What are the Symptoms of Anxiety Disorders and Treatments ?

There are many different ways in which a person with Parkinson’s can experience anxiety. The following is a list of common anxiety disorders and a description of symptoms associated with each form. As many as two out of five people with Parkinson’s will experience one of these forms during the course of their illness.

1. Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is characterized by feelings of nervousness and recurring thoughts of worry and fear. This worrying is in excess of what would normally be expected given the situation and often leaves the person feeling out of control. Physical symptoms that may accompany these feelings include butterflies in the stomach, trouble breathing or swallowing, racing of the heart, sweating and increased tremors.

2. Anxiety Attacks

Anxiety, or panic, attacks usually start suddenly with a sense of severe physical and emotional distress. Individuals may feel as if they cannot breathe or are having a heart attack. They may feel they are experiencing a medical emergency. These episodes usually last less than an hour, particularly when associated with “off” periods, though they can last for longer periods of time.

3. Social Avoidance

Social avoidance, or social anxiety disorder, involves avoiding everyday social situations because of a fear of embarrassment at having Parkinson's symptoms, such as tremor, dyskinesias, or trouble walking noticed in public. Exposure to social situations can lead to severe anxiety in these individuals, which goes away when the person is removed from the situation.

4. Obsessive-Compulsive Disorder

People with obsessive-compulsive disorder (OCD ) may be plagued by persistent, unwelcome thoughts or images (obsessions), and by the urgent need to engage in certain rituals (compulsions) to try to control or rid themselves of these thoughts. As an example, they may be obsessed with germs or dirt, and wash their hands over and over. Performing these so-called rituals, however, only provides temporary relief, and not performing them markedly increases anxiety.

What are the Treatment Options for Anxiety?

There are two main types of treatment options for anxiety:  medications and psychological counseling (psychotherapy).  Depending on the severity of symptoms, psychotherapy can be used alone or combination with medication. NPF recommends a holistic, comprehensive strategy for the treatment of mental health problems, meaning that care should be tailored to each person’s individual health needs and preferences.

The following are treatment options for anxiety disorders:

Medication Therapy

SSRIs (antidepressants)

A newer class of antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs) are typically the first-line treatment for depression and anxiety disorders. All of these medications have been shown to be helpful for one or more anxiety disorder. They include:

• fluoxetine (Prozac®)
• sertraline (Zoloft®)
• paroxetine (Paxil®)
• citalopram (Celexa®)
• escitalopram (Lexapro®)

For patients with anxiety attacks, very low dosages should be used at first, as there is evidence that these medications can actually increase attacks when first started at higher dosages. An added benefit of using SSRIs is that they also work for depression, which often occurs simultaneously. 

Benzodiazepines (anti-anxiety medications)

An older class of medications called benzodiazepines is used to treat anxiety disorders and target the brain chemical GABA. Most of these medications have been around for many years.  They include:

• diazepam (Valium®)
• lorazepam (Ativan®)
• clonazepam (Klonopin®)
• alprazolam (Xanax®)

These medications can be very effective for anxiety, sometimes working better than antidepressants. They take effect very quickly, often providing some relief after a single dose, though they have to be taken regularly for a lasting effect. Also, they can help with other symptoms of Parkinson’s, including certain types of tremor, muscle cramping and sleep changes. Major drawbacks of using benzodiazepines include memory difficulties, confusion, increase in balance problems and tiredness. These medications should not be stopped suddenly, as patients can have serious withdrawal symptoms.

NOTE: Benzodiazepines should be used with caution in older patients with Parkinson’s or in those with dementia. If used regularly, they should never be stopped suddenly to avoid serious withdrawal symptoms.

Psychotherapy

Psychotherapy or “talk therapy” is a term used to refer to the many varieties of counseling available today. This type of treatment can help people diagnosed with an anxiety disorder understand their illness and better manage their symptoms. Mental health professionals who provide therapy include psychologists, social workers, psychiatrists, licensed professional counselors, and specially-trained nurses. Importantly, the first step is to find a compatible therapist. Here are ways that quality therapy can be beneficial.

• Cognitive behavioral therapy (CBT) is a popular technique that has been shown to be very effective at helping people change negative thinking patterns and behaviors in order to solve their problems and engage in life.
• Counseling sessions can provide vital support, understanding and education. Patients may be seen alone, as a couple or family, or in a group.
• For those who do not want to take medication, psychotherapy offers two advantages: no drug side effects and coping skills that can be used over the long term.

New treatment targeting versatile protein may protect brain cells in Parkinson's disease

May 16, 2014

Source:

Lund University

 In Parkinson’s disease (PD), dopamine-producing nerve         cells that control our movements waste away. Current treatments for PD therefore aim at restoring dopamine contents in the brain. In a new study, researchers are attacking the problem from a different angle, through early activation of a protein that improves the brain's capacity to cope with a host of harmful processes.

