Pathopsychologic features and organic psychiatric disorders in Parkinson's disease

The features of the emotional-need sphere, the severity of personality traits, and types of attitudes toward the disease in patients with Parkinson's disease and mental disorders are analyzed. Pathopsychological factors in the formation of organic depressive disorder (F06.36), organic anxiety disorder (F06.4), organic emotionally labile disorder (F06.6) are identified, and their pathogenesis mechanisms are described. As for dementia (F02.3), no single pathopsychological mechanism for its formation has been found in patients with Parkinson's disease; the main role in its pathogenesis belongs to organic brain damage.

Key words: Parkinson's disease, organic mental disorders, pathopsychological patterns of formation.

Parkinson's disease is one of the most common neurological diseases of the elderly, occurring in 1-2% of the population over 65 years of age. The disappointing statistics of recent years indicate an increase in the incidence of this disease in most countries of the world, including Ukraine, which is associated with an increase in average life expectancy, unfavorable environmental factors and improved diagnostics of this pathology.

Although the diagnosis of Parkinson's disease is based on the detection of specific motor manifestations resulting from insufficient dopaminergic transmission in the nigrostriatal system, mental disorders are also characteristic of this disease. Mental disorders are observed at all stages of Parkinson's disease and often precede its motor manifestations. In the late stages of Parkinson's disease, mental disorders begin to dominate as factors affecting the patient's quality of life and become more important and disabling than motor disorders, creating insurmountable difficulties for the patients themselves and their caregivers. The most common psychopathological phenomena of Parkinson's disease include depression, anxiety, hallucinatory-paranoid and cognitive disorders.

A number of studies have noted the multifactorial genesis of neuropsychiatric disorders; among the leading factors of their pathogenesis in Parkinson's disease, dopaminergic, noradrenergic and serotonergic dysfunction in the limbic system of the brain are considered; in addition, the influence of premorbid psychological characteristics of the individual on their formation is noted. However, to date, current studies devoted to the problem of Parkinsonism do not reflect the psychological patterns and mechanisms of the pathogenesis of neuropsychiatric disorders in Parkinson's disease, which necessitates their detailed analysis.

The aim of this study was to investigate the pathopsychological patterns of the formation of organic mental disorders in Parkinson's disease.

A total of 250 patients with Parkinson's disease were examined, of which the main study group consisted of 174 people with organic mental pathology in the clinical picture of Parkinson's disease (89 people with organic nonpsychotic depressive disorder (F06.36); 33 people with organic anxiety disorder (F06.4); 52 people with organic emotionally labile (asthenic) disorder (F06.6); 28 people with dementia (F02.3)), the control group - 76 patients with Parkinson's disease without mental disorders.

The following methods were used: clinical anxiety scale (CAS); SMIL test; Luscher color test; Bekhterev Institute questionnaire to determine the type of attitude towards the disease.

Analysis of the representation of mental pathology in patients with Parkinson's disease demonstrated a significant predominance of mental disorders of organic genesis in its structure in 68.0% of cases. Among organic mental pathology, the most frequently noted was organic nonpsychotic depressive disorder (F06.36) - in 29.9% of cases; organic emotionally labile (asthenic) disorder (F06.6) - 17.5%; organic anxiety disorder (F06.4) - 11.1% and dementia (F02.3) - 9.5%.

An analysis of pathopsychological factors and patterns of formation of these mental disorders is presented below.

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Organic nonpsychotic depressive disorder (F06.36)

According to the results of the anxiety study (according to the CAS scale), patients with Parkinsonism and organic depressive disorder (F06.36) were diagnosed with a low level of anxiety (6.5±1.3; p> 0.5).

The use of SMIL in patients with Parkinson's disease and depressive disorder (F06.36) showed an increase in scores on the depression scale (79±6 T-scores); impulsivity (75±7 T-scores) and anxiety (72±5 T-scores). Such results reflected the presence of an internal conflict associated with a contradictory combination of a high level of aspirations with self-doubt, high activity with rapid psychophysical exhaustion. Awareness of psychological problems and refusal to implement one's intentions were accompanied by a decrease in mood.

The average SMIL profile indicated the presence of a compensatory depressive reaction developing against the background of a pronounced conflict of contradictory motivational-behavioral tendencies in patients with dysthymic, anxious and excitable characteristics of response to unfavorable factors.

