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MIND AND MOVEMENT: THE NEUROPSYCHIATRY OF MOVEMENT DISORDERS
  1. Belinda R Lennox,
  2. Graham G Lennox
  1. Correspondence to:
 Dr Graham G Lennox, Department of Neurology, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK; email:
 bl224{at}cam.ac.uk

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The irritating historical division between neurology and psychiatry is at its most arbitrary in the field of movement disorders. All of the major movement disorders (such as Parkinson's disease, idiopathic dystonia, Huntington's disease, and Gilles de la Tourette's syndrome) have important psychiatric dimensions; indeed these are often the primary determinants of quality of life. Similarly many of the major psychiatric disorders (such as schizophrenia and depression) involve abnormalities of movement, even though psychiatrists and neurologists have traditionally used different terms to describe them. Perhaps as a consequence of the historic division, these huge areas of neuropsychiatric overlap have not been studied as intensively as they deserve; in this review we aim to provide a pragmatic guide to management.

PARKINSON'S DISEASE

Depression

Depression is common in Parkinson's disease (PD), with a prevalence of about 30%. It is regarded by patients as one of the most unpleasant aspects of PD. It can occur at any stage of the disease, and occasionally may precede the onset of motor symptoms by a few years. In general, however, it becomes more common with increasing disease severity as assessed by the doctor, and increasing disability as assessed by the patient. People with PD who are depressed are also more prone to have anxiety disorders, psychotic symptoms or dementia.

Although the miseries of suffering from PD clearly contribute to the development of depression, it is best understood as a biological manifestation of the disease. Certainly PD is associated with pathology in all the brainstem monoaminergic nuclei, causing profound reductions in 5-HT (5-hydroxytryptamine) and noradrenaline (norepinephrine) concentrations. Depression is more common in PD than in other similarly disabling conditions. Neurologists must be proactive in looking for symptoms of depression: low mood, anhedonia, sleep disturbance, and a failure to feel better despite objective motor improvement are all potential pointers. They should trigger …

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