by Dr Ravisankar Moorchilot
Mental health problems like apathy, anxiety, low mood, sleep problems, cognitive impairment and psychosis are well known to be associated with Parkinson’s disease. At any given time, up to 40% people with Parkinson’s disease will experience anxiety, up to 40% will have depression and up to 50% will experience mild psychotic symptoms(1). The majority of mental health problems in Parkinson’s disease are not optimally managed(2). Dementia is a common feature of the later stages of Parkinson’s disease with estimated prevalence between 24-31%(3). The APPG 2009 inquiry revealed many people with Parkinson’s disease are not receiving specialist mental health services(4). Access to treatment for mental health problems in Parkinson’s disease is poor(1).
To assess the effectiveness of assessment and management of mental health issues in Parkinson’s disease in our setting a study was conducted.
- To do a survey among health professionals in secondary care delivering care to patients with Parkinson’s disease regarding management of mental health issues in Parkinson’s disease.
- To review the management of mental health issues in patients with Parkinson’s disease by reviewing the clinic letters and other correspondence letters from secondary care.
A survey was conducted among two geriatricians, two neurologists and three parkinson’s nurse specialists. We also reviewed the clinic letters and correspondence from secondary care related to Parkinson’s disease in 53 cases looking at whether mental health issues were addressed in the previous one year.
The survey among the health professionals revealed about 85% feel patients did not receive adequate care for their mental health needs. The majority felt confident of assessing and diagnosing mental health issues but did not feel confident in managing the mental health problems. All of them felt access to mental health problems is not adequate and for those who had mental health review adequate feedback was not received back from the community mental health team regarding their assessment and management plans. The survey also showed that there is no adequate time available for proper mental health assessments during the routine follow up.
On reviewing the clinic letters and other correspondence letters of patients from secondary care, symptoms related to the mental health issues were asked in less than 50% of the patients during the previous one year. Symptoms addressed the most included hallucinations in 43%, sleep disturbances in 40%, cognition in 39% and mood problems in 30% of cases. Those that were less commonly addressed were agitation and aggression in 7%, psychosis in 10%, anxiety 17% and impulse control disorders 17%. While assessing the memory problems screening tools were used in only in 53% cases who had symptoms of memory problems, 20% cases with anxiety and 18% cases with depression.
We conclude that mental health assessments in Parkinson’s disease need to be improved. One of the key barriers to do adequate assessments is inadequate time available during the follow up review in the clinic. As there is no joined up working between the community mental health team and secondary care it was difficult for the secondary care team to get adequate feedback regarding management plans made for those who were reviewed by the community mental health team. Asking patients to complete a non-motor questionnaire prior to the clinic review which will help to open up the mental health symptoms and, if needed, further assessments and management can be done. We are working with our mental health colleagues to develop a pathway for managing mental health issues in Parkinson’s disease. We also feel having a mental liaison service working alongside our current team will help in supporting the assessments and improving the communication between the secondary care and the community mental health team.
- Parkinson’s UK. Psychological services for people with Parkinson’s disease (2009)
- Dobkin RD, Rubino JT, Friedman J, Allen LA, Gara MA, Menza M. Barriers to mental health utilization in Parkinson’s disease. J Geriatr Psychiatry Neurol. 2013;26(2): 105-116
- AarslandD, Zaccai J, Brayne C. Asystematic review of prevelance studies of dementia in Parkinson’s disease. Mov Disorders 2005 Oct,20(10):1255-63
- All party parliamentary group 2009. Please mind the gap- Parkinson’s disease service today
Dr Ravisankar Moorchilot, Queen’s Medical Centre, Nottingham