Conditions like Parkinson's disease bring additional mental health problems, like depression or psychosis, which warrant attention in their own right. The difficulties regulating emotions which sometimes happen after a stroke, in addition to the psychological reaction at the physical disability, can also be diagnosed and treated at this clinic.
The prevalence of Parkinson’s disease is 200-300 per 100,000 and it increases with age, although sometimes it can affect younger people. Rest tremor is the most characteristic feature; the other two typical symptoms from the triad are rigidity and bradykinesia (slow movement). Depression is common in Parkinson's disease with 50% prevalence (Burn 2002). Depression is one of the most important determinants of quality of life in this disease. It is not completely clear what percentage of depression is caused by the neurological degeneration; mood changes can also be influenced by levodopa and even Bipolar mood changes have even been described.
Anxiety is also commonly associated with the severity of motor symptoms and in particular with the "frozen gait" symptom. Antidepressant therapy as well as CBT approach in conjunction with physiotherapy has proven a successful treatment.
Psychotic symptoms can also occur in Parkinson´s disease, and a thorough assessment is required to ascertain if the psychosis is neurogenic, iatrogenic or caused by a collateral physical health problem. For the iatrogenic psychosis, the cause can be identified depending upon the type of psychosis, acute or subacute and progressive. A neurogenic psychosis is likely to be insidious and tends to be associated with a cognitive decline. Different strategies can be used to treat the different types of psychosis. This clinic brings the opportunity to thoroughly assess collateral psychiatric problems in the context of Parkinson´s disease and treating them alongside the neurological team.
Depression after a stroke is common, and it has an incidence of 25% in the first year. Nevertheless it might be difficult to ascertain due to the communication difficulties suffered by many of those patients. Accounts of informants are crucial. To treat depression in patients with suggestive symptoms is controversial as we carry the risk of causing delirium triggered by antidepressant medication in an already compromised brain although antidepressants are indicated in the cases where depression has been established. This highlights the importance of a very careful assessment. When it comes to the cause of depression, emphasis has been placed on the site of the stroke and the hypothesis that damage to the left frontal area increases the risk of depression. However it seems that the physical disability caused by the stroke is the most likely cause of depression. Catastrophic reactions which are the extreme emotional behaviour when a patient finds a task overwhelming, can predict depression.
Anxiety disorders are also common and they tend to be caused by the fear of recurrence.
Emotional lability with an increase in laughing or crying without previous warning can be quite distressing and happening in the absence of an affective disorder. However a careful clinical assessment is necessary in order to establish a clear diagnosis.
These conditions can be explored and treated at this clinic where the links with the necessary disciplines can be established when required.