Parkinson's.ict Presentation.09

8/8/2019 Parkinson's.ict Presentation.09

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Psychosocial Aspects ofPsychosocial Aspects of

ParkinsonsParkinsons

John Stone (PsychosocialJohn Stone (PsychosocialOccupational Therapist)Occupational Therapist)

J.Stone(OT).10.2009J.Stone(OT).10.2009


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Psychosocial ?Psychosocial ?

Parkinsons is increasingly viewed asParkinsons is increasingly viewed as

more than a movement disorder with nonmore than a movement disorder with non--

motor symptoms or (NMS) that can affectmotor symptoms or (NMS) that can affectcognition, behaviour and mood.cognition, behaviour and mood.



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Cognitive disturbanceCognitive disturbance

Executive functioning.Executive functioning.

Visuospatial ability.Visuospatial ability.

Bradyphreinia.Bradyphreinia.

Attention and memory deficits.Attention and memory deficits.



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DementiaDementia

Dementia with Lewy Bodies 2Dementia with Lewy Bodies 2ndnd most common cause ofmost common cause ofDementia after Alzheimer's.Dementia after Alzheimer's.

Around 50% of those with Parkinsons Disease willAround 50% of those with Parkinsons Disease willwarrant a diagnosis ofDementia.warrant a diagnosis ofDementia.

Characterized by presence of both memory impairment,Characterized by presence of both memory impairment,one of aphasia, apraxia, agnosia, or executiveone of aphasia, apraxia, agnosia, or executivefunctioning, and the following: impaired occupationalfunctioning, and the following: impaired occupationalperformance, emotional disturbance, apathy, reducedperformance, emotional disturbance, apathy, reduced

motivation, diagnosis of Parkinsons, and the exclusionmotivation, diagnosis of Parkinsons, and the exclusionof antiof anti--parkinsons medication effects, delirium, and noparkinsons medication effects, delirium, and noother evident cause ofDementia.other evident cause ofDementia.

Memory impairment is most evident in problems learningMemory impairment is most evident in problems learningnew information.new information.

Drug treatments have mixed benefits.D

rug treatments have mixed benefits.J.Stone(OT).10.2009J.Stone(OT).10.2009


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Present in around 40% of PD clients.

Often presents before any onset of motor problems.

In early stages related to symptom progression and

medications. In later stages related to impairment in ADLs.

Most common in male PD.

Most common complaints relating to depression are said

to be sleep disturbance, sexual dysfunction, impairedoccupational functioning and pain.

Social events requiring challenge to motor skills, can

result in embarrassment and social isolation/withdrawl.

Depression



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Recognizing DepressionRecognizing Depression

DifficultDifficult requiring a range of assessment skills, timerequiring a range of assessment skills, time

and competant practitioners.and competant practitioners.

Key factorKey factor lack of enjoyment in participation, not lacklack of enjoyment in participation, not lackof motivation to do.of motivation to do.

TearfulnessTearfulness or the inability to cry.or the inability to cry.

To dieTo die expressions of wanting to die.expressions of wanting to die.

AntiAnti--depressantsdepressants have a role but are most affectivehave a role but are most affectivewhen accompanied by Psychosocial interventions.when accompanied by Psychosocial interventions.



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Depression related insomniaDepression related insomnia

Can often be noted before diagnosis of PD.Can often be noted before diagnosis of PD.

Requires attention and early treatment, as can develop into REMRequires attention and early treatment, as can develop into REM

behavior disorder (RBD) and nocturnal hallucinations.behavior disorder (RBD) and nocturnal hallucinations.

RBDRBD results in the body being kind of awake when asleep.results in the body being kind of awake when asleep.

Results in acting out of very vivid dreams.Results in acting out of very vivid dreams.

Often frightening.Often frightening.

Clients can jump out of bed, interfere with environments and evenClients can jump out of bed, interfere with environments and even

attack their sleeping partner.attack their sleeping partner.

Sexual DysfunctionSexual Dysfunction InIn womenwomen pain,pain, taughttaught skin,skin, restrictedrestricted movement,movement,

reducedreduced sensation/lubricationsensation/lubrication.. InIn menmen erectileerectile

dysfunctiondysfunction..



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Anxiety StatesAnxiety States

3030 50% of PD clients experience anxiety, mostly50% of PD clients experience anxiety, mostly

general, but less frequently panic attacks.general, but less frequently panic attacks.

Usually occurs alongside depression.Usually occurs alongside depression.

Strong association with social situations that placeStrong association with social situations that placegreater demand on motor skill performance.greater demand on motor skill performance.

Other disturbancesOther disturbances HyperHyper sexuality,sexuality, disinhibition,disinhibition, obsessiveobsessive compulsivecompulsive

behaviors,behaviors, abuseabuse ofof prescribedprescribed medications,medications, persistentpersistent

gamblinggambling..



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PsychosisPsychosis

Often related to anti PD medications.Often related to anti PD medications.

Can result in Delusions, such as:Can result in Delusions, such as:

Paranoia.Paranoia.

Othello Syndrome..Othello Syndrome..

Phantom boarder syndrome.Phantom boarder syndrome.

Illusions.Illusions.

Should be distinguished from delirium.Should be distinguished from delirium. Hallucinations.Hallucinations.

Visual.Visual.



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Psychosocial interventionPsychosocial intervention

Dementia:Dementia:

Early identification and implementation of DementiaEarly identification and implementation of DementiaPathway.Pathway.

Talking therapies.Talking therapies. Coping strategy enhancement.Coping strategy enhancement.

Support groups.Support groups.

PsychoPsycho--education.education.

Communication strategies.Communication strategies.

Maintenance and enhancement of OccupationalMaintenance and enhancement of Occupationalengagement.engagement.

Carer support, education and assessment for their ownCarer support, education and assessment for their ownpsychological welfare.psychological welfare.



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ConclusionConclusion

ICT has the range and skills to meet theICT has the range and skills to meet thePsychosocial needs of PD clients.Psychosocial needs of PD clients.



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Thank you for your timeThank you for your time

QUESTIONS?QUESTIONS?


Parkinson's.ict Presentation.09

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