In Parkinson's disease (PD), dopamine-prodcing nerve cells that control our movements waste away.

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Current treatments for PD therefore aim at restoring dopamine contents in the brain. In a new study from Lund University, researchers are attacking the problem from a different angle, through early activation of a protein that improves the brain's capacity to cope with a host of harmful processes. Stimulatingthe protein, called Sigma-1 receptor, sets off a battery of defence mechanisms and restores lost motor function. The results were obtained in mice, but clinical trials in patients may not be far away.

By activating the Sigma-1 receptor, a versatile protein involved in many cellular functions, levels of several molecules that help nerve cells build new connections increased, inflammation decreased, while dopamine levels also rose. The results, published in the journalBrain, show a marked improvement of motor symptoms in mice with a Parkinson-like condition that had been treated with a Sigma-1-stimulating drug for 5 weeks.

This treatment has never before been studied in connection with Parkinson's disease. However, various publications linked to stroke and motor neurone disease have reported positive results with drugs that stimulate the Sigma-1 receptor, and a biotech company in the US will soon begin clinical trials on Alzheimer's patients. The fact that substances stimulating this protein are already available for clinical use is a major advantage, according to Professor M. Angela Cenci Nilsson, head of the research team at Lund University.

"It is a huge advantage that these substances have already been tested in people and approved for clinical application. It means that we already know that the body tolerates this treatment. Clinical trials for Parkinson's disease could theoretically start any time."

Boosting the brain's in-built defence mechanisms with approaches like this is a rather new idea in Parkinson's research. Professor Cenci Nilsson, however, believes that the number of targets for future treatments is increasing as we learn more and more about the complex effects of PD on many different types of cells in the brain.

"The motor improvements we have seen in mice are disproportionately large compared to the recovery of dopamine levels. We believe this is because the treatment has protected the brain against a series of indirect consequences triggered by the Parkinson-like lesion. For example, we know today that a loss of dopamine causes the target neurons to lose synapses, and also alters both neural pathways and non-neuronal cells in the brain. Since the Sigma-1 receptor is widely expressed in many cell types, the treatment could intervene in many of these damaging processes ."

The treatment was shown to be significantly more effective when started at the beginning of the most aggressive phase of dopamine cell death. As a future potential therapy for Parkinson's disease, this treatment would therefore need to be started as soon as possible after diagnosis in order to deliver maximum impact.

"In order to accelerate a possible clinical translation of our findings, we will now seek further evidence in support of this type of treatment. We are now discussing various opportunities with different collaborating partners, and we will try to procure funding for clinical studies in Parkinson´s disease as soon as possible," concludes M. Angela Cenci Nilsson.

Story Source:

The above story is based on materials provided by Lund University. Note: Materials may be edited for content and length.

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Journal Reference:

1. V. Francardo, F. Bez, T. Wieloch, H. Nissbrandt, K. Ruscher, M. A. Cenci.Pharmacological stimulation of sigma-1 receptors has neurorestorative effects in experimental parkinsonism. Brain, 2014; DOI: 10.1093/brain/awu107

Partners in Parkinson's,

Partners in Parkinson's, a new initiative from the Michael J. Fox Foundation, offers on online tool to help patients locate a movement-disorder specialist, in collaboration with the International Parkinson and Movement Disorder Society, whose members include medical specialists. With funding from pharmaceutical company AbbVie Inc., which has a Parkinson's drug in development, the Fox foundation is holding patient and family events where specialists from local clinics demonstrate a comprehensive evaluation.

                                                                       

Dennis Ploszaj, 65, exercises and volunteers to help patients 

at the University of Toledo's Gardner-McMaster Parkinson Center.

 Dennis Ploszjad

Patients visiting the University of Florida Center for Movement Disorders and Neurorestoration, in Gainesville, are screened for depression, which can be caused by changes in the brain as well as by sadness about the disease's effects, said Michael Okun, the center's co-director and author of the book "Parkinson's Treatment: 10 Secrets to a Happier Life." Patients receive a neurologist's evaluation of motor function, including their gait and balance, as well as their lung function.

Dr. Okun says the aim is to prevent falls, fractures and a respiratory ailment called aspiration pneumonia, which are the leading causes of injury and death in Parkinson's patients. They can see several specialists in a single day, including mental-health and speech and communication therapists, who can help with issues like swallowing.

A study led by Peter Schmidt, vice president of research at the National Parkinson Foundation, estimates that neurologist care prevents more than 4,500 deaths a year in Parkinson's patients. The foundation trains medical teams and is conducting a large study at 20 clinics in its Centers of Excellence network to identify factors that result in longer and more active lives for Parkinson's patients.

Dennis Ploszaj, 65, of Findlay, Ohio, was diagnosed with Parkinson's in 2005 at age 56, after experiencing shakiness and balance issues while volunteering as a high-school sports referee. He says his doctor told him he might have a decade or so to live and provided little information about lifestyle changes that could help.

