Introduction

The term Parkinsonism is used for a motor syndrome whose main symptoms are tremors at rest, stiffness, slowing of movement and postural instability. Parkinson's disease is the most common form of Parkinsonism and is usually defined as "primary" Parkinsonism, meaning Parkinsonism with no external identifiable cause. Parkinson's disease is a degenerative disorder of the central nervous system. It results from the death of dopamine-containing cells in the substantia nigra, a region of the mid brain; the cause of cell-death is unknown. Parkinsons disease affects the way your brain controls your bodys movement. The symptoms usually recognized are Motor Symptoms. Motor symptoms usually first appear only on one side of the body. Over time, the other side of the body tends to develop Motor Symptoms, as well. Most common symptoms are tremors, rigidity (which may involve Micrographia-small handwriting and Hypomimia-decreased facial expression.) along with decreased dexterity and co-ordination. Patient also shows slowness of movement (Bradykinesia), postural instability, stooped posture. Overtime, mobility may also become limited. Non Motor Symptoms may include Muscle weakness, problems with swallowing, choking, drooling and voice changes. It also effects the gastrointestinal muscles, can cause constipation and weaken bladder muscles (incontinence). They suffer from decreased sense of smell (Anosmia), oily skin, dandruff, excessive sweating, low blood pressure on standing up and changes in memory and intelligence. The cause of the disease is not certain. However, numerous studies have shown that exposure to pesticides and industrial solvents can increase your risk for Parkinsons disease. Approximately 2-3% of Parkinsons patients have a genetic mutation that may predispose them to the disease. Modern treatments are effective at managing the early motor symptoms of the disease, mainly through the use of levodopa and dopamine agonists. As the disease progresses and dopamine neurons continue to be lost, a point eventually arrives at which these drugs become ineffective at treating the symptoms and at the same time produce a complication called dyskinesia, marked by involuntary writhing movements. Diet and some forms of

rehabilitation have shown some effectiveness at alleviating symptoms. Surgery and deep brain stimulation have been used to reduce motor symptoms as a last resort in severe cases where drugs are ineffective. Participation in a clinical trial often gives newly diagnosed the opportunity to participate in the development of new treatment options. This participation can be very powerful. One study participant said, Psychologically I feel like participating in research is like striking back at the disease.

Review of Literature
Parkinsons is a degenerative disease. It is important to study the psychological effects of this disease on patients suffering from it and what maybe the different treatment strategies that can be adopted to treat this disease. 1. (Hackney & Earhart, 2010) studied the effect of dance on balance and gait in severe Parkinsons disease- a case study. It is known that dance may improve functional mobility in individuals with mild-to-moderate Parkinson disease (PD), yet dance effects in severe PD remain unexamined. This study's purpose was to evaluate the feasibility and effects of partnered tango classes on balance, endurance and quality of life in an individual with severe PD. It was found that twenty partnered tango lessons improved balance, endurance, and quality of life of the patient. The participant showed improvement in the Berg Balance Scale, the 6 minutes walk test and functional reach. 2. Becker, C et all (2011) studied the risk of incident depression in patients with Parkinson disease in the UK. The non-motor symptoms are not widely recognized in patients with Parkinson disease (PD). They sought to assess the incidence rate as well as the risk of depression in newly diagnosed patients with PD and to compare it to PD-free controls. The conducted a population-based follow-up study with a nested case-control analysis based on data from the UK-based General Practice Research Database (GPRD). It included PD patients aged 40 years with a first PD diagnosis between 1994 and 2005, and a matched comparison group free of PD. The increased relative risk was most pronounced in

women and in individuals 40-69 years of age. Long-term users of levodopa had an increased depression risk when compared to short-term users. Patients with PD are at an approximately twofold increased risk of being diagnosed with depression compared to the PD-free population. 3. studied a masked facial expression, one of the hallmark features of Parkinson disease (PD), can form the basis for misattributions by others about a patient's mood or interest levels. The aim of the present study was to determine whether PD participants exhibit deficits in overall emotional expressivity, and if so, whether they are aware of these deficits. They evaluated 37 non-demented PD participants and 21 comparison participants using the Berkeley Expressivity Questionnaire (BEQ). To examine awareness of emotional expressivity, we compared participant self-ratings of their own expressivity to ratings made by family members or close friends. Participants also completed questionnaires regarding depression and apathy and underwent motor examination and cognitive screening. PD participants' self-ratings of emotional expressivity were significantly lower than comparison participants' self-ratings. Even so, the PD participants viewed themselves as experiencing equivalent levels of emotional intensity to comparison participants, based on analysis of the BEQ subscales. These findings highlight the view that diminished emotional expressivity in PD should not be mistaken for decreased subjective emotional experience. 4. (Leritz, Loftis, Crucian, Friedman, & Bowers, 2004) Anosognosia is an unawareness or denial of deficits. The present study investigated whether anosognosia is a feature of Parkinson disease. Forty-eight Parkinson disease patients with predominantly left- (N = 16) or right-sided (N = 32) motor symptoms who eventually underwent right or left pallidotomies, and 48 individuals identified as caregivers completed questionnaires rating severity of PD. There was no discrepancy in report between patients and caregivers as a function of pallidotomy side. However, as a group, patients rated themselves as significantly less impaired on 2 measures of activities of daily living, indicating

that basal ganglia dysfunction may alter insight into severity of illness. Patients and caregivers in the left-symptom PD group differed significantly on selected measures of functional independence. This suggests the potential interaction of laterality and handedness.

Conclusion
Parkinson Disease does have a Psychological Impact on the individual suffering from it. It leads to low motor co-ordination and less brain functioning over a period of time. Since there is no cure, and only ways to control it, over time the medication does not help and the patient loses motor control. Dance may be one way of therapy for patients with Parkinsons and research suggests that they are more prone to depression. Hence, with proper support, treatment strategies and therapy, these individuals can lead a normal life even with their impairment. As suggested by the research, that even though patients do not show emotional reactions, they still feel them and there maybe a discrepancy between the caregivers and the patients in the understanding of the disease, emotional reactions and general understanding of the environment around them.

References
Becker, C.; Brobert, G. P.; Johansson, S.; Jick, S. S.; Meier, C. R.(2011, March) Risk of incident depression in patients with Parkinson disease in the UK. European Journal of Neurology, 18 (3), p448-453 Hackney, M. E., & Earhart, G. M. (2010). Effects of dance on balance and gait in severe Parkinson disease: a case study. Disability and rehabilitation, 32(8), 679-84. doi: 10.3109/09638280903247905. Leritz, E., Loftis, C., Crucian, G., Friedman, W., & Bowers, D. (2004). Self-awareness of deficits in Parkinson disease. The Clinical neuropsychologist, 18(3), 352-61. doi: 10.1080/1385404049052412. Mikos, A. E., Springer, U. S., Nisenzon, A. N., Kellison, I. L., Fernandez, H. H., Okun, M. S., et al. (2009). Awareness of expressivity deficits in non-demented Parkinson disease. The Clinical neuropsychologist, 23(5), 805-17. doi: 10.1080/13854040802572434.

Health Psychology CIA-2

Submitted to- Dr Radha

Department of Psychology Christ University

Submitted by- Fatema M K Register Number- 0914268 B.A Honors (Psychology)