Johann Heinrich Ellgring, S. Seiler, B. Perleth, T. Gasser, W. Oertel

• Introduction Although symptomatic therapy is available for Parkinson's disease, patients and relatives are faced with continuous severe psychological problems. These psychological problems include: 1. lack of emotional expression, 2. bradephrenia, 3. depression, 4. lack of motivation,S. social anxiety, 6. stress induced increase of symptoms. The first four of these may be at least in part due to the dopamine deficiency. However, even as part of the primary symptoms they have social and communicative impact for patients and relatives. SocialIntroduction Although symptomatic therapy is available for Parkinson's disease, patients and relatives are faced with continuous severe psychological problems. These psychological problems include: 1. lack of emotional expression, 2. bradephrenia, 3. depression, 4. lack of motivation,S. social anxiety, 6. stress induced increase of symptoms. The first four of these may be at least in part due to the dopamine deficiency. However, even as part of the primary symptoms they have social and communicative impact for patients and relatives. Social anxiety and stress induced increase of symptoms on the other hand clearly result from an interaction of somatic and psychological factors. Social anxiety mainly develops in Parkinson I s disease as an indirect consequence of the motor symptoms. Patients are afraid of being negatively evaluated in the public, of receiving negative comments etc. Thus r social withdrawal increases and the improvement of neurological symptoms following drug treatment may not be fully exploited on the psychosocial level. Stress induced increase of motor symptoms is a commonly observed phenomenon in Parkinson's disease. Even minor stressors, mainly social in nature, can have extreme effects and may elicit or increase tremor or rigidity. A patient can be well in one moment, but unable to move in the next when being aware that he has to leave the house in an hour. Given this situation, patients and relatives have to develop strategies fo~ an emotional balance in the presence of a continuous confrontation with the direct and indirect consequences of the disease. A precondition for developing new psychologically based strategies is an optimwn medical treatment. The integrated approach for neurological and psychological support has the following goals: 1. improving medical treatment for the individual patient, 2. improving psychological coping and psychosocial adaptation for patients and relatives, and 3. evaluating and improving medical and psychological therapy. CONCLUSION Psychological intervention can provide considerable help for a substantial part of Parkinson patients. The main target is coping with stressful social situations. Relaxation and cognitive restructuring together with situational behavioral analysis and training of social skills specifically adapted to the disease are" the main strategies. Various problems remain open at the moment, like the maintenance of motivation which is especially critical for Parkinson patients. Parkins on 's disease is a neurological disease with a known pathological substrate and a therapy which is effective at least for several years on a symptomatic level. The symptoms are tightly connected with psychological emotional and cognitive processes. Moreover, patients and relatives have to cope with symptoms which strongly influence social interaction. And they have to cope together with this situation over a period of ten or twenty years. Thus not only for the patient but also for the health of the relatives, psychological aid is urgently needed. We suggest to integrate psychological approach into the neurological diagnosis and treatment.…