"Movement disorder specialist wasn't in my vocabulary," Mr. Ploszaj says. A year later, he attended a seminar held by Lawrence Elmer, director of the University of Toledo's Gardner-McMaster Parkinson Center, and signed on as a new patient.

"There is so much more to offer patients now than just, 'Here, take a pill,' " says Dr. Elmer. He told Mr. Ploszaj that it would be possible for him to delay the disease's progression and lead a good life. Dr. Elmer advised regular exercise.

Mr. Ploszaj signed up for clinical drug trials and hearing and speech therapy. With his disease under control, Mr. Ploszaj now volunteers to help other patients. "A lot of people come in very down and don't yet understand the disease, so I try to pick up their spirits." he says.

Write to Laura Landro at laura.landro@wsj.com
In the Wallstreet Journal

Specialized Care Urged for Treating Parkinson's Disease

Advocacy Groups Urge Patients to See Specialists for Movement Diseases

Updated May 26, 2014 8:00 p.m. ET

Beth Hochstein (center) gave up a career as a podiatrist several years after a diagnosis of young-onset Parkinson's disease.. She now is a Zumba instructor and leads classes for people with Parkinson's near her home in Great Neck, N.Y. Zumba Fitness

A new push is on to provide more specialized care for millions of people with Parkinson's disease and related conditions that impair control of body movement.

Advocacy groups say many doctors aren't extensively trained in treating these conditions, yet studies have shown that only some 40% to 60% of patients ever seek care from a specialist.

Patients benefit most under the care of a neurologist with extra training in movement disorders, backed up by a team including mental health professionals and physical and occupational therapists who can help with the diseases' physical and emotional toll, advocates say.

World-wide, the number of Parkinson's patients alone is projected to double by 2030. The aging population accounts for much of the rise in movement disorders, but they are also being diagnosed in younger patients and can be inherited. Parkinson's affects an estimated 1 million to 1.5 million people in the U.S.

For unknown reasons, Parkinson's leads to degeneration in brain structures called basal ganglia, as well as a loss of chemicals, especially dopamine. The loss causes nerve cells to go haywire and can result in tremors, stiffness and loss of motor control, as well as depression and thinking problems. Dystonia, or involuntary, prolonged and often painful muscle contractions, is caused by dysfunction in similar brain regions and affects about 500,000 people, including some Parkinson's patients. Another condition known as essential tremor, which affected the actress Katharine Hepburn, occurs in as many as 10 million people, and some will develop Parkinson's or dystonia.

Movement disorders often progress slowly and can be controlled with drugs including the central nervous system agent levodopa. There are side effects, such as fluctuations in the ability to control movements, low blood pressure and confusion.

Some patients are candidates for surgical procedures such as deep brain stimulation, in which abnormal movements are regulated with electrical impulses from electrodes implanted in the brain. Side effects can include seizure and mood changes and there can be problems with hardware or poor placement of electrodes, among other issues.

New drugs are in the pipeline, and genetic research is yielding promising clues for future treatment. But the least expensive and most accessible treatment often isn't stressed by doctors unaware of its benefits: Exercise, including dance, has been shown to lead to sharp improvements in some symptoms and may even delay progression of Parkinson's.

Beth Hochstein, who was diagnosed with young-onset Parkinson's in 2007 at age 36, was on medication to control tremors. In 2010, she had to give up her career as a podiatrist in Great Neck, N.Y., because of side effects from medication to control her hands during surgery.

A movement-disorder specialist she consulted early on had advised her that exercise "was the best nonmedical help I could get."

Dr. Hochstein had grown up dancing and took it up again, starting with hip-hop and then popular Zumba classes. She trained with a program called Dance for PD led by the Brooklyn, N.Y.-based Mark Morris Dance Company and now teaches a class affiliated with a hospital near her home.

She starts by telling participants how dance helped her control her symptoms.

Treatment centers specializing in movement disorders have expanded around the country in recent years, with funding from the federal government and nonprofits including the National Parkinson Foundation and the Bachmann-Strauss Dystonia & Parkinson Foundation.

A survey by Harris Poll that included more than 500 patients for the Michael J. Fox Foundation, named for its founder, the actor who has the disease, found that fewer than half were aware of movement-disorder specialists.

Only about 28% of Parkinson's patients surveyed were currently seeing one, and only about half felt "informed" or "very informed" about how to control their symptoms, the survey found.

Conventional treatment may not give proper weight to the link between movement disorders and mental health. Patients may experience anxiety and embarrassment caused by uncontrollable movements and tics, as well as a social stigma.

According to the National Parkinson Foundation, most physicians, especially those who lack training in movement disorders, don't know how to deliver a diagnosis of Parkinson's and often leave the patient feeling lost and alone.

In Wallstreet Journal