According to the results of the Luscher test, patients with Parkinsonism with F06.36 showed a predominance of green and brown (+2+6) colors in the first and second positions (in 79.8% and 75.3%) and yellow and red (–4–3) in the seventh and eighth positions of the row (in 84.3% and 80.9%), p < 0.05. The results obtained indicated frustration of the need for self-realization and recognition, which led to a passive-defensive position and distress, manifested in the form of irritability, anxious uncertainty, fatigue and depression.

Among the predominant types of attitude toward the disease in patients with Parkinsonism and depression (F06.36), melancholic (77.5%) and neurasthenic (60.7%) were diagnosed (at p < 0.01). These types were characterized by a depressed mood with depressive statements; disbelief in the improvement of their health, in the success of treatment; outbursts of irritation ending in remorse and tears; an impatient attitude toward medical personnel and procedures.

Thus, the main pathopsychological features of the formation of organic non-psychotic depressive disorder were: frustration of the needs for self-realization and recognition; a combination of dysthymic, anxious and excitable features of response to unfavorable factors; the formation of a compensatory depressive reaction against the background of a pronounced conflict of contradictory motivational and behavioral tendencies.

The trigger factor for the development of depression (F06.36) was the fact of having Parkinson's disease and its physical consequences, which led to frustration of a high level of aspirations, the need for self-realization and recognition. Persistence in defending frustrated positions in combination with internal multifaceted motivational and behavioral tendencies (achieving success - avoiding failure, activity and determination - blocking activity, striving for dominance - lack of self-confidence) caused a compensatory depressive reaction, characteristic of individuals with dysthymic, anxious and excitable features of reaction to unfavorable factors.

Organic emotionally labile (asthenic) personality disorder (F06.6)

In patients with Parkinsonism with organic disorder (F06.6), a low level of anxiety (5.2±2.8) was diagnosed according to the results of the CAS scale.

In the personality profile (SMIL) of patients with F06.6 disorder, an increase in scores was observed on the scales of depression (72±6 T-scores); anxiety (70±7 T-scores) and neurotic overcontrol (68±7 T-scores), which indicated a pronounced hyposthenic form of emotional and behavioral response to unfavorable factors.

According to the results of M. Luscher's test, in patients with Parkinson's disease with F06.6, a shift of gray and dark blue (+0+1) colors to the first positions of the row (in 82.7% and 78.8%) and red and brown (–3–6) to the last positions of the row (in 86.5% and 82.7%) was observed (p < 0.05), which reflected the frustration of physiological needs, infringing on the feeling of independence and causing fatigue, a feeling of helplessness, a need for rest and restrictive behavior.

Among the predominant types of attitude to the disease in patients with Parkinsonism with F06.6, neurasthenic (61.5%) and apathetic (48.1%) types of attitude to Parkinson's disease were noted (p < 0.01), which were characterized by outbursts of irritation; severe psychophysical exhaustion; indifference to one's fate, the outcome of the disease, and the results of treatment; passive submission to procedures and treatment; loss of interest in everything that previously worried them.

Consequently, among the main pathopsychological features of the formation of disorder F06.6 in patients with Parkinsonism, the following were identified: frustration of physiological needs, excessively limiting the patient's independence; a combination of acquired dysthymic and psychasthenic personality traits, leading to a hyposthenic (psychasthenic) form of emotional and behavioral response of patients to unfavorable factors.

The triggering factor for the development of organic emotionally labile disorder (F06.6) was the fact of recurrent Parkinson's disease, which caused frustration of physiological needs for full physical and mental activity through limitation of independence. This frustration, against the background of dysthymic and psychasthenic personality traits acquired as a result of organic brain damage, led to the formation of a compensatory hyposthenic form of emotional and behavioral response.

Organic anxious personality disorder (F06.4)

According to the results of the CAS scale, patients with Parkinsonism and anxiety disorder (F06.4) were diagnosed with high anxiety (20.2±1.1). The most pronounced components of anxiety were mental tension (78.8%), muscle tension (72.7%), worry (69.7%) and apprehension (63.6%) (p < 0.05).

According to the SMIL profile, patients with Parkinson's disease and anxiety disorder (F06.4) showed increased scores on the anxiety scale (78±8 T-scores) and introversion (72±6 T-scores), which reflected weakening of social contacts, isolation and alienation, inertia of mental functions, rigidity of attitudes, and escape from problems into solitude. The average SMIL profile indicated pronounced social maladaptation and the leading anxious form of patients' response to unfavorable factors.

