1982). Reliability of the Beck Depression Inventory with older adults. Journal of Consulting and Clinical Psychology, 50, 152–153.

    Google Scholar 

  • George, M., Ketter, T., & Post, R. (1993). SPECT and PET imaging in mood disorders. Journal of Clinical Psychiatry, 54, 6–13.

    Google Scholar 

  • Girotti, F., Carella, F., Grassi, M., Soliveri, P., Marano, R., & Caraceni, T. (1986). Motor and cognitive performance of parkinsonian patients in the on and off phases of the disease. Journal of Neurology, Neurosurgery, and Psychiatry, 49, 657–660.

    Google Scholar 

  • Gotham, A., Brown, R., & Marsden, C. (1986). Depression in Parkinson's disease: A quantitative and qualitative analysis. Journal of Neurology, Neurosurgery, and Psychiatry, 49, 381–389.

    Google Scholar 

  • Hardie, R., Lees, A., & Stern, G. (1984). “On–off” fluctuations in Parkinson's disease. Brain, 107, 487–506.

    Google Scholar 

  • Hoehn, M., & Yahr, M. (1967). Parkinsonism: Onset, progression and mortality. Neurology, 17, 427–442.

    Google Scholar 

  • Jacobsen, P., Bovbjerg, D., Schwartz, M., Hudis, C., Gilewski, T., & Norton, L. (1995). Conditioned emotional distress in women receiving chemotherapy for breast cancer. Journal of Consulting and Clinical Psychology, 63, 108–114.

    Google Scholar 

  • Kempen, G., & Suurmeijer, T. (1990). The development of a hierarchical polychotomous ADL–IADL scale for noninstitutionalized elders. The Gerontologist, 30, 497–502.

    Google Scholar 

  • Kostic, V., Djuricic, B., Covickovic–Sternic, N., Bumbasirevic, L., Nikolic, M., & Mrsulja, B. (1987). Depression and Parkinson's disease: Possible role of serotonergic mechanisms. Journal of Neurology, 234, 94–96.

    Google Scholar 

  • Maricle, R., Nutt, J., & Carter, J. (1995). Mood and anxiety fluctuation in Parkinson's disease associated with levodopa infusion: Preliminary findings. Movement Disorders, 10, 329–332.

    Google Scholar 

  • Mayberg, H., Starkstein, S., Sadzot, B., Preziosi, T., Andrezejewski, P., Dannals, R., Wagner, H., & Robinson, R. (1990). Selective hypometabolism in the inferior frontal lobe in depressed patients with Parkinson's disease. Annals of Neurology, 28, 57–64.

    Google Scholar 

  • Mayeux, R., Stern, Y., Cote, L., & Williams, J. (1984). Altered serotonin metabolism in depressed patients with Parkinson's disease. Neurology, 34, 642–646.

    Google Scholar 

  • Menza, M., Sage, J., Marshall, E., Cody, R., & Duvoisin, R. (1990). Moodchanges and “on–off” phenomenain Parkinson's disease. Movement Disorders, 5, 148–151.

    Google Scholar 

  • Mizuno, Y., Kondo, T., & Mori, H. (1994). Various aspects of motor fluctuations and their management in Parkinson's disease. Neurology, 44(Suppl. 6), S29–S34.

    Google Scholar 

  • Mouradian, M., Juncos, J., Fabbrini, G., Schlegel, J., Bartko, J., & Chase, T. (1988). Motor fluctuations in Parkinson's disease: Central pathophysiological mechanisms, part II. Annals of Neurology, 24, 372–378.

    Google Scholar 

  • Nissenbaum, H., Quinn, N., Brown, R., Toone, B., Gotham, A., & Marsden, C. (1987). Mood swings associated with the “on–off” phenomenon in Parkinson's disease. Psychological Medicine, 17, 899–904.

    Google Scholar 

  • Quinn, N. (1998). Classification of fluctuations in patients with Parkinson's disease. Neurology, 51(Suppl. 2), S25–S29.

    Google Scholar 

  • Riley, D., & Lang, A. (1993). The spectrum of levodopa–related fluctuations in Parkinson's disease. Neurology, 43, 1459–1464.

    Google Scholar 

  • Sandyk, R. (1989). Locus coeruleus–pineal melatonin interactions and the pathogenesis of the “on–off” phenomenon associated with mood changes and sensory symptoms in Parkinson's disease. International Journal of Neuroscience, 49, 95–101.

    Google Scholar 

  • Sano, M., & Mayeux, R. (1992). Biochemistry of depression in Parkinson's disease. In S. Huber & J. Cummings (Eds.), Parkinson's disease: Neurobehavioral aspects (pp. 229–239). New York: Oxford University Press.

    Google Scholar 

  • Seligman, M. (1975). Helplessness:Ondepression, development and death. San Francisco: Freeman.

    Google Scholar 

  • Siemers, E., Shekhar, A., Quaid, K., & Dickson, H. (1993). Anxiety and motor performance in Parkinson's disease. Movement Disorders, 8, 501–506.

    Google Scholar 

  • Spielberger, C., Gorsuch, R., & Lushene, R. (1970). Manual for the state–trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press.

    Google Scholar 

  • Stein, M., Heuser, I., Juncos, J., & Uhde, T. (1990). Anxiety disorders in patients with Parkinson's disease. American Journal of Psychiatry, 147, 217–220.

    Google Scholar 

  • Stocchi, F., Bonamartini, A., Vacca, L., & Ruggieri, S. (1996). Motor fluctuations in levodopa treatment: Clinical pharmacology. European Neurology, 36(Suppl. 1), 38–42.

    Google Scholar 

  • Taylor, S. (1999). Health psychology. Boston: McGraw Hill.

    Google Scholar 

  • Taylor, S., & Aspinwall, L. (1996). Psychological aspects of chronic illness. In G. VandenBos & P. Costa Jr. (Eds.), Psychological aspects of serious illness (pp. 7–60). Washington, DC: American Psychological Association.

    Google Scholar 

  • Vazquez, A., Jimenez–Jimenez, F., Garcia–Ruiz, P., & Garcia–Urra, D. (1993). “Panic attacks” in Parkinson's disease. Acta Neurologica Scandinavica, 87, 14–18.

    Google Scholar 

  • Zimmerman, M., & Coryell, W. (1987). The Inventory to Diagnose Depression (IDD):Aself–report scale to diagnose Major Depressive Disorder. Journal of Consulting and Clinical Psychology, 55, 55–59.

    Google Scholar 

  • Zung, W. (1965). Aself–rating depression scale. Archives of General Psychiatry, 12, 63–70.

    Google Scholar 

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Erdal, K.J. Depression and Anxiety in Persons with Parkinson's Disease With and Without “On–Off” Phenomena. Journal of Clinical Psychology in Medical Settings 8, 293–299 (2001). https://doi.org/10.1023/A:1011972930917

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