The impact of Parkinson’s on psychological functioning - depression, sleep disorders, anxiety, slowness of thought and hallucinations.
A report on the talk given by Heinrich Ellgring at the 2005 Euroyapmeet
He said that this was a very public disease, not for instance like diabetes where you looked normal, and Parkinson’s patients often became socially withdrawn. He cited the effect of slowness of thought on social functioning. Depression was quite common in people with Parkinson’s. He spoke of the lack of social reinforcement and the possible misinterpretation of the reduced expressive capacity.
He warned carers not to take it literally - “I don’t know whether he likes or dislikes it” - and to make sure to talk things over. To an outsider, a PWP might look depressed, but might not be at all. Carers, he said, also suffer substantially from depression, and need to seek treatment.
The psychosocial problems resulted from the obvious presence of symptoms and the apparent barriers to communication. By way of example he described the neurologist speaking only to the carer and not the patient! He said this was because the carer gave a lot of non-verbal feedback.
The stress dependency of motor symptoms also stacked the cards against the patient, as even talking to another person in a social situaition may lead to an increase in symptoms, and as a result the patient may avoid such situations in the future.
The disease is always there - the cognitive omnipresence of Parkinson’s, the lack of control and fear about its progression, all contribute to stress levels. Diabetes, he said, you can give yourself an injection, and you can forget about it.
He described tremor as the seismograph of your feelings, and said that freezing episodes occurred at the most unsuitable moments, and even minor social stressors can have major efects on motor symptoms.
He advised that even just saying you have PD can reduce stress.
For optimal doctor-patient communication, there should be regular meetings, no time pressure, an open and trusting atmosphere, adaptation to each individual situation, and clear and understandable explanations.
For the carer, stressors include their own stress, that of the patient, the dependence of the patient on them, impatience with partner and the restrictions that PD places on them. The carer is often angry about the patient. This negative emotion conjures up feelings of remorse -- they should not be angry with an ill patient - and this in turn may double the anger!. “You have to look at how you can improve that and ease the situation.”
He spoke of the benefits of integrated patient health management, where the patient is involved in the treatment, and psychosocial intervention should complement the medical treatment. Coping is helped by knowing about the psychological factors.
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