According to the results of the Luscher test, patients with Parkinson's disease and F06.4 showed a predominance of dark blue and brown (+1+6) colors in the first and second positions of the row (in 72.7% and 63.6%) and yellow and red (–4–3) in the seventh and eighth positions (in 78.8% and 66.7%) (p < 0.05), which reflected frustration of the need for self-realization, passivity of the position, dependence, anxiety, worry, insecurity, suspiciousness and concerns for their health, fear of the future, a feeling of lack of emotional warmth from others, the need for their protection and help.

Among the types of attitude towards Parkinson's disease, these patients were predominantly diagnosed with anxious (81.8%) and hypochondriacal (42.4%, p < 0.01), which were manifested by anxiety, worry and suspiciousness regarding the unfavorable course of the disease, possible complications, ineffectiveness of treatment; search for new methods of treatment, additional information about Parkinson's disease, possible complications, treatment methods; focus on subjective painful sensations; exaggeration of real and non-existent manifestations of Parkinson's disease; demands for a more thorough examination.

In general, the main pathopsychological factors in the development of anxiety disorder (F06.4) in patients with Parkinson's disease were frustration of the need for self-realization and recognition, disappointment and fear of the future; passivity of position, dependence, a feeling of lack of emotional warmth from others, the need for their protection and help; anxious personality traits leading to an anxious form of emotional and behavioral response of patients to unfavorable factors and the development of social maladaptation.

The triggering factor for the development of anxiety disorder (F06.4) was the fact of having Parkinson's disease, which caused frustration of the need for self-realization and recognition due to the inferiority complex formed due to the manifestations of Parkinson's disease. This frustration against the background of constitutional anxious personality traits contributed to compensatory anxious forms of behavior, expressed in passivity, dependence, anxiety, insecurity, suspiciousness, a feeling of lack of emotional warmth from others, the need for their protection and help.

Dementia (F02.3) in Parkinson's disease

According to the results of the anxiety study using the CAS scale, patients with parkinsonism with dementia (F02.3) were diagnosed with a low anxiety level (5.5±1.1; p> 0.5). When using the SMIL test in patients with dementia (F02.3), unreliable results were obtained; due to their intellectual disability, patients from this group could not cope with the questionnaire, and the results obtained could not be interpreted. According to the Luscher test, patients with parkinsonism with dementia (F02.3) did not reveal statistically significant patterns in the distribution of colors in the first-second and seventh-eighth positions. Among the types of attitude towards the disease, patients in this group were predominantly apathetic (57.1%), anosognosic (35.7%) and euphoric (32.1%), p< 0.01, which were characterized by complete indifference to their fate, the outcome of the disease, and the results of treatment; passive submission to procedures and treatment; loss of interest in everything that previously worried; disregard and frivolous attitude towards the disease and treatment; denial of the manifestations of the disease, attributing them to other minor diseases; refusal of examination and treatment.

The results obtained during the study do not allow us to identify a single pathopsychological mechanism for the formation of dementia (F02.3) in Parkinson's disease. The main role in this process belongs to organic damage to the brain, and the pathopsychological mechanisms involved in the formation of individual clinical psychopathological manifestations are derivatives of cognitive disorders and thinking disorders in this form of dementia.

Thus, the conducted study of organic mental disorders in patients with Parkinsonism allows us to identify common pathopsychological patterns of formation of organic mental disorders in Parkinson's disease: the main reason for the formation of organic mental disorders is the fact of the presence of severe Parkinson's disease and its consequences. Parkinson's disease triggers organic (F06.6) or combined (F06.36, F06.4) mechanisms of formation of mental pathology, or mental pathology is a pathogenetic non-motor manifestation of Parkinson's disease itself (F02.3).

The main cause of development of organic mental disorders in patients with Parkinsonism is frustration of high level of aspirations, need for self-realization and recognition (for patients with F06.36 and F06.4), physiological needs for full physical and mental activity (for patients with F06.6). The main mechanism of development of organic mental disorders in patients with Parkinsonism is the mechanism of constitutionally conditioned or acquired cognitive, emotional and behavioral response to frustration of basic needs: depressive reaction as a compensatory reaction to a pronounced conflict of contradictory motivational and behavioral tendencies (for F06.36); hyposthenic form of emotional and behavioral response due to acquired dysthymic and psychasthenic personality traits of organic genesis (for F06.6); anxious form of emotional and behavioral response of constitutional and organic genesis (for F06.4).

The results obtained during the study seem to need to be used in developing programs for the prevention and differentiated therapy of patients with Parkinson's disease complicated by organic mental pathology.

PhD D. Yu. Saiko. Pathopsychological features and organic mental disorders in Parkinson's disease // International Medical Journal - 2012 - No. 3 - pp. 5-9