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Psychoses in Parkinsons disease - Generics
Parkinson's disease (PD) is a chronic progressive neurodegenerative disorder characterized by the loss of dopaminergic neurons in the substantia nigra pars compacta of the brain, leading to motor symptoms such as tremors, rigidity, bradykinesia, and postural instability. However, non-motor symptoms are also prevalent in PD, including cognitive impairment, depression, anxiety, and psychosis.
Psychosis is a common neuropsychiatric complication of PD, with a prevalence ranging from 10% to 60% in different studies. Psychosis in PD refers to a set of symptoms that include visual hallucinations, delusions, and paranoia. These symptoms can occur at any stage of the disease, but they are more common in advanced stages.
The pathophysiology of psychosis in PD is not well understood. However, it is believed to be multifactorial, involving both neurochemical and neuroanatomical changes. The degeneration of dopaminergic neurons in the mesocorticolimbic pathway and the nigrostriatal pathway is thought to contribute to the development of psychosis in PD. Other neurotransmitters, such as acetylcholine and serotonin, have also been implicated in the development of psychosis in PD.
Treatment of psychosis in PD is challenging because antipsychotic medications, which are the mainstay of treatment for psychosis in the general population, can worsen motor symptoms and cause extrapyramidal side effects. Therefore, non-pharmacological interventions are usually the first line of treatment for psychosis in PD. These interventions include education and counseling for patients and their families, environmental modifications, and behavioral interventions.
If non-pharmacological interventions are insufficient, atypical antipsychotic medications such as quetiapine and clozapine are the preferred pharmacological treatments for psychosis in PD. These medications have a lower risk of causing extrapyramidal side effects than typical antipsychotics such as haloperidol. However, they still have some risk of causing metabolic side effects such as weight gain and hyperlipidemia.
In conclusion, psychosis is a common complication of PD that can significantly impact the quality of life of patients and their caregivers. Treatment of psychosis in PD is challenging, and non-pharmacological interventions should be the first line of treatment. When pharmacological treatment is needed, atypical antipsychotics such as quetiapine and clozapine are the preferred medications due to their lower risk of extrapyramidal side effects.
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Psychoses in Parkinsons disease, পারকিনসন রোগের মনোবিজ্ঞান
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