Neuropsychiatric Aspects of Parkinsons Disease
Identifieur interne : 000330 ( Main/Corpus ); précédent : 000329; suivant : 000331Neuropsychiatric Aspects of Parkinsons Disease
Auteurs : Laura MarshSource :
- Psychosomatics [ 0033-3182 ] ; 1999.
Abstract
Parkinsons disease (PD), a disorder characterized by movement abnormalities, is frequently complicated by psychiatric syndromes. Psychiatric assessment of the PD patient requires familiarity with the motor and cognitive aspects of PD, the various effects of antiparkinsonian medications, and how these relate to mental status changes and psychiatric phenomena. This review describes the various motor and nonmotor features of PD and focuses on the differential diagnosis of affective disorders in PD and their treatment.
Url:
DOI: 10.1016/S0033-3182(00)71169-8
Links to Exploration step
ISTEX:A5CA17C7DEA4EAC8A766CF937A46750BCC75EF80Le document en format XML
<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Neuropsychiatric Aspects of Parkinsons Disease</title><author><name sortKey="Marsh, Laura" sort="Marsh, Laura" uniqKey="Marsh L" first="Laura" last="Marsh">Laura Marsh</name><affiliation><mods:affiliation>Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: lmarsh@hmi.edu</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:A5CA17C7DEA4EAC8A766CF937A46750BCC75EF80</idno><date when="2011" year="2011">2011</date><idno type="doi">10.1016/S0033-3182(00)71169-8</idno><idno type="url">https://api.istex.fr/document/A5CA17C7DEA4EAC8A766CF937A46750BCC75EF80/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">000330</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Neuropsychiatric Aspects of Parkinsons Disease</title><author><name sortKey="Marsh, Laura" sort="Marsh, Laura" uniqKey="Marsh L" first="Laura" last="Marsh">Laura Marsh</name><affiliation><mods:affiliation>Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: lmarsh@hmi.edu</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Psychosomatics</title><title level="j" type="abbrev">PSYM</title><idno type="ISSN">0033-3182</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1999">1999</date><biblScope unit="volume">41</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="15">15</biblScope><biblScope unit="page" to="23">23</biblScope></imprint><idno type="ISSN">0033-3182</idno></series><idno type="istex">A5CA17C7DEA4EAC8A766CF937A46750BCC75EF80</idno><idno type="DOI">10.1016/S0033-3182(00)71169-8</idno><idno type="PII">S0033-3182(00)71169-8</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0033-3182</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Parkinsons disease (PD), a disorder characterized by movement abnormalities, is frequently complicated by psychiatric syndromes. Psychiatric assessment of the PD patient requires familiarity with the motor and cognitive aspects of PD, the various effects of antiparkinsonian medications, and how these relate to mental status changes and psychiatric phenomena. This review describes the various motor and nonmotor features of PD and focuses on the differential diagnosis of affective disorders in PD and their treatment.</div></front></TEI><istex><corpusName>elsevier</corpusName><author><json:item><name>Laura Marsh M.D.</name><affiliations><json:string>Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland</json:string><json:string>E-mail: lmarsh@hmi.edu</json:string></affiliations></json:item></author><language><json:string>eng</json:string></language><abstract>Parkinsons disease (PD), a disorder characterized by movement abnormalities, is frequently complicated by psychiatric syndromes. Psychiatric assessment of the PD patient requires familiarity with the motor and cognitive aspects of PD, the various effects of antiparkinsonian medications, and how these relate to mental status changes and psychiatric phenomena. This review describes the various motor and nonmotor features of PD and focuses on the differential diagnosis of affective disorders in PD and their treatment.</abstract><qualityIndicators><score>7.876</score><pdfVersion>1.7</pdfVersion><pdfPageSize>612 x 792 pts (letter)</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>0</keywordCount><abstractCharCount>520</abstractCharCount><pdfWordCount>5972</pdfWordCount><pdfCharCount>40371</pdfCharCount><pdfPageCount>9</pdfPageCount><abstractWordCount>73</abstractWordCount></qualityIndicators><title>Neuropsychiatric Aspects of Parkinsons Disease</title><pii><json:string>S0033-3182(00)71169-8</json:string></pii><genre><json:string>research-article</json:string></genre><host><volume>41</volume><pii><json:string>S0033-3182(00)X7066-1</json:string></pii><pages><last>23</last><first>15</first></pages><issn><json:string>0033-3182</json:string></issn><issue>1</issue><genre><json:string>Journal</json:string></genre><language><json:string>unknown</json:string></language><title>Psychosomatics</title><publicationDate>2000</publicationDate></host><categories><wos><json:string>PSYCHIATRY</json:string><json:string>PSYCHOLOGY</json:string></wos></categories><publicationDate>1999</publicationDate><copyrightDate>2011</copyrightDate><doi><json:string>10.1016/S0033-3182(00)71169-8</json:string></doi><id>A5CA17C7DEA4EAC8A766CF937A46750BCC75EF80</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/A5CA17C7DEA4EAC8A766CF937A46750BCC75EF80/fulltext/pdf</uri></json:item><json:item><original>true</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/A5CA17C7DEA4EAC8A766CF937A46750BCC75EF80/fulltext/txt</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/A5CA17C7DEA4EAC8A766CF937A46750BCC75EF80/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/A5CA17C7DEA4EAC8A766CF937A46750BCC75EF80/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Neuropsychiatric Aspects of Parkinsons Disease</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>ELSEVIER</p></availability><date>2011</date></publicationStmt><notesStmt><note type="content">Table 1: Symptoms common to Parkinsons disease and major depression</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Neuropsychiatric Aspects of Parkinsons Disease</title><author><persName><forename type="first">Laura</forename><surname>Marsh</surname></persName><roleName type="degree">M.D.</roleName><email>lmarsh@hmi.edu</email><note type="biography">Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 3166, Baltimore, MD 21287.</note><affiliation>Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 3166, Baltimore, MD 21287.</affiliation><affiliation>Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland</affiliation></author></analytic><monogr><title level="j">Psychosomatics</title><title level="j" type="abbrev">PSYM</title><idno type="pISSN">0033-3182</idno><idno type="PII">S0033-3182(00)X7066-1</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1999"></date><biblScope unit="volume">41</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="15">15</biblScope><biblScope unit="page" to="23">23</biblScope></imprint></monogr><idno type="istex">A5CA17C7DEA4EAC8A766CF937A46750BCC75EF80</idno><idno type="DOI">10.1016/S0033-3182(00)71169-8</idno><idno type="PII">S0033-3182(00)71169-8</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2011</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Parkinsons disease (PD), a disorder characterized by movement abnormalities, is frequently complicated by psychiatric syndromes. Psychiatric assessment of the PD patient requires familiarity with the motor and cognitive aspects of PD, the various effects of antiparkinsonian medications, and how these relate to mental status changes and psychiatric phenomena. This review describes the various motor and nonmotor features of PD and focuses on the differential diagnosis of affective disorders in PD and their treatment.</p></abstract></profileDesc><revisionDesc><change when="1999-09-02">Registration</change><change when="1999">Published</change></revisionDesc></teiHeader></istex:fulltextTEI></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier doc found" wicri:toSee="Elsevier, no converted or simple article"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 5.1.0//EN//XML" URI="art510.dtd" name="istex:docType"></istex:docType><istex:document><article version="5.1" xml:lang="en" docsubtype="fla"><item-info><jid>PSYM</jid><aid>71169</aid><ce:pii>S0033-3182(00)71169-8</ce:pii><ce:doi>10.1016/S0033-3182(00)71169-8</ce:doi><ce:copyright type="other" year="2011">The Academy of Psychosomatic Medicine</ce:copyright></item-info><ce:floats><ce:table id="tbl0005" frame="topbot" rowsep="0" colsep="0"><ce:label>Table 1</ce:label><ce:caption><ce:simple-para id="spar0010">Symptoms common to Parkinson’s disease and major depression</ce:simple-para></ce:caption><tgroup cols="3"><colspec colname="col1"></colspec><colspec colname="col2"></colspec><colspec colname="col3"></colspec><thead valign="top"><row><entry rowsep="1"></entry><entry rowsep="1" align="left">Parkinson’s Disease</entry><entry rowsep="1" align="left">Major Depression</entry></row></thead><tbody><row><entry morerows="2" align="left">Motor</entry><entry align="left">Bradykinesia</entry><entry align="left">Psychomotor</entry></row><row><entry align="left">Stooped posture</entry><entry align="left">±Stooped posture</entry></row><row><entry align="left">Masked facies</entry><entry align="left">Restricted/depressed affect</entry></row><row><entry morerows="2" align="left">Cognitive</entry><entry align="left">Impaired memory</entry><entry align="left">Impaired memory</entry></row><row><entry align="left">Impaired concentration</entry><entry align="left">Impaired concentration</entry></row><row><entry align="left">Indecisiveness</entry><entry align="left">Indecisiveness</entry></row><row><entry morerows="3" align="left">Vegetative</entry><entry align="left">Decreased energy</entry><entry align="left">Decreased energy</entry></row><row><entry align="left">Fatigue</entry><entry align="left">Fatigue</entry></row><row><entry align="left">Impaired sleep</entry><entry align="left">Impaired sleep</entry></row><row><entry align="left">Appetite changes</entry><entry align="left">Appetite changes</entry></row><row><entry align="left">Somatic</entry><entry align="left">Physical complaints</entry><entry align="left">Physical complaints</entry></row></tbody></tgroup></ce:table></ce:floats><head><ce:title>Neuropsychiatric Aspects of Parkinson’s Disease</ce:title><ce:author-group><ce:author><ce:given-name>Laura</ce:given-name><ce:surname>Marsh</ce:surname><ce:degrees>M.D.</ce:degrees><ce:cross-ref refid="cor0005"><ce:sup>⁎</ce:sup></ce:cross-ref><ce:e-address type="email">lmarsh@hmi.edu</ce:e-address></ce:author><ce:affiliation><ce:textfn>Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland</ce:textfn></ce:affiliation><ce:correspondence id="cor0005"><ce:label>⁎</ce:label><ce:text>Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 3–166, Baltimore, MD 21287.</ce:text></ce:correspondence></ce:author-group><ce:date-received day="2" month="9" year="1999"></ce:date-received><ce:date-accepted day="2" month="9" year="1999"></ce:date-accepted><ce:abstract><ce:abstract-sec><ce:simple-para id="spar0005">Parkinson’s disease (PD), a disorder characterized by movement abnormalities, is frequently complicated by psychiatric syndromes. Psychiatric assessment of the PD patient requires familiarity with the motor and cognitive aspects of PD, the various effects of antiparkinsonian medications, and how these relate to mental status changes and psychiatric phenomena. This review describes the various motor and nonmotor features of PD and focuses on the differential diagnosis of affective disorders in PD and their treatment.</ce:simple-para></ce:abstract-sec></ce:abstract></head><body><ce:sections><ce:para id="par0005">Psychiatric syndromes as well as cognitive impairment frequently complicate Parkinson’s disease (PD), a neurodegenerative disorder defined by its movement abnormalities. Development of psychopathology in PD is attributed to a number of factors, including underlying disease processes related to PD, medication effects, and psychological reactions to the illness. This review focuses on mood disturbances in PD and has two major thrusts. The first is to convey the heterogeneity of PD and how its motor and cognitive features overlap or enhance the clinical features of psychiatric illnesses. The second emphasis is on the differential diagnosis and treatment of mood disorders in PD. Although major depression is common, conditions with similar features, such as apathetic syndromes and anxiety disorders, are also encountered in PD and warrant distinct consideration and management.</ce:para><ce:section id="sec0005"><ce:section-title>Clinical Features of Parkinson’s Disease: Relationship to Psychopathology</ce:section-title><ce:para id="par0010">The disease is named after James Parkinson, a general practitioner in London during the 19th century, who described the features of PD in six individuals.<ce:cross-ref refid="bib0005"><ce:sup>1</ce:sup></ce:cross-ref> Currently, PD affects about 1% of the population over age 50 and up to 2.5% of the population over age 70. U.S. government figures from 1994 placed annual societal costs related to PD at $20 billion.<ce:cross-ref refid="bib0010"><ce:sup>2</ce:sup></ce:cross-ref> The clinical onset of PD is typically around age 60, although juvenile or young-adult onset of the disease has been reported. It affects all races about equally, with reported discrepancies between incidence rates among Caucasians and African Americans said to be related to population sampling.<ce:cross-ref refid="bib0015"><ce:sup>3</ce:sup></ce:cross-ref> Men are affected slightly more often than women.</ce:para><ce:section id="sec0010"><ce:section-title>Motor Features</ce:section-title><ce:para id="par0015">The definitive diagnosis of PD is based on specific neuropathological findings: degeneration and loss of pigmented neurons of the substantia nigra (pars compacta) and intraneuronal inclusion bodies (Lewy bodies) in the substantia nigra.<ce:cross-ref refid="bib0020"><ce:sup>4</ce:sup></ce:cross-ref> The hallmark clinical signs of PD are its motor triad: 1) a pill-rolling rest tremor; 2) rigidity; and 3) bradykinesia/akinesia (slowness of movement and absence of movement, respectively). The clinical diagnosis of PD requires some combination of these cardinal signs, but there is a great deal of heterogeneity among patients, and none of these signs is specific to PD.<ce:cross-ref refid="bib0025"><ce:sup>5</ce:sup></ce:cross-ref> Furthermore, the classic motor signs may not be obvious early in the course of PD and might be mistaken for depressive phenomena.<ce:cross-ref refid="bib0030"><ce:sup>6</ce:sup></ce:cross-ref> For example, one clinic patient noted that others had commented for nearly 10 years before the onset of more obvious PD motor signs that she was not smiling in photographs. In one earlier large clinical series, only 70% of the PD patients demonstrated the classical rest tremor at the time of initial diagnosis, and about 5% presented with depression or nervousness.<ce:cross-ref refid="bib0035"><ce:sup>7</ce:sup></ce:cross-ref> In the same series, a subgroup complained of various somatic symptoms that, especially in the presence of facial masking or fatigue, might suggest a primary depressive illness rather than PD.