Neuropsychiatric aspects of Parkinson disease psychopharmacology: Insights from circuit dynamics

Handb Clin Neurol. 2019:165:83-121. doi: 10.1016/B978-0-444-64012-3.00007-1.

Abstract

Parkinson disease (PD) is a neurodegenerative disorder with a complex pathophysiology characterized by the progressive loss of dopaminergic neurons within the substantia nigra. Persons with PD experience several motoric and neuropsychiatric symptoms. Neuropsychiatric features of PD include depression, anxiety, psychosis, impulse control disorders, and apathy. In this chapter, we will utilize the National Institutes of Mental Health Research Domain Criteria (RDoC) to frame and integrate observations from two prevailing disease constructions: neurotransmitter anomalies and circuit physiology. When there is available evidence, we posit how unified translational observations may have clinical relevance and postulate importance outside of PD. Finally, we review the limited evidence available for pharmacologic management of these symptoms.

Keywords: Anxiety; Apathy; Circuit; Depression; Impulse control; Parkinson disease; Psychopharmacology; Psychosis; RDoC.

Publication types

  • Review

MeSH terms

  • Adrenergic Uptake Inhibitors / pharmacology
  • Adrenergic Uptake Inhibitors / therapeutic use
  • Antiparkinson Agents / pharmacology
  • Antiparkinson Agents / therapeutic use
  • Brain / drug effects
  • Brain / physiopathology*
  • Humans
  • Mental Disorders / drug therapy*
  • Mental Disorders / physiopathology*
  • Mental Disorders / psychology
  • Nerve Net / drug effects
  • Nerve Net / physiopathology*
  • Parkinson Disease / drug therapy*
  • Parkinson Disease / physiopathology*
  • Parkinson Disease / psychology
  • Psychopharmacology

Substances

  • Adrenergic Uptake Inhibitors
  • Antiparkinson Agents