Abstract
Psychiatric complications in Parkinson's disease (PD) are associated with a range of negative outcomes, including excess disability, worse quality of life, poorer motor and cognitive outcomes, and caregiver distress. Specific psychiatric disorders—including affective disorders (depression and anxiety), psychosis, impulse control disorders (ICDs), disorders of sleep and wakefulness, apathy, and involuntary emotional expression disorder (IEED)—are discussed. The chapter focuses on an understanding of the epidemiology, phenomenology, risk factors, neuropathophysiology, and optimal treatment strategies for these disorders. The treatment methods and clinical recommendations of various PD psychiatric disorders are presented. Deep brain stimulation (DBS), usually bilateral DBS of the subthalamic nucleus, is increasingly used as a treatment for PD. Psychiatric intervention may take the form of adjusting DBS parameters, adjusting PD drugs, or initiating pharmacotherapy or psychotherapy. A range of psychiatric complications, frequently comorbid or multimorbid, is common in PD. The etiology of these disorders is complex and includes the hallmark neuropathophysiological changes of PD, exposure to PD treatments, and psychosocial factors.
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