title: Thinking about motor fluctuations: An examination of metacognitions in Parkinson's disease.
abstract: OBJECTIVE
  Motor fluctuations (characterised by a sudden increase in symptom intensity, referred to as an 'off-period') are common side effects after treatment of Parkinson's disease (PD) with dopaminergic medication. A proportion of these people find motor fluctuations highly distressing. This study aimed to identify metacognitions associated with cognitive and attentional responses to these experiences.
  
  
  METHODS
  Ten individuals with PD who experience motor fluctuations were interviewed for this study using an adapted metacognitive profiling schedule. Participants were asked about their metacognitions, and the cognitive processes and attentional strategies activated in response to a distressing off-period.
  
  
  RESULTS
  Metacognitions identified were more often related to conceptual thinking about symptoms rather than symptom focus and data suggested trends for increased depressive symptoms among individuals with stronger metacognitive beliefs.
  
  
  CONCLUSIONS
  Metacognitions may play a role in determining or maintaining off-period distress in PD.
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, London, UK; CASCAID, South London & Maudsley NHS Foundation Trust, London, UK. Electronic address: bruce.fernie@kcl.ac.uk.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Fernie
authors.affiliation: London South Bank University, London, UK.
authors.forename: Marcantonio M
authors.initials: MM
authors.lastname: Spada
authors.affiliation: King's College and NPF Centre of Excellence, Kings College Hospital NHS Foundation Trust, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Ray Chaudhuri
authors.affiliation: King's College Hospital NHS Foundation Trust, London, UK; Department of Neurology, Technical University Dresden, Fetscherstraße 74, Dresden, Germany.
authors.forename: Lisa
authors.initials: L
authors.lastname: Klingelhoefer
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, London, UK.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology; D001288:Attention; D005260:Female; D006801:Humans; D008297:Male; D000067489:Metacognition; D008875:Middle Aged; D009068:Movement; D010300:Parkinson Disease / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*
keywords: Distress; Metacognitions; Motor fluctuations; Off-periods; Parkinson's disease