</ce:para><ce:para id="par0020">A host of symptoms are related to the PD motor triad, some of which also overlap with the core features of mood disorders. Accordingly, PD can be misdiagnosed as a primary depressive illness, and concomitant depression may go unrecognized in the PD patient. Even when both conditions (PD and depression) are diagnosed concurrently, it can be difficult to tease apart which clinical phenomena are related to primary motor vs. primary psychiatric pathology (see <ce:cross-ref refid="tbl0005">Table 1</ce:cross-ref><ce:float-anchor refid="tbl0005"></ce:float-anchor>). For example, the slowed movements of bradykinesia are a well-recognized component of depression, usually described as psychomotor retardation. Stooped posture, reduced dexterity, decreased facial expression (hypomimia), and small handwriting (micrographia) are also related to bradykinesia.</ce:para><ce:para id="par0025">Tremor, seen in up to 80% of PD patients,<ce:cross-ref refid="bib0040"><ce:sup>8</ce:sup></ce:cross-ref> can be a significant component of anxiety syndromes. Considering that postural and action tremors are also common in PD and that some patients never develop a rest tremor, tremor may go unrecognized as a feature of PD or a related neurological condition until other motor signs emerge. Some patients also report a sensation of internal tremor that is associated with anxiety.<ce:cross-ref refid="bib0045"><ce:sup>9</ce:sup></ce:cross-ref> Rigidity, represented by increased tone during passive motor movements, is often manifest as cramps, aches, or pains. These motor features contribute to gait and postural disturbances, with a loss of righting reflexes, unsteadiness, imbalance and falls, sometimes up to multiple times daily, as the disease progresses. Sialorrhea, dysarthria, visual and genitourinary dysfunction, sleep disturbances, sweating, seborrhea, edema, constipation, paresthesias, fatigue, and a decreased sense of smell are other common complaints throughout the course of the illness. Mood disorders and antidepressant treatments can exacerbate any of these phenomena.</ce:para></ce:section><ce:section id="sec0015"><ce:section-title>Cognitive Deficits</ce:section-title><ce:para id="par0030">The cognitive features of PD are present to varying degrees early in the course of the disease and are multifactorial in origin, involving subcortical–frontal dopaminergic systems as well as extrastriatal systems.<ce:cross-refs refid="bib0050 bib0055 bib0060 bib0065 bib0070"><ce:sup>10–14</ce:sup></ce:cross-refs> The various forms of executive dysfunction, visuospatial impairment,memory impairment, and attention deficits that occur in PD can render patients less able to accomplish familiar tasks or make them feel overwhelmed in situations that were not previously challenging. The presence of a mood disorder, which can precede, accompany, or follow cognitive changes, may also confound assessment of cognitive impairment and intensify deficits.<ce:cross-ref refid="bib0075"><ce:sup>15</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0080"><ce:sup>16</ce:sup></ce:cross-ref> About 25% of patients develop an Alzheimer- type dementia with cortical features of aphasia, apraxia, and memory deficits.<ce:cross-ref refid="bib0085"><ce:sup>17</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0090"><ce:sup>18</ce:sup></ce:cross-ref> While depressive disorders can coexist with dementia in PD, families and clinicians may also misinterpret a tendency to reduce social interactions in early dementia as a sign of depression rather than impaired cognition only and seek antidepressant treatment. The distinction is important, since PD patients with dementia are especially vulnerable to psychoactive medication effects and the development of delirium, a leading cause of nursing home placement in PD.<ce:cross-ref refid="bib0095"><ce:sup>19</ce:sup></ce:cross-ref></ce:para></ce:section><ce:section id="sec0020"><ce:section-title>Treatment of Motor Features and Related Complications</ce:section-title><ce:para id="par0035">Most antiparkinsonian medications reduce the primary motor symptoms through increased dopamine availability, although new therapies are emerging.<ce:cross-ref refid="bib0100"><ce:sup>20</ce:sup></ce:cross-ref> However, delirium, mood changes, and psychosis are common complications of therapy.<ce:cross-ref refid="bib0105"><ce:sup>21</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0110"><ce:sup>22</ce:sup></ce:cross-ref> Levodopa, a dopamine precursor, is the mainstay of PD therapy and the most effective medicine for controlling PD motor symptoms. Levodopa is generally available as a combined preparation with carbidopa, an enzyme that inhibits the peripheral metabolism of dopamine. Bromocriptine, pergolide, and newer agents such as pramipexole and ropinirole are dopamine-receptor agonists that act by increasing postsynaptic dopamine activity. Deprenyl or selegiline, a monoamine oxidase-B inhibitor, and tolcapone, a catecholamine transferase inhibitor, inhibit dopamine metabolism and increase synaptic dopamine. Amantadine and anticholinergic agents such as trihexiphenidyl and benztropine are also used to treat motor symptoms.</ce:para><ce:para id="par0045">Over long-term treatment, the beneficial motor effects of levodopa wane, and its adverse motor side effects become seriously limiting.<ce:cross-ref refid="bib0115"><ce:sup>23</ce:sup></ce:cross-ref> These side effects, in combination with the disease itself, further influence mood stability.<ce:cross-ref refid="bib0120"><ce:sup>24</ce:sup></ce:cross-ref> The period of improved motor functioning is referred to as the “on” state and the period of reduced mobility at the end of a dosing interval is referred to as the “off” state. To relieve “on–off” motor fluctuations, higher doses of levodopa are required at more frequent intervals (e.g., every 2–3 hours), or even as a constant infusion, in rare cases, to achieve comparable efficacy. Eventually, most patients on chronic levodopa therapy also develop abnormal, involuntary hyperkinetic movements, referred to as drug-induced dyskinesias.<ce:cross-ref refid="bib0125"><ce:sup>25</ce:sup></ce:cross-ref> These movements are usually peakdose choreic or dystonic motions of the extremities, trunk, or even head. The “on–off” motor fluctuations and dyskinesia can be quite dramatic, with complete immobility or “freezing” in the “off” state and extreme motor activity in the “on” state, accompanied with flailing and writhing dyskinetic movements.<ce:cross-ref refid="bib0130"><ce:sup>26</ce:sup></ce:cross-ref></ce:para><ce:para id="par0050">Motor fluctuations are a significant problem in the long-term management of the PD patient. Most remarkable, though, is how individuals vary greatly in terms of their ability to tolerate motor fluctuations. Whereas some patients find these fluctuations distressing, disabling, disfiguring, or embarrassing, other patients are indifferent. Psychiatric illness and cognitive abilities further modify how patients cope with fluctuations. Emotional triggers may provoke or intensify motor fluctuations, although sometimes there are no clear precipitants.<ce:cross-ref refid="bib0110"><ce:sup>22</ce:sup></ce:cross-ref> Anticipatory anxiety, for example, associated with the desire to arrive on time for an appointment, is commonly cited as a cause of motor fluctuations. Anxiety can also be a response to motor dysfunction. Sudden akinesia, or “freezing,” can be disabling and even dangerous, such as when attempting to leave a public restroom, reaching for one’s wallet in a checkout line, or crossing a street. In some instances, positive emotions also incite motor fluctuations. One patient, a musician, described how her passionate feelings while listening to classical music provoked extreme dyskinesias.</ce:para><ce:para id="par0055">In addition to psychological reactions to the motor fluctuations, mood changes can be temporally related to the motor fluctuations, suggesting a primary role for dopaminergic mechanisms.<ce:cross-ref refid="bib0135"><ce:sup>27</ce:sup></ce:cross-ref> Typically, patients with such mood changes describe depression or anxiety in the “off” period and a neutral or elevated mood in the “on” state.<ce:cross-ref refid="bib0140"><ce:sup>28</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0145"><ce:sup>29</ce:sup></ce:cross-ref> Panic states with prominent autonomic symptoms can occur as the medication wears off, but anxious states may be protracted even after there is a motor response to levodopa.<ce:cross-ref refid="bib0150"><ce:sup>30</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0155"><ce:sup>31</ce:sup></ce:cross-ref> There are also descriptions of irritability, apathy, hallucinosis, psychosis, screaming, and cognitive slowing during “off” periods and hypersexuality, hypomania, withdrawal, and thought racing during “on” periods.<ce:cross-ref refid="bib0130"><ce:sup>26</ce:sup></ce:cross-ref> Management of mood disorders associated with motor fluctuations is complicated. Management requires primary attention to the antiparkinsonian regimen, and determination of whether treatment of a more pervasive mood disorder is also warranted.</ce:para><ce:para id="par0060">Neurosurgical therapies for PD, started over 30 years ago, provide additional relief of symptoms and may limit complications related to medications. Pallidotomy is indicated for treatment-related dyskinesias and motor fluctuations in PD. Thalamotomy is used to treat tremor in PD and other conditions such as essential tremor or multiple sclerosis. Several analyses have shown reductions in anxiety and depression following pallidotomy that are unrelated to the improved motor function.<ce:cross-refs refid="bib0160 bib0165 bib0170"><ce:sup>32–34</ce:sup></ce:cross-refs> More recently, the availability of deep brain stimulation (DBS) offers an alternative to destructive lesions. With DBS, a patient-controlled pacemaker-like device sends electrical impulses to the thalamus or globus pallidus, as needed, to reduce tremor. Fetal brain tissue implantation remains experimental.<ce:cross-ref refid="bib0175"><ce:sup>35</ce:sup></ce:cross-ref></ce:para></ce:section></ce:section><ce:section id="sec0025"><ce:section-title>Psychiatric Complications</ce:section-title><ce:para id="par0065">For many years, it was thought that psychiatric phenomena in PD, particularly affective changes, were related to the lack of dopamine and the motor impairment. After availability of levodopa treatment in the 1960s, it became apparent that up to two-thirds of PD patients have persistent affective disturbances, despite antiparkinsonian treatment, and that the mood changes were amenable to antidepressant treatment.<ce:cross-ref refid="bib0180"><ce:sup>36</ce:sup></ce:cross-ref> In this context, it is now apparent that the underlying neurodegenerative disorder is a major cause of psychiatric disturbances in PD, although psychological reactions to the clinical illness are also important to consider. Integral to the development of PD is the loss of dopaminergic neurons in the substantia nigra and secondary effects on projection systems involving the caudate nucleus and putamen (striatum) and frontal and cingulate cortical regions. Accordingly, the diverse motor and nonmotor features of PD and their interrelationships are thought to result from dysfunction of putative cortical–basal ganglia–thalamic neural loops.<ce:cross-ref refid="bib0185"><ce:sup>37</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0190"><ce:sup>38</ce:sup></ce:cross-ref></ce:para><ce:para id="par0070">In addition to loss of dopaminergic neurons, PD is accompanied by degeneration of noradrenergic neurons in the locus coeruleus, serotonergic neurons in the dorsal raphe, and cholinergic neurons in the nucleus basalis and their attendant projections systems. Differential degrees of pathology among these neuronal systems are thought to underlie the heterogeneous motor, cognitive, and psychiatric features of PD. For example, Paulus and Jellinger<ce:cross-ref refid="bib0195"><ce:sup>39</ce:sup></ce:cross-ref> showed different neuropathological patterns in akineticrigid PD, compared with tremor-dominant PD. Also, the series by Paulus and Jellinger showed more cortical Alzheimer-type lesions and greater neuronal loss in the medial substantia nigra in the dementia subjects they studied, whereas the depressed patients had increased neuronal loss in the dorsal raphe. However, the patients with psychosis had no specific neuropathologic features.</ce:para><ce:para id="par0075">The interrelations of motor, cognitive, and psychiatric phenomena in PD create unique challenges for assessment of psychopathology in a given patient. Clearly, the mere experience of motor disability influences mental state. However, some patients with very mild motor impairment are greatly incapacitated by psychiatric disturbances, whereas others with severe motor symptoms maintain their mental health. Cognitive deficits exert additional independent effects on mental state but further influence how one copes with the motor disability. In turn, psychiatric phenomena can exacerbate cognitive and motor dysfunction and influence mental status in their own right. Further complicating assessment is the dynamic nature of psychopathology in PD due to fluctuating psychoactive medication effects, plus the progressive nature of the disease. In addition to PD-specific factors, equally important are the usual factors relevant to any psychiatric evaluation (e.g., prior psychiatric conditions, family history, temperament, coping styles, social resources, and life events). The clinician’s challenge is to integrate and understand the role of various PD-related and non–PD-related factors on psychopathology and determine the salient influences, which are then targets of psychiatric treatment.</ce:para></ce:section><ce:section id="sec0030"><ce:section-title>Mood Disturbances</ce:section-title><ce:para id="par0080">Up to 90% of PD patients with idiopathic PD experience psychiatric complications, including major mood disorders (major depression, dysthymia, or bipolar disorder); adjustment disorders; disabling anxiety syndromes; drug-induced mood changes; pathological tearfulness; dementia; apathetic states; psychosis; or delirium.<ce:cross-ref refid="bib0200"><ce:sup>40</ce:sup></ce:cross-ref> Mood disturbances, the emphasis in this review, are especially common and present diagnostic and management challenges to clinicians. Since most studies of affective disturbances in PD have focused on depression, clinical practice has followed accordingly. Less attention has been paid to the differential diagnosis of depressive phenomena and the characterization and management of related affective syndromes. Discernment of these syndromes requires insight into the various motor and cognitive features of PD, as described earlier, as well as the phenomenology of each discrete condition.</ce:para><ce:section id="sec0035"><ce:section-title>Depression</ce:section-title><ce:para id="par0085">The prevalence of major depression in PD is estimated to be 40%,<ce:cross-ref refid="bib0205"><ce:sup>41</ce:sup></ce:cross-ref> with reported prevalence rates ranging from 4% to 70%.<ce:cross-ref refid="bib0210"><ce:sup>42</ce:sup></ce:cross-ref> Major depression accounts for about half of the cases with significant depression, whereas others experience adjustment disorders, dysthymia, or bipolar disorder. The major depressive syndrome is generally of moderate-to-severe intensity and is frequently accompanied by anxiety symptoms.