ABSTRACT
OBJECTIVES: Impulse Control Disorders (ICDs) in Parkinson's disease (PD) have previously almost exclusively been considered to result from anti-parkinsonian medication. However, this biomedical perspective has failed to achieve a full understanding of the phenomenon and it is argued that a failure to consider psychological factors is a critical omission. DESIGN: The present study examined the predictive relationship between ICDs in PD and a range of psychological measures, whilst controlling for a number of biomedical determinants. MAIN OUTCOME MEASURES: One hundred participants with idiopathic PD completed questionnaires that assessed demographic and clinical characteristics, psychological measures and the presence of ICDs (QUIP-RS). RESULTS: Increased use of a 'negative' coping strategy, stronger illness identity, more emotional illness representations and stress were found to be significant predictors of ICDs, and different psychological predictors were associated with different ICDs. Medication was not found to predict ICDs in the presence of psychological factors, either when total treatment levels were considered or when agonist dose was considered alone. CONCLUSIONS: This study provides the first quantitative evidence of a predominant predictive relationship between psychological factors and ICDs in PD. The results suggest that psychological interventions may have useful therapeutic role to play for ICDs in PD.
Subject(s)
Disruptive, Impulse Control, and Conduct Disorders/epidemiology , Parkinson Disease/psychology , Aged , Female , Humans , Male , Middle Aged , Risk FactorsABSTRACT
OBJECTIVES: Parkinson's disease (PD) is a neurodegenerative disorder, affecting the motor system with psychological difficulties also frequently reported. While explanations for psychological difficulties are historically situated within a biomedical framework, more recently the relevance of psychological determinants has become a research focus. This review therefore examines this relationship with the two most commonly reported psychological difficulties (anxiety and depression) in people with PD. METHOD: Databases were systematically searched up to December 17, 2013, identifying 24 studies meeting inclusion criteria. RESULTS: Significant predictors of heightened anxiety and depression included increased emotion-focused coping; less problem-focused coping; lower perceived control; more dominant beliefs about PD as part of a person's identity and influence on life; less social support and more avoidant personality types. CONCLUSIONS: Relationships between some specific psychological predictors and depression and anxiety seem well supported. The complexity of relationships between these psychological determinants should be taken into consideration when delivering psychological interventions.
