tailieunhanh - Parkinson disease and related disorders part - part 8

Nếu bệnh nhân đã thất bại hai thử nghiệm đầy đủ của thuốc chống trầm cảm, tư vấn với bác sĩ tâm thần có thể giúp giải quyết bất kỳ vấn đề chẩn đoán và cung cấp hướng dẫn bổ sung về phương pháp điều trị thích hợp soma. Việc bổ sung hoặc thay thế của tâm lý trị liệu | 428 D. WEINTRAUB AND M. B. STERN as an antidepressant or a PD medication. There has also been concern that the combination of selegiline and SSRIs might lead to serotonin syndrome although clinical experience suggests that the combination is safe Richard et al. 1997b . Many questions remain concerning the pharmacologic treatment of dPD. For instance it is unclear if the altered neural substrate . impairment of neural networks servicing the frontal lobe and multiple mono-aminergic deficits means PD patients will experience a more limited or variable response to standard antidepressant treatment than that reported in other populations. Also the appropriate dosing titration schedules and final therapeutic ranges for antidepressant use in PD have yet to be established. Likewise the duration of antidepressant treatment for PD patients is not clear including as to whether chronic antidepressant therapy is indicated for general or for select patients. Concerning non-pharmacologic approaches electroconvulsive therapy can successfully treat both depression and the motor symptoms associated with PD although the motor benefits wear off once treatment is discontinued Moellentine et al. 1998 . Two open trials of transcranial magnetic stimulation for dPD reported a moderate improvement in both mood and motor symptoms Dragasevic et al. 2004 Fregni et al. 2004 . It is unclear whether there is a place for psychotherapy . cognitive-behavioral therapy or problem-solving therapy in the treatment of dPD either as an alternative first line treatment or as an approach to rehabilitation for those with partial medication response. Anecdotally however there are many PD patients who prefer psychotherapy do not respond to pharmacotherapy or are reluctant to take another medication for fear of side-effects or to avoid adding to an already complex medication regimen so psychotherapy may be an important alternative. When using psychotherapy in PD we have often found it helpful to involve .