<ce:cross-ref refid="bib0215"><ce:sup>43</ce:sup></ce:cross-ref> In general, studies have shown that there is no clear relationship to age at onset or duration of PD, family history of mood disorders, or a personal history of previous depressive episodes.<ce:cross-ref refid="bib0210"><ce:sup>42</ce:sup></ce:cross-ref></ce:para><ce:para id="par0090">A central issue is whether the major depressive syndrome in PD is a reaction to the motor disability or whether the syndrome is intrinsic to the disease processes of PD. In support of the latter idea is considerable evidence that depression can precede development of motor symptoms, suggesting that the depression is in itself a neurological sign.<ce:cross-ref refid="bib0075"><ce:sup>15</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0080"><ce:sup>16</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0220"><ce:sup>44</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0225"><ce:sup>45</ce:sup></ce:cross-ref> Other studies suggest that depression is a reaction to the disability, on the basis of correlations between depression severity and motor impairment.<ce:cross-ref refid="bib0230"><ce:sup>46</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0235"><ce:sup>47</ce:sup></ce:cross-ref> Although these relationships are not always detected,<ce:cross-ref refid="bib0075"><ce:sup>15</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0220"><ce:sup>44</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0240"><ce:sup>48</ce:sup></ce:cross-ref> correlations between depression severity and motor impairment in late-stage PD suggest a differential basis for depressive syndromes as the disease progresses.<ce:cross-ref refid="bib0240"><ce:sup>48</ce:sup></ce:cross-ref></ce:para><ce:para id="par0095">Clearly, the relationship between mood and motor phenomena in PD is complex. Interestingly, motor improvement with medications is not associated with improved mood,<ce:cross-refs refid="bib0245 bib0250 bib0255"><ce:sup>49–51</ce:sup></ce:cross-refs> but successful treatment of depression is associated with better motor function.<ce:cross-ref refid="bib0240"><ce:sup>48</ce:sup></ce:cross-ref> A few studies also demonstrate close relationships between depression and impaired cognition during depressive episodes that reverse after treatment of the mood syndrome.<ce:cross-ref refid="bib0075"><ce:sup>15</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0240"><ce:sup>48</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0260"><ce:sup>52</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0265"><ce:sup>53</ce:sup></ce:cross-ref></ce:para><ce:para id="par0100">A number of studies implicate serotonin in the pathogenesis of depression in PD. Neurochemical studies show reduced peripheral and central serotonin metabolites (5-HIAA),<ce:cross-ref refid="bib0080"><ce:sup>16</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0270"><ce:sup>54</ce:sup></ce:cross-ref> improved depressive symptoms with serotonergic therapies,<ce:cross-ref refid="bib0275"><ce:sup>55</ce:sup></ce:cross-ref> and decreased platelet-imipramine binding in depressed PD patients.<ce:cross-ref refid="bib0280"><ce:sup>56</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0285"><ce:sup>57</ce:sup></ce:cross-ref> A neuroanatomical basis for depression in PD is suggested by neuroimaging studies. These show relative hypometabolism in the caudate and inferior orbital-frontal regions<ce:cross-ref refid="bib0290"><ce:sup>58</ce:sup></ce:cross-ref> and in the medial-frontal lobes<ce:cross-ref refid="bib0295"><ce:sup>59</ce:sup></ce:cross-ref> in depressed PD patients relative to non-depressed PD patients and control subjects.</ce:para></ce:section><ce:section id="sec0040"><ce:section-title>Apathy</ce:section-title><ce:para id="par0105">Apathy, defined as a state of diminished motivation, can present in PD as a symptom of major depression, delirium, dementia, or demoralization or as an independent syndrome.<ce:cross-ref refid="bib0300"><ce:sup>60</ce:sup></ce:cross-ref> With the latter, the patient’s inactivity and indifference are particularly frustrating for families and caregivers who frequently perceive the patient as depressed. Two studies have examined apathy in PD in detail.<ce:cross-ref refid="bib0305"><ce:sup>61</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0310"><ce:sup>62</ce:sup></ce:cross-ref> In the earlier study,<ce:cross-ref refid="bib0305"><ce:sup>61</ce:sup></ce:cross-ref> depression and apathy coexisted in 30% of the sample, and 12% of subjects had apathy alone. Compared with the euthymic PD patients, there were no differences in age, gender, duration of PD, or motor impairment, but the patients with apathetic syndromes tended to have a later age-at-onset relative to those with PD plus depression. Also, the patients with apathy had specific deficits on neuropsychological tests, although this finding was not confirmed in the later report.<ce:cross-ref refid="bib0310"><ce:sup>62</ce:sup></ce:cross-ref></ce:para><ce:para id="par0110">The features of apathy are analogous to other aspects of PD, in particular bradyphrenia and bradykinesia,<ce:cross-ref refid="bib0315"><ce:sup>63</ce:sup></ce:cross-ref> suggesting that some cognitive, behavioral, and motor features in PD are related to shared pathophysiology. Evidence that bradyphrenia is related to neuronal loss in the locus coeruleus implicates a role for noradrenergic dysfunction.<ce:cross-ref refid="bib0320"><ce:sup>64</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0325"><ce:sup>65</ce:sup></ce:cross-ref></ce:para></ce:section><ce:section id="sec0045"><ce:section-title>Emotionalism</ce:section-title><ce:para id="par0115">Several studies have recognized an increased frequency of crying or emotional lability in PD patients relative to control subjects.<ce:cross-ref refid="bib0180"><ce:sup>36</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-refs refid="bib0325 bib0330 bib0335"><ce:sup>65–67</ce:sup></ce:cross-refs> Emotionalism in PD refers to heightened and excessive sentimentality that is inappropriate, unmotivated, and involuntary. It is usually fleeting, but there are often visible tears or weeping. Excessive tearfulness in PD can occur as a feature of major depression, emotional incontinence (also referred to as pathological laughter or crying), delirium, or with benzodiazapine use. Pathological laughter can also occur but is less common.<ce:cross-ref refid="bib0340"><ce:sup>68</ce:sup></ce:cross-ref> Patients describe how uncontrollable and excessive emotionality is triggered by a variety of positive and negative stimuli, such as poignant scenes on television, concerns about the future, or watching someone do a kind deed. For some patients, emotionalism leads to severe social embarrassment, along with phobic avoidance. Patients and/or their families will often conclude that the crying means they “must be depressed,” and are relieved to learn that this phenomenon occurs frequently in PD, often in the absence of a more pervasive depressive syndrome. Closer examination of emotionalism in PD showed that nearly 40% of patients reported increased tearfulness since the onset of PD, and 11% had more pervasive emotionalism.<ce:cross-ref refid="bib0325"><ce:sup>65</ce:sup></ce:cross-ref> There were no consistent associations between emotionalism and cognitive impairment or major depressive syndromes.</ce:para></ce:section><ce:section id="sec0050"><ce:section-title>Anxiety</ce:section-title><ce:para id="par0120">Anxiety is a common problem in PD, but relatively little attention has been paid to this phenomenon.<ce:cross-ref refid="bib0210"><ce:sup>42</ce:sup></ce:cross-ref> While anxiety can present as an isolated symptom or as a feature of depression,<ce:cross-ref refid="bib0345"><ce:sup>69</ce:sup></ce:cross-ref> clinically significant anxiety syndromes occur in up to 40% of PD patients.<ce:cross-ref refid="bib0350"><ce:sup>70</ce:sup></ce:cross-ref> Particularly common are generalized anxiety disorder, social phobia, and panic disorder, which has a prevalence rate of 25% in some series.<ce:cross-ref refid="bib0150"><ce:sup>30</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0355"><ce:sup>71</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0360"><ce:sup>72</ce:sup></ce:cross-ref> These syndromes may also precede or accompany a major depressive syndrome, and can persist after the depressive illness is treated. Above all, they should be regarded as distinct from anxiety, which is an understandable psychological response to motor impairment or other personal concerns. These syndromes are also independent of anxiety that occurs with fluctuations in levodopa levels.<ce:cross-ref refid="bib0145"><ce:sup>29</ce:sup></ce:cross-ref> Autonomic dysfunction, a common complication of PD regardless of psychiatric status, can also be associated with anxiety or depression. Accordingly, somatic complaints related to autonomic symptoms (e.g., flushing, dizziness, urinary frequency, or changes in heart rate) must be evaluated carefully because they can be misdiagnosed (and mistreated), as if they represented affective syndromes.<ce:cross-ref refid="bib0365"><ce:sup>73</ce:sup></ce:cross-ref></ce:para><ce:para id="par0125">The anxiety syndromes in PD appear related to underlying brain disease, with evidence implicating noradrenergic dysfunction.<ce:cross-refs refid="bib0370 bib0375 bib0380"><ce:sup>74–76</ce:sup></ce:cross-refs> In several studies, anxiety syndromes preceded the onset of motor symptoms,<ce:cross-ref refid="bib0165"><ce:sup>33</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0360"><ce:sup>72</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0385"><ce:sup>77</ce:sup></ce:cross-ref> but anxiety disorders can also develop later.<ce:cross-ref refid="bib0150"><ce:sup>30</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0390"><ce:sup>78</ce:sup></ce:cross-ref> Some studies show relationships between panic symptoms and fluctuations in antiparkinsonian medications and motor symptoms,<ce:cross-ref refid="bib0150"><ce:sup>30</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0215"><ce:sup>43</ce:sup></ce:cross-ref> but clear relationships among anxiety and disability ratings, motor symptoms, and dopaminergic medications have not been established.<ce:cross-ref refid="bib0345"><ce:sup>69</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0360"><ce:sup>72</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0390"><ce:sup>78</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0395"><ce:sup>79</ce:sup></ce:cross-ref> However, discrete anxiety syndromes in PD may represent regional differences in PDrelated pathology. In a recent analysis, cognitive performance in PD patients with and without anxiety disorders was relatively better in the anxious group, especially on tasks involving frontal lobe cognitive processes.<ce:cross-ref refid="bib0155"><ce:sup>31</ce:sup></ce:cross-ref></ce:para></ce:section><ce:section id="sec0055"><ce:section-title>Psychosis</ce:section-title><ce:para id="par0130">Hallucinations and delusions occur in up to 40% of PD patients and are a major precipitant of nursing home placement.<ce:cross-ref refid="bib0095"><ce:sup>19</ce:sup></ce:cross-ref> Psychosis is related to dopaminergic medications in about 20% of PD patients,<ce:cross-ref refid="bib0400"><ce:sup>80</ce:sup></ce:cross-ref> a relationship that tends to overshadow other important causes of psychosis in PD. Psychosis can also develop spontaneously or in association with cognitive impairment, on–off fluctuations, mood disturbance, other psychoactive medications, and/or delirium.<ce:cross-ref refid="bib0110"><ce:sup>22</ce:sup></ce:cross-ref> The psychotic syndromes are frequently categorized into three general groups:<ce:cross-ref refid="bib0405"><ce:sup>81</ce:sup></ce:cross-ref> The first group consists of visual hallucinations that tend to be vivid depictions of animals or people that occur in a clear sensorium and are accompanied by insight. The second type generally involves more persistent hallucinations or delusions in a clear sensorium but with diminished insight. This second state often requires definitive antipsychotic treatment. In the third group, hallucinations or delusions occur in the context of a delirium.</ce:para><ce:para id="par0135">Hallucinations and delusions also occur as features of major depressive or manic syndromes, diagnoses that can be overlooked when patients are especially agitated. A population-based study of psychosis showed associations among psychotic symptoms and age, stage, and diagnostic subgroup of PD, severity of depression, and cognitive impairment, whereas antiparkinsonian medications did not discriminate between the PD patients with and without psychosis.<ce:cross-ref refid="bib0410"><ce:sup>82</ce:sup></ce:cross-ref> This finding suggests more widespread pathologic brain involvement in the setting of psychosis and argues against a prominent role for antiparkinsonian medicines in the development of psychosis. A role for cholinergic deficits in the psychosis of PD has also been suggested.<ce:cross-ref refid="bib0415"><ce:sup>83</ce:sup></ce:cross-ref></ce:para></ce:section></ce:section><ce:section id="sec0060"><ce:section-title>Treatment</ce:section-title><ce:para id="par0140">Several reviews describe the treatment of psychiatric conditions in PD, including strategies for prescribing medications and nonpharmacological approaches.<ce:cross-ref refid="bib0110"><ce:sup>22</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0400"><ce:sup>80</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-refs refid="bib0420 bib0425 bib0430 bib0435"><ce:sup>84–87</ce:sup></ce:cross-refs> However, there are few empirical data to guide treatment; the majority of the reports involve open-label trials or descriptive case studies. A recent meta-analysis noted only 12 controlled trials in the literature on treatment of depression in PD and noted that the quality of most studies was poor.<ce:cross-ref refid="bib0440"><ce:sup>88</ce:sup></ce:cross-ref> Further, none involved newer antidepressants available over the last decade. The situation is similar for treatment of psychosis in PD, except for one recent, large, multicenter, double-blind, placebo-controlled trial that demonstrated efficacy of low-dose clozapine (6.25<ce:hsp sp="0.25"></ce:hsp>mg–50<ce:hsp sp="0.25"></ce:hsp>mg/day).<ce:cross-ref refid="bib0445"><ce:sup>89</ce:sup></ce:cross-ref> Behavioral or medical treatments of anxiety, emotionalism, or apathy in PD have not been studied.</ce:para><ce:para id="par0145">Most treatments are aimed at the specific syndromes just described. When psychotropic medications are indicated, the most important point to remember is that the underlying brain disease and older age of most PD patients renders them especially vulnerable to adverse effects. Also, psychiatric medications run the risk of aggravating motor and cognitive symptoms. For every patient, the first step should include careful review of antiparkinsonian and other medical treatments, elimination of unwarranted polypharmacy, and minimization of medication fluctuations and adverse drug–drug interactions. Many patients use nonprescription and herbal treatments, and these should be considered in the overall treatment plan. As treatment proceeds, motor, cognitive, and psychiatric functioning, including the risks of falls, confusion, oversedation, and enhanced parkinsonism, should be monitored carefully, with adjustments made to balance treatment effects.