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Autonomic disturbance and pain. While most people are troubled by these problems in the later stages of their, certain non-motor conditions can develop throughout the course of the condition (eg depression, anxiety, ) or even precede it (eg sleep disturbance, depression, anxiety). A recent study reported on the non-motor problems experienced by a group of 149 people with followed for 15–18 years. They found the occurrence rates were: falls 81% (with 23% suffering fractures), cognitive decline 84% (48% fulfilling criteria for dementia), hallucinations 50%, depression 50%, choking 50%, symptomatic postural hypotension 35%, and urinary incontinence 41%. There have previously been few therapeutic studies examining the effects of treatments for non-motor disorders. However, there is now a real desire to increase research into the non-motor features of as their effect on people’s well-being has been recognised. The non-motor features of considered in the scope of this guideline and thus undergoing literature review were: •.

Depression, dementia and psychosis are frequent problems in and some research has been performed on their treatment. Therefore, these topics were included in the scope of this guideline. Other important mental health issues in include anxiety and apathy, but little work has been done in these areas specific to PD so they were not included in the scope. Standard treatment therefore applies in these areas; see guidance entitled: ‘Anxiety: management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care’. Depression Depression affects around 40–50% of people with. It is usually mild to moderate but can be severe, and symptoms of depression can predate motor manifestations.

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The relationship of depression to the pathology of is unclear but the inconsistent relationship between mood changes and the severity of motor symptoms indicates that depression should not simply be considered a reaction to motor disability. There are difficulties in diagnosing mild depression in people with as the clinical features of depression overlap with the motor features of PD. The characteristic features of depression are low mood, loss of interest and enjoyment, and fatigue.

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This is accompanied by various combinations of: •. Disturbance of cognitive function and thought processes. The disturbance of cognitive functions and thought processes may result in poor concentration and memory, excessive worry, feelings of worthlessness, hopelessness and guilt, negative views of self and life, and thoughts of suicide. Psychological and physical symptoms of anxiety are also common. The development of depression creates an added burden for people with and their carers and has been shown to be an important determinant of. Factors relevant to the aetiology of depression that need to be considered are: •. Methodology A and two randomised controlled trials, (published after the review’s search date) were found which addressed the effectiveness of antidepressant therapies versus or active comparator.

No controlled trials were found on electroconvulsive therapy or behavioural therapy for the treatment of depression in people. The included three trials: one trial compared a selective serotonin re- inhibitor (SSRI) with; another study compared a tricyclic antidepressant (TCA) with placebo; and the third trial compared the effectiveness of an SSRI versus a TCA. These trials included small sample sizes (range 22–47). There were several methodological limitations of the included studies: lack of power calculations, lack of characteristics, and no details on methods of. The duration of the included trials varied from 16 to 52 weeks (with one study not reporting the trial duration). One of the independent RCTs compared the effectiveness of an SSRI with. The methodological limitations of this study included unclear methods of and, small (N=12, six in each arm) and lack of power calculations.

The study reported that, because of the low recruitment, the study was terminated after 10 weeks. The second independent compared repetitive transcranial magnetic stimulation (rTMS) versus an SSRI as an effective antidepressant therapy. The methodological limitations included: short trial duration (8 weeks), small (N=42, 21 in each arm) and lack of power calculation. Confusion and visual hallucination were infrequently reported in people taking fluvoxamine and amitriptyline; otherwise, no other major were reported. (1++) One of the independent RCTs reported no significant difference between sertraline (SSRI) and in terms of ‘response’ to treatment (defined as at least 50% reduction of the pre-treatment ), or motor scores.