title: Neuropsychiatric Complications of Parkinson Disease Treatments: Importance of Multidisciplinary Care.
abstract: Although Parkinson disease (PD) is defined clinically by its motor symptoms, it is increasingly recognized that much of the disability and worsened quality of life experienced by patients with PD is attributable to psychiatric symptoms. The authors describe a model of multidisciplinary care that enables these symptoms to be effectively managed. They describe neuropsychiatric complications of PD itself and pharmacologic and neurostimulation treatments for parkinsonian motor symptoms and discuss the management of these complications. Specifically, they describe the clinical associations between motor fluctuations and anxiety and depressive symptoms, the compulsive overuse of dopaminergic medications prescribed for motor symptoms (the dopamine dysregulation syndrome), and neuropsychiatric complications of these medications, including impulse control disorders, psychosis, and manic syndromes. Optimal management of these problems requires close collaboration across disciplines because of the potential for interactions among the pathophysiologic process of PD, motor symptoms, dopaminergic drugs, and psychiatric symptoms. The authors emphasize how their model of multidisciplinary care facilitates close collaboration among psychiatrists, other mental health professionals, neurologists, and functional neurosurgeons and how this facilitates effective care for patients who develop the specific neuropsychiatric complications discussed.
authors.affiliation: Department of Psychiatry, Brigham and Women's Hospital, Boston, MA; The Stanley Center for Psychiatric Research at The Broad Institute, Cambridge, MA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Taylor
authors.affiliation: Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: William S
authors.initials: WS
authors.lastname: Anderson
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Jason
authors.initials: J
authors.lastname: Brandt
authors.affiliation: Department of Neurology, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Mari
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, Baltimore, MD. Electronic address: gpontone@jhmi.edu.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Pontone
mesh_terms: D000978:Antiparkinson Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001007:Anxiety / Q000139:chemically induced / Q000209:etiology; D003863:Depression / Q000139:chemically induced / Q000209:etiology; D018450:Disease Progression; D015259:Dopamine Agents / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D033183:Interdisciplinary Communication; D001523:Mental Disorders / Q000139:chemically induced / Q000209:etiology*; D008962:Models, Theoretical; D016472:Motor Neuron Disease / Q000139:chemically induced / Q000209:etiology / Q000523:psychology; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D010348:Patient Care Team
chemical_list: D000978:Antiparkinson Agents; D015259:Dopamine Agents
keywords: anxiety; depression; dopamine replacement therapy (DRT); multidisciplinary care; neuropsychiatric (symptoms), nonmotor (symptoms); parkinson disease