</ce:para><ce:para id="par0150">Dosing and treatment duration play a role in nonresponse or side effects. Often, patients respond to small amounts of medicine (e.g., nortriptyline elixir, 5<ce:hsp sp="0.25"></ce:hsp>mg qhs or clozapine, 6.25<ce:hsp sp="0.25"></ce:hsp>mg qod), but other patients require and tolerate standard or higher doses. The risk of developing serotonin syndrome or hypertensive reactions when combining selegiline with antidepressant medications is often discussed;<ce:cross-ref refid="bib0450"><ce:sup>90</ce:sup></ce:cross-ref> however, most patients tolerate this combination.<ce:cross-ref refid="bib0110"><ce:sup>22</ce:sup></ce:cross-ref></ce:para><ce:para id="par0155">Given limited data on the use of antidepressant agents in PD, medication choices are usually based on consideration of side-effect profiles. Controlled antidepressant trials, conducted most recently in the 1980s, show particular efficacy for tricyclic antidepressants such as nortriptyline, which inhibits serotonin–norepinephrine reuptake, and bupropion, which inhibits norepinephrine and dopamine reuptake.<ce:cross-ref refid="bib0440"><ce:sup>88</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-refs refid="bib0455 bib0460 bib0465"><ce:sup>91–93</ce:sup></ce:cross-refs> A few studies describe effects of more recently developed antidepressants.<ce:cross-ref refid="bib0430"><ce:sup>86</ce:sup></ce:cross-ref> The putative role of serotonin in PD-related depression suggests a role for serotonin reuptake inhibitors. Response to these varies,<ce:cross-ref refid="bib0250"><ce:sup>50</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0470"><ce:sup>94</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0475"><ce:sup>95</ce:sup></ce:cross-ref> and motor symptoms can worsen.<ce:cross-ref refid="bib0480"><ce:sup>96</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0485"><ce:sup>97</ce:sup></ce:cross-ref> Electroconvulsive therapy (ECT) is another safe and effective treatment for depression in PD.<ce:cross-ref refid="bib0490"><ce:sup>98</ce:sup></ce:cross-ref> Studies of the use of ECT for PD patients without depression show sustained motor improvement up to 1 year in some individuals.<ce:cross-ref refid="bib0495"><ce:sup>99</ce:sup></ce:cross-ref> In general, benzodiazapines are poorly tolerated for treatment of anxiety, agitation, or sleep disturbances associated with depression because of adverse cognitive effects, although there are exceptions. Low-dose trazodone (e.g., 25<ce:hsp sp="0.25"></ce:hsp>mg–100<ce:hsp sp="0.25"></ce:hsp>mg) can help with insomnia.</ce:para><ce:para id="par0160">Treatment of psychosis generally involves adjusting antiparkinsonian medications, addressing problems with sleep and anxiety, patient and caregiver education, and, ultimately, if necessary, antipsychotics. ECT is used to treat psychotic depression as well as dopamine-induced psychosis.<ce:cross-ref refid="bib0500"><ce:sup>100</ce:sup></ce:cross-ref> Since most antipsychotic medications block dopamine type II receptors, there is the risk of increased and markedly disabling parkinsonism. However, atypical agents (e.g., clozapine, olanzapine, quetiapine, and risperidone) have been shown to be effective at low doses for the treatment of psychosis.<ce:cross-ref refid="bib0400"><ce:sup>80</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0435"><ce:sup>87</ce:sup></ce:cross-ref><ce:sup>,</ce:sup><ce:cross-ref refid="bib0445"><ce:sup>89</ce:sup></ce:cross-ref> Unfortunately, many patients still do not tolerate these agents, either developing confusion/delirium, intolerable sedation, or increased parkinsonism. Odansetron, a pure 5-HT3 inhibitor is also an effective antipsychotic,<ce:cross-ref refid="bib0505"><ce:sup>101</ce:sup></ce:cross-ref> but its expense often precludes continuing treatment. I have found odansetron useful for postoperative agitation. Cholinergic agents (e.g., donepezil) may also reduce psychosis in PD, implicating nondopaminergic mechanisms.<ce:cross-ref refid="bib0415"><ce:sup>83</ce:sup></ce:cross-ref></ce:para><ce:para id="par0165">Given the complexity and risks of medications for treatment of psychiatric problems in PD, nonpharmacologic treatments are a significant cornerstone of treatment.<ce:cross-ref refid="bib0420"><ce:sup>84</ce:sup></ce:cross-ref> Many patients have never been evaluated psychiatrically, so the initial consultation can prove beneficial to patients and family members. Education on the signs and symptoms of psychiatric conditions, their potential relationship to the underlying neurodegenerative disease, and the relative contributions of the motor features of PD helps patients and their families cope better with the presenting problems. Psychotherapy ranges from supportive to insight-oriented therapy, including grief counseling.<ce:cross-ref refid="bib0510"><ce:sup>102</ce:sup></ce:cross-ref> Coping styles and strategies as well as caretaker status also need to be addressed. Homecare programs can assist in patient management and enhance function through services such as occupational, physical, and speech therapy. Visiting nurses, including those with psychiatric training, and social workers allow more frequent observation of the patient than is possible with an office-based practice and provide additional caretaker support.<ce:cross-ref refid="bib0515"><ce:sup>103</ce:sup></ce:cross-ref> Patients are also encouraged to take part in relaxation training, physical exercise, and support groups to promote overall well-being and functioning.</ce:para></ce:section></ce:sections><ce:acknowledgment><ce:para id="par0170">Support for this work was provided by the <ce:grant-sponsor id="gs0005">National Association for Research on Schizophrenia and Affective Disorders</ce:grant-sponsor> and the <ce:grant-sponsor id="gs0010">Morris K. Udall Parkinson’s Disease Research Center of Excellence</ce:grant-sponsor> (<ce:grant-sponsor id="gs0015">National Institutes of Health</ce:grant-sponsor>, Grant <ce:grant-number refid="gs0005">P50-NS-38377</ce:grant-number>).</ce:para></ce:acknowledgment></body><tail><ce:bibliography id="bibl0005"><ce:section-title>References</ce:section-title><ce:bibliography-sec id="bibs0005"><ce:bib-reference id="bib0005"><ce:label>1.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>J.</ce:given-name><ce:surname>Parkinson</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>An Essay on the Shaking Palsy</sb:maintitle></sb:title></sb:contribution><sb:host><sb:book><sb:date>1817</sb:date><sb:publisher><sb:name>Sherwood, Neely, and Jones</sb:name><sb:location>London, UK</sb:location></sb:publisher></sb:book></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0010"><ce:label>2.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>J.L.</ce:given-name><ce:surname>Cummings</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Understanding Parkinson disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>JAMA</sb:maintitle></sb:title><sb:volume-nr>281</sb:volume-nr></sb:series><sb:date>1999</sb:date></sb:issue><sb:pages><sb:first-page>376</sb:first-page><sb:last-page>378</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0015"><ce:label>3.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>C.M.</ce:given-name><ce:surname>Tanner</ce:surname></sb:author><sb:author><ce:given-name>J.P.</ce:given-name><ce:surname>Hubble</ce:surname></sb:author><sb:author><ce:given-name>P.</ce:given-name><ce:surname>Chan</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Epidemiology and genetics of Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:edited-book><sb:editors><sb:editor><ce:given-name>R.K.</ce:given-name><ce:surname>Watts</ce:surname></sb:editor><sb:editor><ce:given-name>W.C.</ce:given-name><ce:surname>Koller</ce:surname></sb:editor></sb:editors><sb:title><sb:maintitle>Movement Disorders: Neurologic Principles and Practice</sb:maintitle></sb:title><sb:date>1997</sb:date><sb:publisher><sb:name>McGraw-Hill</sb:name><sb:location>New York</sb:location></sb:publisher></sb:edited-book><sb:pages><sb:first-page>137</sb:first-page><sb:last-page>152</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0020"><ce:label>4.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>A.J.</ce:given-name><ce:surname>Hughes</ce:surname></sb:author><sb:author><ce:given-name>S.E.</ce:given-name><ce:surname>Daniel</ce:surname></sb:author><sb:author><ce:given-name>L.</ce:given-name><ce:surname>Kilford</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Neurol Neurosurg Psychiatry</sb:maintitle></sb:title><sb:volume-nr>55</sb:volume-nr></sb:series><sb:date>1992</sb:date></sb:issue><sb:pages><sb:first-page>181</sb:first-page><sb:last-page>184</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0025"><ce:label>5.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>D.J.</ce:given-name><ce:surname>Gelb</ce:surname></sb:author><sb:author><ce:given-name>E.</ce:given-name><ce:surname>Oliver</ce:surname></sb:author><sb:author><ce:given-name>S.</ce:given-name><ce:surname>Gilman</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Diagnostic criteria for Parkinson disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Arch Neurol</sb:maintitle></sb:title><sb:volume-nr>56</sb:volume-nr></sb:series><sb:date>1999</sb:date></sb:issue><sb:pages><sb:first-page>33</sb:first-page><sb:last-page>39</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0030"><ce:label>6.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>E.G.</ce:given-name><ce:surname>Gonera</ce:surname></sb:author><sb:author><ce:given-name>M.</ce:given-name><ce:surname>van’t Hof</ce:surname></sb:author><sb:author><ce:given-name>J.C.</ce:given-name><ce:surname>Berger</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Symptoms and duration of the prodromal phase in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Mov Disord</sb:maintitle></sb:title><sb:volume-nr>12</sb:volume-nr></sb:series><sb:date>1997</sb:date></sb:issue><sb:pages><sb:first-page>871</sb:first-page><sb:last-page>876</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0035"><ce:label>7.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>M.M.</ce:given-name><ce:surname>Hoehn</ce:surname></sb:author><sb:author><ce:given-name>M.D.</ce:given-name><ce:surname>Yahr</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Parkinsonism: onset, progression, and mortality</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Neurology</sb:maintitle></sb:title><sb:volume-nr>17</sb:volume-nr></sb:series><sb:date>1967</sb:date></sb:issue><sb:pages><sb:first-page>427</sb:first-page><sb:last-page>442</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0040"><ce:label>8.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>W.E.</ce:given-name><ce:surname>Martin</ce:surname></sb:author><sb:author><ce:given-name>R.B.</ce:given-name><ce:surname>Loewenson</ce:surname></sb:author><sb:author><ce:given-name>J.A.</ce:given-name><ce:surname>Resch</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Parkinson’s disease: clinical analysis of 100 patients</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Neurology</sb:maintitle></sb:title><sb:volume-nr>23</sb:volume-nr></sb:series><sb:date>1973</sb:date></sb:issue><sb:pages><sb:first-page>783</sb:first-page><sb:last-page>790</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0045"><ce:label>9.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>L.M.</ce:given-name><ce:surname>Shulman</ce:surname></sb:author><sb:author><ce:given-name>C.</ce:given-name><ce:surname>Singer</ce:surname></sb:author><sb:author><ce:given-name>J.A.</ce:given-name><ce:surname>Bean</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Internal tremor in patients with Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Mov Disord</sb:maintitle></sb:title><sb:volume-nr>11</sb:volume-nr></sb:series><sb:date>1996</sb:date></sb:issue><sb:pages><sb:first-page>3</sb:first-page><sb:last-page>7</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0050"><ce:label>10.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>J.A.</ce:given-name><ce:surname>Cooper</ce:surname></sb:author><sb:author><ce:given-name>H.J.</ce:given-name><ce:surname>Sagar</ce:surname></sb:author><sb:author><ce:given-name>N.</ce:given-name><ce:surname>Jordan</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Cognitive impairment in early, untreated Parkinson’s disease and its relationship to motor disability</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Brain</sb:maintitle></sb:title><sb:volume-nr>114</sb:volume-nr></sb:series><sb:date>1991</sb:date></sb:issue><sb:pages><sb:first-page>2095</sb:first-page><sb:last-page>2122</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0055"><ce:label>11.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>J.A.</ce:given-name><ce:surname>Cooper</ce:surname></sb:author><sb:author><ce:given-name>H.J.</ce:given-name><ce:surname>Sagar</ce:surname></sb:author><sb:author><ce:given-name>S.M.</ce:given-name><ce:surname>Doherty</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Different effects of dopaminergic and anticholinergic therapies on cognitive and motor function in Parkinson’s disease: a follow-up study of untreated patients</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Brain</sb:maintitle></sb:title><sb:volume-nr>115</sb:volume-nr></sb:series><sb:date>1992</sb:date></sb:issue><sb:pages><sb:first-page>1701</sb:first-page><sb:last-page>1725</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0060"><ce:label>12.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>B.E.</ce:given-name><ce:surname>Levin</ce:surname></sb:author><sb:author><ce:given-name>H.L.</ce:given-name><ce:surname>Katzen</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Early cognitive changes and nondementing behavioral abnormalities in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Adv Neurol</sb:maintitle></sb:title><sb:volume-nr>65</sb:volume-nr></sb:series><sb:date>1995</sb:date></sb:issue><sb:pages><sb:first-page>85</sb:first-page><sb:last-page>95</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0065"><ce:label>13.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>B.</ce:given-name><ce:surname>Dubois</ce:surname></sb:author><sb:author><ce:given-name>B.</ce:given-name><ce:surname>Pillon</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Cognitive deficits in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Neurol</sb:maintitle></sb:title><sb:volume-nr>244</sb:volume-nr></sb:series><sb:date>1997</sb:date></sb:issue><sb:pages><sb:first-page>2</sb:first-page><sb:last-page>8</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0070"><ce:label>14.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>A.M.</ce:given-name><ce:surname>Gotham</ce:surname></sb:author><sb:author><ce:given-name>R.G.</ce:given-name><ce:surname>Brown</ce:surname></sb:author><sb:author><ce:given-name>C.D.</ce:given-name><ce:surname>Marsden</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>“Frontal” cognitive function in patients with Parkinson’s disease “on” and “off” levodopa</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Brain</sb:maintitle></sb:title><sb:volume-nr>111</sb:volume-nr></sb:series><sb:date>1988</sb:date></sb:issue><sb:pages><sb:first-page>299</sb:first-page><sb:last-page>321</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0075"><ce:label>15.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>R.</ce:given-name><ce:surname>Mayeux</ce:surname></sb:author><sb:author><ce:given-name>Y.</ce:given-name><ce:surname>Stern</ce:surname></sb:author><sb:author><ce:given-name>J.</ce:given-name><ce:surname>Rosen</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Depression, intellectual impairment, and Parkinson disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Neurology</sb:maintitle></sb:title><sb:volume-nr>31</sb:volume-nr></sb:series><sb:date>1981</sb:date></sb:issue><sb:pages><sb:first-page>645</sb:first-page><sb:last-page>650</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0080"><ce:label>16.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>M.</ce:given-name><ce:surname>Sano</ce:surname></sb:author><sb:author><ce:given-name>Y.</ce:given-name><ce:surname>Stern</ce:surname></sb:author><sb:author><ce:given-name>J.</ce:given-name><ce:surname>Williams</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Coexisting dementia and depression in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Arch Neurol</sb:maintitle></sb:title><sb:volume-nr>46</sb:volume-nr></sb:series><sb:date>1989</sb:date></sb:issue><sb:pages><sb:first-page>1284</sb:first-page><sb:last-page>1286</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0085"><ce:label>17.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>E.</ce:given-name><ce:surname>Mohr</ce:surname></sb:author><sb:author><ce:given-name>I.</ce:given-name><ce:surname>Litvan</ce:surname></sb:author><sb:author><ce:given-name>J.</ce:given-name><ce:surname>Williams</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Selective deficits in Alzheimer and parkinsonian dementia: visuospatial function</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Can J Neurol Sci</sb:maintitle></sb:title><sb:volume-nr>17</sb:volume-nr></sb:series><sb:date>1990</sb:date></sb:issue><sb:pages><sb:first-page>292</sb:first-page><sb:last-page>297</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0090"><ce:label>18.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>E.</ce:given-name><ce:surname>Mohr</ce:surname></sb:author><sb:author><ce:given-name>T.</ce:given-name><ce:surname>Mendis</ce:surname></sb:author><sb:author><ce:given-name>J.D.</ce:given-name><ce:surname>Grimes</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Late cognitive changes in Parkinson’s disease with an emphasis on dementia</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Adv Neurol</sb:maintitle></sb:title><sb:volume-nr>65</sb:volume-nr></sb:series><sb:date>1995</sb:date></sb:issue><sb:pages><sb:first-page>97</sb:first-page><sb:last-page>113</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0095"><ce:label>19.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>C.G.</ce:given-name><ce:surname>Goetz</ce:surname></sb:author><sb:author><ce:given-name>G.T.</ce:given-name><ce:surname>Stebbins</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Risk factors for nursing home placement in advanced Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Neurology</sb:maintitle></sb:title><sb:volume-nr>43</sb:volume-nr></sb:series><sb:date>1993</sb:date></sb:issue><sb:pages><sb:first-page>2227</sb:first-page><sb:last-page>2229</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0100"><ce:label>20.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>J.</ce:given-name><ce:surname>Jankovic</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>New and emerging therapies for Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Arch Neurol</sb:maintitle></sb:title><sb:volume-nr>56</sb:volume-nr></sb:series><sb:date>1999</sb:date></sb:issue><sb:pages><sb:first-page>785</sb:first-page><sb:last-page>790</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0105"><ce:label>21.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>B.K.</ce:given-name><ce:surname>Young</ce:surname></sb:author><sb:author><ce:given-name>R.</ce:given-name><ce:surname>Camicioli</ce:surname></sb:author><sb:author><ce:given-name>L.</ce:given-name><ce:surname>Ganzini</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Neuropsychiatric adverse effects of antiparkinsonian drugs: characteristics, evaluation and treatment</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Drugs Aging</sb:maintitle></sb:title><sb:volume-nr>10</sb:volume-nr></sb:series><sb:date>1997</sb:date></sb:issue><sb:pages><sb:first-page>367</sb:first-page><sb:last-page>383</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0110"><ce:label>22.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>C.W.</ce:given-name><ce:surname>Olanow</ce:surname></sb:author><sb:author><ce:given-name>W.C.</ce:given-name><ce:surname>Koller</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>An algorithm (decision tree) for the management of Parkinson’s disease: treatment guidelines</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>American Academy of Neurology. Neurology</sb:maintitle></sb:title><sb:volume-nr>50</sb:volume-nr></sb:series><sb:issue-nr>suppl 3</sb:issue-nr><sb:date>1998</sb:date></sb:issue><sb:pages><sb:first-page>S1</sb:first-page><sb:last-page>S57</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0115"><ce:label>23.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>W.C.</ce:given-name><ce:surname>Koller</ce:surname></sb:author><sb:author><ce:given-name>M.G.</ce:given-name><ce:surname>Rueda</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Mechanism of action of dopaminergic agents in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Neurology</sb:maintitle></sb:title><sb:volume-nr>50</sb:volume-nr></sb:series><sb:issue-nr>suppl 6</sb:issue-nr><sb:date>1998</sb:date></sb:issue><sb:pages><sb:first-page>S11</sb:first-page><sb:last-page>S14</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0120"><ce:label>24.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>R.</ce:given-name><ce:surname>Cantello</ce:surname></sb:author><sb:author><ce:given-name>M.</ce:given-name><ce:surname>Gilli</ce:surname></sb:author><sb:author><ce:given-name>A.</ce:given-name><ce:surname>Riccio</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Mood changes associated with “end-of-dose deterioration” in Parkinson’s disease: a controlled study</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Neurol Neurosurg Psychiatry</sb:maintitle></sb:title><sb:volume-nr>49</sb:volume-nr></sb:series><sb:date>1986</sb:date></sb:issue><sb:pages><sb:first-page>1182</sb:first-page><sb:last-page>1190</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0125"><ce:label>25.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>C.D.</ce:given-name><ce:surname>Marsden</ce:surname></sb:author><sb:author><ce:given-name>J.D.</ce:given-name><ce:surname>Parkes</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Success and problems of long-term levodopa therapy in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Lancet</sb:maintitle></sb:title><sb:volume-nr>1</sb:volume-nr></sb:series><sb:date>1977</sb:date></sb:issue><sb:pages><sb:first-page>345</sb:first-page><sb:last-page>349</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0130"><ce:label>26.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>N.P.</ce:given-name><ce:surname>Quinn</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Classification of fluctuations in patients with Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Neurology</sb:maintitle></sb:title><sb:volume-nr>51</sb:volume-nr></sb:series><sb:issue-nr>suppl 2</sb:issue-nr><sb:date>1998</sb:date></sb:issue><sb:pages><sb:first-page>S25</sb:first-page><sb:last-page>S29</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0135"><ce:label>27.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>R.G.</ce:given-name><ce:surname>Brown</ce:surname></sb:author><sb:author><ce:given-name>C.D.</ce:given-name><ce:surname>Marsden</ce:surname></sb:author><sb:author><ce:given-name>N.</ce:given-name><ce:surname>Quinn</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Alterations in cognitive performance and affect-arousal state during fluctuations in motor function in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Neurol Neurosurg Psychiatry</sb:maintitle></sb:title><sb:volume-nr>47</sb:volume-nr></sb:series><sb:date>1984</sb:date></sb:issue><sb:pages><sb:first-page>454</sb:first-page><sb:last-page>465</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0140"><ce:label>28.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>H.</ce:given-name><ce:surname>Nissenbaum</ce:surname></sb:author><sb:author><ce:given-name>N.P.</ce:given-name><ce:surname>Quinn</ce:surname></sb:author><sb:author><ce:given-name>R.G.</ce:given-name><ce:surname>Brown</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Mood swings associated with the “on-off” phenomenon in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Psychol Med</sb:maintitle></sb:title><sb:volume-nr>17</sb:volume-nr></sb:series><sb:date>1987</sb:date></sb:issue><sb:pages><sb:first-page>899</sb:first-page><sb:last-page>904</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0145"><ce:label>29.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>R.A.</ce:given-name><ce:surname>Maricle</ce:surname></sb:author><sb:author><ce:given-name>J.G.</ce:given-name><ce:surname>Nutt</ce:surname></sb:author><sb:author><ce:given-name>J.H.</ce:given-name><ce:surname>Carter</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Mood and anxiety fluctuation in Parkinson’s disease associated with levodopa infusion: preliminary findings</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Mov Disord</sb:maintitle></sb:title><sb:volume-nr>10</sb:volume-nr></sb:series><sb:date>1995</sb:date></sb:issue><sb:pages><sb:first-page>329</sb:first-page><sb:last-page>332</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0150"><ce:label>30.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>A.</ce:given-name><ce:surname>Vazquez</ce:surname></sb:author><sb:author><ce:given-name>F.J.</ce:given-name><ce:surname>Jimenez-Jimenez</ce:surname></sb:author><sb:author><ce:given-name>P.</ce:given-name><ce:surname>Garcia-Ruiz</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>“Panic attacks” in Parkinson’s disease: a long-term complication of levodopa therapy</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Acta Neurol Scand</sb:maintitle></sb:title><sb:volume-nr>87</sb:volume-nr></sb:series><sb:date>1993</sb:date></sb:issue><sb:pages><sb:first-page>14</sb:first-page><sb:last-page>18</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0155"><ce:label>31.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>L.</ce:given-name><ce:surname>Marsh</ce:surname></sb:author><sb:author><ce:given-name>D.A.</ce:given-name><ce:surname>Cahn</ce:surname></sb:author><sb:author><ce:given-name>S.</ce:given-name><ce:surname>Spears</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Anxiety in Parkinson’s disease: relationship to cognitive function (abstract)</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Neuropsychiatry Clin Neurosci</sb:maintitle></sb:title><sb:volume-nr>9</sb:volume-nr></sb:series><sb:date>1998</sb:date></sb:issue><sb:pages><sb:first-page>653</sb:first-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0160"><ce:label>32.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>H.J.</ce:given-name><ce:surname>Riordan</ce:surname></sb:author><sb:author><ce:given-name>L.A.</ce:given-name><ce:surname>Flashman</ce:surname></sb:author><sb:author><ce:given-name>D.W.</ce:given-name><ce:surname>Roberts</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Neurocognitive and psychosocial correlates of ventroposterolateral pallidotomy surgery in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Neurosurg Focus</sb:maintitle></sb:title><sb:volume-nr>2</sb:volume-nr></sb:series><sb:date>1997</sb:date></sb:issue><sb:pages><sb:first-page>1</sb:first-page><sb:last-page>9</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0165"><ce:label>33.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>L.</ce:given-name><ce:surname>Marsh</ce:surname></sb:author><sb:author><ce:given-name>B.</ce:given-name><ce:surname>Solvasson</ce:surname></sb:author><sb:author><ce:given-name>D.A.</ce:given-name><ce:surname>Cahn</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Psychiatric outcome after pallidotomy for Parkinson’s disease (abstract)</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Biol Psychiatry</sb:maintitle></sb:title><sb:volume-nr>41</sb:volume-nr></sb:series><sb:issue-nr>suppl</sb:issue-nr><sb:date>1997</sb:date></sb:issue><sb:pages><sb:first-page>107S</sb:first-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0170"><ce:label>34.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>D.</ce:given-name><ce:surname>Masterman</ce:surname></sb:author><sb:author><ce:given-name>A.</ce:given-name><ce:surname>DeSalles</ce:surname></sb:author><sb:author><ce:given-name>R.W.</ce:given-name><ce:surname>Baloh</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Motor, cognitive, and behavioral performance following unilateral ventroposterior pallidotomy for Parkinson disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Arch Neurol</sb:maintitle></sb:title><sb:volume-nr>55</sb:volume-nr></sb:series><sb:date>1998</sb:date></sb:issue><sb:pages><sb:first-page>1201</sb:first-page><sb:last-page>1208</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0175"><ce:label>35.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>C.W.</ce:given-name><ce:surname>Olanow</ce:surname></sb:author><sb:author><ce:given-name>J.H.</ce:given-name><ce:surname>Kordower</ce:surname></sb:author><sb:author><ce:given-name>T.B.</ce:given-name><ce:surname>Freeman</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Fetal nigral transplantation as a therapy for Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Trends Neurosci</sb:maintitle></sb:title><sb:volume-nr>19</sb:volume-nr></sb:series><sb:date>1996</sb:date></sb:issue><sb:pages><sb:first-page>102</sb:first-page><sb:last-page>109</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0180"><ce:label>36.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>R.H.</ce:given-name><ce:surname>Mindham</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Psychiatric symptoms in Parkinsonism</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Neurol Neurosurg Psychiatry</sb:maintitle></sb:title><sb:volume-nr>33</sb:volume-nr></sb:series><sb:date>1970</sb:date></sb:issue><sb:pages><sb:first-page>188</sb:first-page><sb:last-page>191</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0185"><ce:label>37.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>G.E.</ce:given-name><ce:surname>Alexander</ce:surname></sb:author><sb:author><ce:given-name>M.R.</ce:given-name><ce:surname>DeLong</ce:surname></sb:author><sb:author><ce:given-name>P.L.</ce:given-name><ce:surname>Strick</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Parallel organization of functionally segregated circuits linking basal ganglia and cortex</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Annu Rev Neurosci</sb:maintitle></sb:title><sb:volume-nr>9</sb:volume-nr></sb:series><sb:date>1986</sb:date></sb:issue><sb:pages><sb:first-page>357</sb:first-page><sb:last-page>381</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0190"><ce:label>38.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>T.</ce:given-name><ce:surname>Wichmann</ce:surname></sb:author><sb:author><ce:given-name>M.R.</ce:given-name><ce:surname>DeLong</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Functional and pathophysiological models of the basal ganglia</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Curr Opin Neurobiol</sb:maintitle></sb:title><sb:volume-nr>6</sb:volume-nr></sb:series><sb:date>1996</sb:date></sb:issue><sb:pages><sb:first-page>751</sb:first-page><sb:last-page>758</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0195"><ce:label>39.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>W.</ce:given-name><ce:surname>Paulus</ce:surname></sb:author><sb:author><ce:given-name>K.</ce:given-name><ce:surname>Jellinger</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>The neuropathologic basis of different clinical subgroups of Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Neuropathol Exp Neurol</sb:maintitle></sb:title><sb:volume-nr>50</sb:volume-nr></sb:series><sb:date>1991</sb:date></sb:issue><sb:pages><sb:first-page>743</sb:first-page><sb:last-page>755</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0200"><ce:label>40.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>S.E.</ce:given-name><ce:surname>Starkstein</ce:surname></sb:author><sb:author><ce:given-name>H.S.</ce:given-name><ce:surname>Mayberg</ce:surname></sb:author></sb:authors></sb:contribution><sb:host><sb:edited-book><sb:editors><sb:editor><ce:given-name>S.E.</ce:given-name><ce:surname>Starkstein</ce:surname></sb:editor><sb:editor><ce:given-name>R.G.</ce:given-name><ce:surname>Robinson</ce:surname></sb:editor></sb:editors><sb:title><sb:maintitle>Depression in Parkinson’s disease, in Depression in Neurologic Disease</sb:maintitle></sb:title><sb:date>1993</sb:date><sb:publisher><sb:name>Johns Hopkins University Press</sb:name><sb:location>Baltimore, MD</sb:location></sb:publisher></sb:edited-book><sb:pages><sb:first-page>97</sb:first-page><sb:last-page>116</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0205"><ce:label>41.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>R.</ce:given-name><ce:surname>Mayeux</ce:surname></sb:author></sb:authors></sb:contribution><sb:host><sb:edited-book><sb:editors><sb:editor><ce:given-name>W.C.</ce:given-name><ce:surname>Koller</ce:surname></sb:editor></sb:editors><sb:title><sb:maintitle>The mental state in Parkinson’s disease, in Handbook of Parkinson’s Disease</sb:maintitle></sb:title><sb:edition>2nd Edition</sb:edition><sb:date>1992</sb:date><sb:publisher><sb:name>Marcel Dekker</sb:name><sb:location>New York</sb:location></sb:publisher></sb:edited-book><sb:pages><sb:first-page>159</sb:first-page><sb:last-page>184</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0210"><ce:label>42.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>J.L.</ce:given-name><ce:surname>Cummings</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Depression and Parkinson’s disease: a review</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Am J Psychiatry</sb:maintitle></sb:title><sb:volume-nr>149</sb:volume-nr></sb:series><sb:date>1992</sb:date></sb:issue><sb:pages><sb:first-page>443</sb:first-page><sb:last-page>454</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0215"><ce:label>43.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>R.B.</ce:given-name><ce:surname>Schiffer</ce:surname></sb:author><sb:author><ce:given-name>R.</ce:given-name><ce:surname>Kurlan</ce:surname></sb:author><sb:author><ce:given-name>A.</ce:given-name><ce:surname>Rubin</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Evidence for atypical depression in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Am J Psychiatry</sb:maintitle></sb:title><sb:volume-nr>145</sb:volume-nr></sb:series><sb:date>1988</sb:date></sb:issue><sb:pages><sb:first-page>1020</sb:first-page><sb:last-page>1022</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0220"><ce:label>44.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>J.</ce:given-name><ce:surname>Santamaria</ce:surname></sb:author><sb:author><ce:given-name>E.</ce:given-name><ce:surname>Tolosa</ce:surname></sb:author><sb:author><ce:given-name>A.</ce:given-name><ce:surname>Valles</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Parkinson’s disease with depression: a possible subgroup of idiopathic parkinsonism</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Neurology</sb:maintitle></sb:title><sb:volume-nr>36</sb:volume-nr></sb:series><sb:date>1986</sb:date></sb:issue><sb:pages><sb:first-page>1130</sb:first-page><sb:last-page>1133</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0225"><ce:label>45.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>I.</ce:given-name><ce:surname>Fukunishi</ce:surname></sb:author><sb:author><ce:given-name>K.</ce:given-name><ce:surname>Hosokawa</ce:surname></sb:author><sb:author><ce:given-name>S.</ce:given-name><ce:surname>Ozaki</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Depression antedating the onset of Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Jpn J Psychiatry Neurol</sb:maintitle></sb:title><sb:volume-nr>45</sb:volume-nr></sb:series><sb:date>1991</sb:date></sb:issue><sb:pages><sb:first-page>7</sb:first-page><sb:last-page>11</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0230"><ce:label>46.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>A.M.</ce:given-name><ce:surname>Gotham</ce:surname></sb:author><sb:author><ce:given-name>R.G.</ce:given-name><ce:surname>Brown</ce:surname></sb:author><sb:author><ce:given-name>C.D.</ce:given-name><ce:surname>Marsden</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Depression in Parkinson’s disease: a quantitative and qualitative analysis</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Neurol Neurosurg Psychiatry</sb:maintitle></sb:title><sb:volume-nr>49</sb:volume-nr></sb:series><sb:date>1986</sb:date></sb:issue><sb:pages><sb:first-page>381</sb:first-page><sb:last-page>389</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0235"><ce:label>47.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>S.</ce:given-name><ce:surname>Huber</ce:surname></sb:author><sb:author><ce:given-name>G.W.</ce:given-name><ce:surname>Paulson</ce:surname></sb:author><sb:author><ce:given-name>E.C.</ce:given-name><ce:surname>Shuttleworth</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Depression in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Neuropsychiatry Neuropsychol Behav Neurol</sb:maintitle></sb:title><sb:volume-nr>1</sb:volume-nr></sb:series><sb:date>1988</sb:date></sb:issue><sb:pages><sb:first-page>47</sb:first-page><sb:last-page>51</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0240"><ce:label>48.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>S.E.</ce:given-name><ce:surname>Starkstein</ce:surname></sb:author><sb:author><ce:given-name>T.J.</ce:given-name><ce:surname>Preziosi</ce:surname></sb:author><sb:author><ce:given-name>P.L.</ce:given-name><ce:surname>Bolduc</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Depression in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Nerv Ment Dis</sb:maintitle></sb:title><sb:volume-nr>178</sb:volume-nr></sb:series><sb:date>1990</sb:date></sb:issue><sb:pages><sb:first-page>27</sb:first-page><sb:last-page>31</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0245"><ce:label>49.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>S.</ce:given-name><ce:surname>Horn</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Some psychological factors in Parkinsonism</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Neurol Neurosurg Psychiatry</sb:maintitle></sb:title><sb:volume-nr>37</sb:volume-nr></sb:series><sb:date>1974</sb:date></sb:issue><sb:pages><sb:first-page>27</sb:first-page><sb:last-page>31</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0250"><ce:label>50.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>G.G.</ce:given-name><ce:surname>Marsh</ce:surname></sb:author><sb:author><ce:given-name>C.H.</ce:given-name><ce:surname>Markham</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Does levodopa alter depression and psychopathology in Parkinsonism patients?</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Neurol Neurosurg Psychiatry</sb:maintitle></sb:title><sb:volume-nr>36</sb:volume-nr></sb:series><sb:date>1973</sb:date></sb:issue><sb:pages><sb:first-page>925</sb:first-page><sb:last-page>935</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0255"><ce:label>51.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>A.H.</ce:given-name><ce:surname>Robins</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Depression in patients with Parkinsonism</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Br J Psychiatry</sb:maintitle></sb:title><sb:volume-nr>128</sb:volume-nr></sb:series><sb:date>1976</sb:date></sb:issue><sb:pages><sb:first-page>141</sb:first-page><sb:last-page>145</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0260"><ce:label>52.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>G.L.</ce:given-name><ce:surname>Brown</ce:surname></sb:author><sb:author><ce:given-name>W.P.</ce:given-name><ce:surname>Wilson</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Parkinsonism and depression</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>South Med J</sb:maintitle></sb:title><sb:volume-nr>65</sb:volume-nr></sb:series><sb:date>1972</sb:date></sb:issue><sb:pages><sb:first-page>540</sb:first-page><sb:last-page>545</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0265"><ce:label>53.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>S.E.</ce:given-name><ce:surname>Starkstein</ce:surname></sb:author><sb:author><ce:given-name>R.G.</ce:given-name><ce:surname>Robinson</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Dementia of depression in Parkinson’s disease and stroke</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Nerv Ment Dis</sb:maintitle></sb:title><sb:volume-nr>179</sb:volume-nr></sb:series><sb:date>1991</sb:date></sb:issue><sb:pages><sb:first-page>593</sb:first-page><sb:last-page>601</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0270"><ce:label>54.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>R.</ce:given-name><ce:surname>Mayeux</ce:surname></sb:author><sb:author><ce:given-name>Y.</ce:given-name><ce:surname>Stern</ce:surname></sb:author><sb:author><ce:given-name>L.</ce:given-name><ce:surname>Cote</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Altered serotonin metabolism in depressed patients with Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Neurology</sb:maintitle></sb:title><sb:volume-nr>34</sb:volume-nr></sb:series><sb:date>1984</sb:date></sb:issue><sb:pages><sb:first-page>642</sb:first-page><sb:last-page>646</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0275"><ce:label>55.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>R.</ce:given-name><ce:surname>Mayeux</ce:surname></sb:author><sb:author><ce:given-name>Y.</ce:given-name><ce:surname>Stern</ce:surname></sb:author><sb:author><ce:given-name>M.</ce:given-name><ce:surname>Sano</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>The relationship of serotonin to depression in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Mov Disord</sb:maintitle></sb:title><sb:volume-nr>3</sb:volume-nr></sb:series><sb:date>1988</sb:date></sb:issue><sb:pages><sb:first-page>237</sb:first-page><sb:last-page>244</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0280"><ce:label>56.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>S.Z.</ce:given-name><ce:surname>Langer</ce:surname></sb:author><sb:author><ce:given-name>A.M.</ce:given-name><ce:surname>Galzin</ce:surname></sb:author><sb:author><ce:given-name>M.F.</ce:given-name><ce:surname>Poirier</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Association of the (3H)- imipramine and (<ce:sup>3</ce:sup>H)-paroxetine binding with the 5HT transporter in brain and platelets: relevance to studies in depression</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Receptor Res</sb:maintitle></sb:title><sb:volume-nr>7</sb:volume-nr></sb:series><sb:date>1987</sb:date></sb:issue><sb:pages><sb:first-page>499</sb:first-page><sb:last-page>521</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0285"><ce:label>57.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>R.</ce:given-name><ce:surname>Raisman</ce:surname></sb:author><sb:author><ce:given-name>R.</ce:given-name><ce:surname>Cash</ce:surname></sb:author><sb:author><ce:given-name>Y.</ce:given-name><ce:surname>Agid</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Parkinson’s disease: decreased density of (3H)-imipramine and (3H)-paroxetine binding sites in putamen</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Neurology</sb:maintitle></sb:title><sb:volume-nr>36</sb:volume-nr></sb:series><sb:date>1986</sb:date></sb:issue><sb:pages><sb:first-page>556</sb:first-page><sb:last-page>560</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0290"><ce:label>58.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>H.S.</ce:given-name><ce:surname>Mayberg</ce:surname></sb:author><sb:author><ce:given-name>S.E.</ce:given-name><ce:surname>Starkstein</ce:surname></sb:author><sb:author><ce:given-name>B.</ce:given-name><ce:surname>Sadzot</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Selective hypometabolism in the inferior frontal lobe in depressed patients with Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Ann Neurol</sb:maintitle></sb:title><sb:volume-nr>28</sb:volume-nr></sb:series><sb:date>1990</sb:date></sb:issue><sb:pages><sb:first-page>57</sb:first-page><sb:last-page>64</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0295"><ce:label>59.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>H.A.</ce:given-name><ce:surname>Ring</ce:surname></sb:author><sb:author><ce:given-name>C.J.</ce:given-name><ce:surname>Bench</ce:surname></sb:author><sb:author><ce:given-name>M.R.</ce:given-name><ce:surname>Trimble</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Depression in Parkinson’s disease: a positron emission study</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Br J Psychiatry</sb:maintitle></sb:title><sb:volume-nr>165</sb:volume-nr></sb:series><sb:date>1994</sb:date></sb:issue><sb:pages><sb:first-page>333</sb:first-page><sb:last-page>339</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0300"><ce:label>60.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>R.S.</ce:given-name><ce:surname>Marin</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Differential diagnosis of apathy and related disorders of diminished motivation</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Psychiatric Annals</sb:maintitle></sb:title><sb:volume-nr>27</sb:volume-nr></sb:series><sb:date>1997</sb:date></sb:issue><sb:pages><sb:first-page>30</sb:first-page><sb:last-page>33</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0305"><ce:label>61.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>S.E.</ce:given-name><ce:surname>Starkstein</ce:surname></sb:author><sb:author><ce:given-name>H.S.</ce:given-name><ce:surname>Mayberg</ce:surname></sb:author><sb:author><ce:given-name>T.J.</ce:given-name><ce:surname>Preziosi</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Reliability, validity, and clinical correlates of apathy in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Neuropsychiatry Clin Neurosci</sb:maintitle></sb:title><sb:volume-nr>4</sb:volume-nr></sb:series><sb:date>1992</sb:date></sb:issue><sb:pages><sb:first-page>134</sb:first-page><sb:last-page>139</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0310"><ce:label>62.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>M.L.</ce:given-name><ce:surname>Levy</ce:surname></sb:author><sb:author><ce:given-name>J.L.</ce:given-name><ce:surname>Cummings</ce:surname></sb:author><sb:author><ce:given-name>L.A.</ce:given-name><ce:surname>Fairbanks</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Apathy is not depression</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Neuropsychiatry Clin Neurosci</sb:maintitle></sb:title><sb:volume-nr>10</sb:volume-nr></sb:series><sb:date>1998</sb:date></sb:issue><sb:pages><sb:first-page>314</sb:first-page><sb:last-page>319</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0315"><ce:label>63.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>D.</ce:given-name><ce:surname>Rogers</ce:surname></sb:author><sb:author><ce:given-name>A.J.</ce:given-name><ce:surname>Lees</ce:surname></sb:author><sb:author><ce:given-name>E.</ce:given-name><ce:surname>Smith</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Bradyphrenia in Parkinson’s disease and psychomotor retardation in depressive illness: an experimental study</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Brain</sb:maintitle></sb:title><sb:volume-nr>1987</sb:volume-nr></sb:series><sb:date>1987</sb:date></sb:issue><sb:pages><sb:first-page>761</sb:first-page><sb:last-page>776</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0320"><ce:label>64.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>R.</ce:given-name><ce:surname>Mayeux</ce:surname></sb:author><sb:author><ce:given-name>Y.</ce:given-name><ce:surname>Stern</ce:surname></sb:author><sb:author><ce:given-name>M.</ce:given-name><ce:surname>Sano</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Clinical and biochemical correlates of bradyphrenia in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Neurology</sb:maintitle></sb:title><sb:volume-nr>37</sb:volume-nr></sb:series><sb:date>1987</sb:date></sb:issue><sb:pages><sb:first-page>1130</sb:first-page><sb:last-page>1134</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0325"><ce:label>65.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>P.</ce:given-name><ce:surname>Madeley</ce:surname></sb:author><sb:author><ce:given-name>C.A.</ce:given-name><ce:surname>Biggins</ce:surname></sb:author><sb:author><ce:given-name>J.L.</ce:given-name><ce:surname>Boyd</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Emotionalism in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Ir J Pychol Med</sb:maintitle></sb:title><sb:volume-nr>9</sb:volume-nr></sb:series><sb:date>1992</sb:date></sb:issue><sb:pages><sb:first-page>24</sb:first-page><sb:last-page>25</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0330"><ce:label>66.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>B.E.</ce:given-name><ce:surname>Levin</ce:surname></sb:author><sb:author><ce:given-name>M.M.</ce:given-name><ce:surname>Llabre</ce:surname></sb:author><sb:author><ce:given-name>W.J.</ce:given-name><ce:surname>Weiner</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Parkinson’s disease and depression: psychometric properties of the Beck Depression Inventory</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Neurol Neurosurg Psychiatry</sb:maintitle></sb:title><sb:volume-nr>51</sb:volume-nr></sb:series><sb:date>1988</sb:date></sb:issue><sb:pages><sb:first-page>1401</sb:first-page><sb:last-page>1404</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0335"><ce:label>67.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>L.</ce:given-name><ce:surname>Diller</ce:surname></sb:author><sb:author><ce:given-name>M.</ce:given-name><ce:surname>Ricklan</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Psychosocial factors in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Am Geriatr Soc</sb:maintitle></sb:title><sb:volume-nr>4</sb:volume-nr></sb:series><sb:date>1956</sb:date></sb:issue><sb:pages><sb:first-page>1291</sb:first-page><sb:last-page>1300</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0340"><ce:label>68.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>M.F.</ce:given-name><ce:surname>Mendez</ce:surname></sb:author><sb:author><ce:given-name>T.V.</ce:given-name><ce:surname>Nakawatase</ce:surname></sb:author><sb:author><ce:given-name>C.V.</ce:given-name><ce:surname>Brown</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Involuntary laughter and inappropriate hilarity</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Neuropsychiatry Clin Neurosci</sb:maintitle></sb:title><sb:volume-nr>11</sb:volume-nr></sb:series><sb:date>1999</sb:date></sb:issue><sb:pages><sb:first-page>253</sb:first-page><sb:last-page>258</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0345"><ce:label>69.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>M.A.</ce:given-name><ce:surname>Menza</ce:surname></sb:author><sb:author><ce:given-name>D.E.</ce:given-name><ce:surname>Robertson-Hoffman</ce:surname></sb:author><sb:author><ce:given-name>A.S.</ce:given-name><ce:surname>Bonapace</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Parkinson’s disease and anxiety: comorbidity with depression</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Biol Psychiatry</sb:maintitle></sb:title><sb:volume-nr>34</sb:volume-nr></sb:series><sb:date>1993</sb:date></sb:issue><sb:pages><sb:first-page>465</sb:first-page><sb:last-page>470</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0350"><ce:label>70.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>I.H.</ce:given-name><ce:surname>Richard</ce:surname></sb:author><sb:author><ce:given-name>R.B.</ce:given-name><ce:surname>Schiffer</ce:surname></sb:author><sb:author><ce:given-name>R.</ce:given-name><ce:surname>Kurlan</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Anxiety and Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Neuropsychiatry Clin Neurosci</sb:maintitle></sb:title><sb:volume-nr>8</sb:volume-nr></sb:series><sb:date>1996</sb:date></sb:issue><sb:pages><sb:first-page>383</sb:first-page><sb:last-page>392</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0355"><ce:label>71.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>A.J.</ce:given-name><ce:surname>Rubin</ce:surname></sb:author><sb:author><ce:given-name>R.</ce:given-name><ce:surname>Kurlan</ce:surname></sb:author><sb:author><ce:given-name>C.</ce:given-name><ce:surname>Miller</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Atypical depression and Parkinson’s disease (abstract)</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Ann Neurol</sb:maintitle></sb:title><sb:volume-nr>20</sb:volume-nr></sb:series><sb:date>1986</sb:date></sb:issue><sb:pages><sb:first-page>150</sb:first-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0360"><ce:label>72.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>M.B.</ce:given-name><ce:surname>Stein</ce:surname></sb:author><sb:author><ce:given-name>I.J.</ce:given-name><ce:surname>Heuser</ce:surname></sb:author><sb:author><ce:given-name>J.L.</ce:given-name><ce:surname>Juncos</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Anxiety disorders in patients with Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Am J Psychiatry</sb:maintitle></sb:title><sb:volume-nr>147</sb:volume-nr></sb:series><sb:date>1990</sb:date></sb:issue><sb:pages><sb:first-page>217</sb:first-page><sb:last-page>220</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0365"><ce:label>73.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>G.E.</ce:given-name><ce:surname>Berrios</ce:surname></sb:author><sb:author><ce:given-name>C.</ce:given-name><ce:surname>Campbell</ce:surname></sb:author><sb:author><ce:given-name>B.E.</ce:given-name><ce:surname>Politynska</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Autonomic failure, depression and anxiety in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Br J Psychiatry</sb:maintitle></sb:title><sb:volume-nr>166</sb:volume-nr></sb:series><sb:date>1995</sb:date></sb:issue><sb:pages><sb:first-page>789</sb:first-page><sb:last-page>792</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0370"><ce:label>74.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>L.M.</ce:given-name><ce:surname>Iruela</ce:surname></sb:author><sb:author><ce:given-name>V.</ce:given-name><ce:surname>Ibanez-Rojo</ce:surname></sb:author><sb:author><ce:given-name>I.</ce:given-name><ce:surname>Palanca</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Anxiety disorders and Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Am J Psychiatry</sb:maintitle></sb:title><sb:volume-nr>149</sb:volume-nr></sb:series><sb:date>1992</sb:date></sb:issue><sb:pages><sb:first-page>719</sb:first-page><sb:last-page>720</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0375"><ce:label>75.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>R.</ce:given-name><ce:surname>Cash</ce:surname></sb:author><sb:author><ce:given-name>T.</ce:given-name><ce:surname>Dennis</ce:surname></sb:author><sb:author><ce:given-name>R.</ce:given-name><ce:surname>L’Heureux</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Parkinson’s disease and dementia: norepinephrine and dopamine in locus ceruleus</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Neurology</sb:maintitle></sb:title><sb:volume-nr>37</sb:volume-nr></sb:series><sb:date>1987</sb:date></sb:issue><sb:pages><sb:first-page>42</sb:first-page><sb:last-page>46</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0380"><ce:label>76.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>E.C.</ce:given-name><ce:surname>Lauterbach</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>The locus ceruleus and anxiety disorders in demented and nondemented familial parkinsonism (letter)</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Am J Psychiatry</sb:maintitle></sb:title><sb:volume-nr>150</sb:volume-nr></sb:series><sb:date>1993</sb:date></sb:issue><sb:pages><sb:first-page>994</sb:first-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0385"><ce:label>77.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>E.C.</ce:given-name><ce:surname>Lauterbach</ce:surname></sb:author><sb:author><ce:given-name>R.C.</ce:given-name><ce:surname>Duvoisin</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Anxiety disorders in familial parkinsonism (letter)</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Am J Psychiatry</sb:maintitle></sb:title><sb:volume-nr>148</sb:volume-nr></sb:series><sb:date>1992</sb:date></sb:issue><sb:pages><sb:first-page>274</sb:first-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0390"><ce:label>78.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>R.</ce:given-name><ce:surname>Henderson</ce:surname></sb:author><sb:author><ce:given-name>R.</ce:given-name><ce:surname>Kurlan</ce:surname></sb:author><sb:author><ce:given-name>J.M.</ce:given-name><ce:surname>Kersun</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Preliminary examination of the comorbidity of anxiety and depression in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Neuropsychiatry Clin Neurosci</sb:maintitle></sb:title><sb:volume-nr>4</sb:volume-nr></sb:series><sb:date>1992</sb:date></sb:issue><sb:pages><sb:first-page>257</sb:first-page><sb:last-page>264</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0395"><ce:label>79.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>E.R.</ce:given-name><ce:surname>Seimers</ce:surname></sb:author><sb:author><ce:given-name>A.</ce:given-name><ce:surname>Shekhar</ce:surname></sb:author><sb:author><ce:given-name>K.</ce:given-name><ce:surname>Quaid</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Anxiety and motor performance in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Mov Disord</sb:maintitle></sb:title><sb:volume-nr>8</sb:volume-nr></sb:series><sb:date>1993</sb:date></sb:issue><sb:pages><sb:first-page>501</sb:first-page><sb:last-page>506</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0400"><ce:label>80.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>E.C.</ce:given-name><ce:surname>Wolters</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Dopaminomimetic psychosis in Parkinson’s disease patients</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Neurology</sb:maintitle></sb:title><sb:volume-nr>52</sb:volume-nr></sb:series><sb:issue-nr>suppl 3</sb:issue-nr><sb:date>1999</sb:date></sb:issue><sb:pages><sb:first-page>S10</sb:first-page><sb:last-page>S13</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0405"><ce:label>81.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>C.E.</ce:given-name><ce:surname>Peyser</ce:surname></sb:author><sb:author><ce:given-name>D.</ce:given-name><ce:surname>Naimark</ce:surname></sb:author><sb:author><ce:given-name>R.</ce:given-name><ce:surname>Zuniga</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Psychoses in Parkinson’s Disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Semin Clin Neuropsychiatry</sb:maintitle></sb:title><sb:volume-nr>3</sb:volume-nr></sb:series><sb:date>1998</sb:date></sb:issue><sb:pages><sb:first-page>41</sb:first-page><sb:last-page>50</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0410"><ce:label>82.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>D.</ce:given-name><ce:surname>Aarsland</ce:surname></sb:author><sb:author><ce:given-name>J.P.</ce:given-name><ce:surname>Larsen</ce:surname></sb:author><sb:author><ce:given-name>J.L.</ce:given-name><ce:surname>Cummings</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Prevalence and clinical correlates of psychotic symptoms in Parkinson’s disease: a community-based study</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Arch Neurol</sb:maintitle></sb:title><sb:volume-nr>56</sb:volume-nr></sb:series><sb:date>1999</sb:date></sb:issue><sb:pages><sb:first-page>595</sb:first-page><sb:last-page>601</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0415"><ce:label>83.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>M.</ce:given-name><ce:surname>Hutchinson</ce:surname></sb:author><sb:author><ce:given-name>E.</ce:given-name><ce:surname>Fazzini</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Cholinesterase inhibition in Parkinson’s disease (letter)</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Neurol Neurosurg Psychiatry</sb:maintitle></sb:title><sb:volume-nr>61</sb:volume-nr></sb:series><sb:date>1996</sb:date></sb:issue><sb:pages><sb:first-page>324</sb:first-page><sb:last-page>325</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0420"><ce:label>84.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>A.</ce:given-name><ce:surname>Lieberman</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Managing the neuropsychiatric symptoms of Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Neurology</sb:maintitle></sb:title><sb:volume-nr>50</sb:volume-nr></sb:series><sb:issue-nr>suppl 6</sb:issue-nr><sb:date>1998</sb:date></sb:issue><sb:pages><sb:first-page>S33</sb:first-page><sb:last-page>S38</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0425"><ce:label>85.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>S.E.</ce:given-name><ce:surname>Starkstein</ce:surname></sb:author><sb:author><ce:given-name>G.</ce:given-name><ce:surname>Petracca</ce:surname></sb:author></sb:authors></sb:contribution><sb:host><sb:edited-book><sb:editors><sb:editor><ce:given-name>R.G.</ce:given-name><ce:surname>Robinson</ce:surname></sb:editor><sb:editor><ce:given-name>W.R.</ce:given-name><ce:surname>Yates</ce:surname></sb:editor></sb:editors><sb:title><sb:maintitle>Parkinson’s disease, in Psychiatric Treatment of the Medically Ill</sb:maintitle></sb:title><sb:date>1999</sb:date><sb:publisher><sb:name>Marcel Dekker</sb:name><sb:location>New York</sb:location></sb:publisher></sb:edited-book><sb:pages><sb:first-page>443</sb:first-page><sb:last-page>457</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0430"><ce:label>86.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>W.</ce:given-name><ce:surname>Poewe</ce:surname></sb:author><sb:author><ce:given-name>E.</ce:given-name><ce:surname>Luginger</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Depression in Parkinson’s disease: impediments to recognition and treatment options</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Neurology</sb:maintitle></sb:title><sb:volume-nr>52</sb:volume-nr></sb:series><sb:issue-nr>suppl 3</sb:issue-nr><sb:date>1999</sb:date></sb:issue><sb:pages><sb:first-page>S2</sb:first-page><sb:last-page>S6</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0435"><ce:label>87.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>J.L.</ce:given-name><ce:surname>Juncos</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Management of psychotic aspects of Parkinson’s Disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Clin Psychiatry</sb:maintitle></sb:title><sb:volume-nr>60</sb:volume-nr></sb:series><sb:date>1999</sb:date></sb:issue><sb:pages><sb:first-page>42</sb:first-page><sb:last-page>53</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0440"><ce:label>88.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>T.</ce:given-name><ce:surname>Klaassen</ce:surname></sb:author><sb:author><ce:given-name>F.R.</ce:given-name><ce:surname>Verhey</ce:surname></sb:author><sb:author><ce:given-name>G.H.</ce:given-name><ce:surname>Sneijders</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Treatment of depression in Parkinson’s disease: a meta-analysis</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Neuropsychiatry Clin Neurosci</sb:maintitle></sb:title><sb:volume-nr>7</sb:volume-nr></sb:series><sb:date>1995</sb:date></sb:issue><sb:pages><sb:first-page>281</sb:first-page><sb:last-page>286</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0445"><ce:label>89.</ce:label><sb:reference><sb:contribution><sb:authors><sb:collaboration>Parkinson Study Group</sb:collaboration></sb:authors><sb:title><sb:maintitle>Low-dose clozapine for the treatment of drug-induced psychosis in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>N Engl J Med</sb:maintitle></sb:title><sb:volume-nr>340</sb:volume-nr></sb:series><sb:date>1999</sb:date></sb:issue><sb:pages><sb:first-page>757</sb:first-page><sb:last-page>763</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0450"><ce:label>90.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>O.</ce:given-name><ce:surname>Suchowersky</ce:surname></sb:author><sb:author><ce:given-name>J.D.</ce:given-name><ce:surname>de Vries</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Interaction of fluoxetine and selegeline</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Can J Psychiatry</sb:maintitle></sb:title><sb:volume-nr>35</sb:volume-nr></sb:series><sb:date>1990</sb:date></sb:issue><sb:pages><sb:first-page>571</sb:first-page><sb:last-page>572</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0455"><ce:label>91.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>J.</ce:given-name><ce:surname>Andersen</ce:surname></sb:author><sb:author><ce:given-name>E.</ce:given-name><ce:surname>Aabro</ce:surname></sb:author><sb:author><ce:given-name>N.</ce:given-name><ce:surname>Gulmann</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Antidepressant treatment in Parkinson’s disease: a controlled trial of the effect of nortriptyline in patients with Parkinson’s disease treated with L-dopa</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Acta Neurol Scand</sb:maintitle></sb:title><sb:volume-nr>62</sb:volume-nr></sb:series><sb:date>1980</sb:date></sb:issue><sb:pages><sb:first-page>210</sb:first-page><sb:last-page>219</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0460"><ce:label>92.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>L.</ce:given-name><ce:surname>Laitinen</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Desipramine in treatment of Parkinson’s disease: a placebo-controlled study</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Acta Neurol Scand</sb:maintitle></sb:title><sb:volume-nr>45</sb:volume-nr></sb:series><sb:date>1969</sb:date></sb:issue><sb:pages><sb:first-page>109</sb:first-page><sb:last-page>113</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0465"><ce:label>93.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>C.G.</ce:given-name><ce:surname>Goetz</ce:surname></sb:author><sb:author><ce:given-name>C.M.</ce:given-name><ce:surname>Tanner</ce:surname></sb:author><sb:author><ce:given-name>H.L.</ce:given-name><ce:surname>Klawans</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Bupropion in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Neurology</sb:maintitle></sb:title><sb:volume-nr>34</sb:volume-nr></sb:series><sb:date>1984</sb:date></sb:issue><sb:pages><sb:first-page>1092</sb:first-page><sb:last-page>1094</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0470"><ce:label>94.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>E.F.</ce:given-name><ce:surname>McCance-Katz</ce:surname></sb:author><sb:author><ce:given-name>K.L.</ce:given-name><ce:surname>Marek</ce:surname></sb:author><sb:author><ce:given-name>L.H.</ce:given-name><ce:surname>Price</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Serotonergic dysfunction in depression associated with Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Neurology</sb:maintitle></sb:title><sb:volume-nr>42</sb:volume-nr></sb:series><sb:date>1992</sb:date></sb:issue><sb:pages><sb:first-page>1813</sb:first-page><sb:last-page>1814</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0475"><ce:label>95.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>R.A.</ce:given-name><ce:surname>Hauser</ce:surname></sb:author><sb:author><ce:given-name>T.A.</ce:given-name><ce:surname>Zesiewicz</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Sertraline for the treatment of depression in Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Mov Disord</sb:maintitle></sb:title><sb:volume-nr>12</sb:volume-nr></sb:series><sb:date>1997</sb:date></sb:issue><sb:pages><sb:first-page>756</sb:first-page><sb:last-page>759</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0480"><ce:label>96.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>E.</ce:given-name><ce:surname>Jansen Steur</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Increase of Parkinson disability after fluoxetine medication</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Neurology</sb:maintitle></sb:title><sb:volume-nr>43</sb:volume-nr></sb:series><sb:date>1993</sb:date></sb:issue><sb:pages><sb:first-page>211</sb:first-page><sb:last-page>213</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0485"><ce:label>97.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>G.</ce:given-name><ce:surname>Chouinard</ce:surname></sb:author><sb:author><ce:given-name>S.</ce:given-name><ce:surname>Sultan</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>A case of Parkinson’s disease exacerbated by fluoxetine</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Human Psychopharmacology</sb:maintitle></sb:title><sb:volume-nr>7</sb:volume-nr></sb:series><sb:date>1992</sb:date></sb:issue><sb:pages><sb:first-page>63</sb:first-page><sb:last-page>66</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0490"><ce:label>98.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>R.</ce:given-name><ce:surname>Faber</ce:surname></sb:author><sb:author><ce:given-name>M.R.</ce:given-name><ce:surname>Trimble</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Electroconvulsive therapy in Parkinson’s disease and other movement disorders</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Mov Disord</sb:maintitle></sb:title><sb:volume-nr>6</sb:volume-nr></sb:series><sb:date>1991</sb:date></sb:issue><sb:pages><sb:first-page>293</sb:first-page><sb:last-page>303</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0495"><ce:label>99.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>P.A.</ce:given-name><ce:surname>Fall</ce:surname></sb:author><sb:author><ce:given-name>R.</ce:given-name><ce:surname>Ekman</ce:surname></sb:author><sb:author><ce:given-name>A.K.</ce:given-name><ce:surname>Granerus</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>ECT in Parkinson’s disease: changes in motor symptoms, monoamine metabolites, and neuropeptides</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>J Neural Transm Park Dis Dement Sect</sb:maintitle></sb:title><sb:volume-nr>10</sb:volume-nr></sb:series><sb:date>1995</sb:date></sb:issue><sb:pages><sb:first-page>129</sb:first-page><sb:last-page>140</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0500"><ce:label>100.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>S.A.</ce:given-name><ce:surname>Factor</ce:surname></sb:author><sb:author><ce:given-name>E.S.</ce:given-name><ce:surname>Molho</ce:surname></sb:author><sb:author><ce:given-name>G.D.</ce:given-name><ce:surname>Podskalny</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Parkinson’s disease: drug-induced psychiatric states</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Adv Neurol</sb:maintitle></sb:title><sb:volume-nr>65</sb:volume-nr></sb:series><sb:date>1995</sb:date></sb:issue><sb:pages><sb:first-page>115</sb:first-page><sb:last-page>138</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0505"><ce:label>101.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>J.</ce:given-name><ce:surname>Zoldan</ce:surname></sb:author><sb:author><ce:given-name>G.</ce:given-name><ce:surname>Friedberg</ce:surname></sb:author><sb:author><ce:given-name>A.</ce:given-name><ce:surname>Weizman</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Ondansetron, a 5-HT3 antagonist for visual hallucinations and paranoid delusional disorder associated with chronic L-DOPA therapy in advanced Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Adv Neurol</sb:maintitle></sb:title><sb:volume-nr>69</sb:volume-nr></sb:series><sb:date>1996</sb:date></sb:issue><sb:pages><sb:first-page>541</sb:first-page><sb:last-page>544</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0510"><ce:label>102.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>H.</ce:given-name><ce:surname>Ellring</ce:surname></sb:author><sb:author><ce:given-name>S.</ce:given-name><ce:surname>Seiler</ce:surname></sb:author><sb:author><ce:given-name>B.</ce:given-name><ce:surname>Perleth</ce:surname></sb:author><sb:et-al></sb:et-al></sb:authors><sb:title><sb:maintitle>Psychosocial aspects of Parkinson’s disease</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Neurology</sb:maintitle></sb:title><sb:volume-nr>43</sb:volume-nr></sb:series><sb:issue-nr>suppl 6</sb:issue-nr><sb:date>1993</sb:date></sb:issue><sb:pages><sb:first-page>S41</sb:first-page><sb:last-page>S44</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference><ce:bib-reference id="bib0515"><ce:label>103.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>D.G.</ce:given-name><ce:surname>MacMahon</ce:surname></sb:author></sb:authors><sb:title><sb:maintitle>Parkinson’s disease nurse-specialists: an important role in disease management</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Neurology</sb:maintitle></sb:title><sb:volume-nr>52</sb:volume-nr></sb:series><sb:issue-nr>suppl 3</sb:issue-nr><sb:date>1999</sb:date></sb:issue><sb:pages><sb:first-page>S21</sb:first-page><sb:last-page>S25</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference></ce:bibliography-sec></ce:bibliography></tail></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Neuropsychiatric Aspects of Parkinsons Disease</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Neuropsychiatric Aspects of Parkinson</title></titleInfo><name type="personal"><namePart type="given">Laura</namePart><namePart type="family">Marsh</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland</affiliation><affiliation>E-mail: lmarsh@hmi.edu</affiliation><description>Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 3166, Baltimore, MD 21287.</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1999</dateIssued><dateValid encoding="w3cdtf">1999-09-02</dateValid><copyrightDate encoding="w3cdtf">2011</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Parkinsons disease (PD), a disorder characterized by movement abnormalities, is frequently complicated by psychiatric syndromes. Psychiatric assessment of the PD patient requires familiarity with the motor and cognitive aspects of PD, the various effects of antiparkinsonian medications, and how these relate to mental status changes and psychiatric phenomena. This review describes the various motor and nonmotor features of PD and focuses on the differential diagnosis of affective disorders in PD and their treatment.</abstract><note type="content">Table 1: Symptoms common to Parkinsons disease and major depression</note><relatedItem type="host"><titleInfo><title>Psychosomatics</title></titleInfo><titleInfo type="abbreviated"><title>PSYM</title></titleInfo><genre type="Journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">200001</dateIssued></originInfo><identifier type="ISSN">0033-3182</identifier><identifier type="PII">S0033-3182(00)X7066-1</identifier><part><date>200001</date><detail type="volume"><number>41</number><caption>vol.</caption></detail><detail type="issue"><number>1</number><caption>no.</caption></detail><extent unit="issue pages"><start>1</start><end>81</end></extent><extent unit="pages"><start>15</start><end>23</end></extent></part></relatedItem><identifier type="istex">A5CA17C7DEA4EAC8A766CF937A46750BCC75EF80</identifier><identifier type="DOI">10.1016/S0033-3182(00)71169-8</identifier><identifier type="PII">S0033-3182(00)71169-8</identifier><accessCondition type="use and reproduction" contentType="">© 2011The Academy of Psychosomatic Medicine</accessCondition><recordInfo><recordContentSource>ELSEVIER</recordContentSource><recordOrigin>The Academy of Psychosomatic Medicine, ©2011</recordOrigin></recordInfo></mods></metadata><enrichments><istex:catWosTEI uri="https://api.istex.fr/document/A5CA17C7DEA4EAC8A766CF937A46750BCC75EF80/enrichments/catWos"><teiHeader><profileDesc><textClass><classCode scheme="WOS">PSYCHIATRY</classCode><classCode scheme="WOS">PSYCHOLOGY</classCode></textClass></profileDesc></teiHeader></istex:catWosTEI></enrichments><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/ParkinsonV1/Data/Main/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000330 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Main/Corpus/biblio.hfd -nk 000330 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Sante
|area= ParkinsonV1
|flux= Main
|étape= Corpus
|type= RBID
|clé= ISTEX:A5CA17C7DEA4EAC8A766CF937A46750BCC75EF80
|texte= Neuropsychiatric Aspects of Parkinsons Disease
}}
| This area was generated with Dilib version V0.6.23. |  |