Anxiety, depression, apathy, sleep disturbance and changes in impulse control are common in Parkinson's disease and can affect quality of life as much as tremor or stiffness. Dystonia and essential tremor carry their own social and emotional weight — the self-consciousness of a visible symptom, and the narrowing of life that follows from avoiding it. Psychiatry contributes in three distinct ways.
Mood and behavior in movement disorders
Non-motor symptoms are often under-reported, partly because patients assume they are unrelated to the neurological condition. Identifying and treating depression, anxiety or sleep disturbance frequently produces a larger improvement in daily life than any adjustment to motor therapy.
These symptoms also bear directly on surgical planning. Untreated depression or significant apathy influences how a patient experiences the months of programming that follow DBS, and the team wants to understand that beforehand rather than afterward.
Evaluation before neuromodulation for psychiatric illness
Deep brain stimulation for obsessive-compulsive disorder is an established option for a small, carefully selected group of patients with severe, treatment-resistant illness. DBS for depression remains investigational. In both cases the evaluation is fundamentally a psychiatric one, and the surgical question comes last.
That evaluation establishes the diagnosis and its subtype, documents which treatments have been tried at adequate dose and duration, assesses insight and expectations, and identifies the support a patient will need through a long process. A recommendation against proceeding is a normal and appropriate outcome.
Read more about obsessive-compulsive disorder and depression.
Shared care with neuropsychology
Psychiatry and neuropsychology answer different questions. Neuropsychological testing measures cognition objectively — memory, attention, language, executive function — and establishes the baseline used to judge whether anything changes after treatment. Psychiatric assessment addresses mood, thought content, behavior and psychiatric history.
Both feed into the same team discussion, and for patients being considered for advanced therapy the two evaluations are usually completed in the same period. Learn more about our neuropsychology team.
Working with your own psychiatrist
Many patients already have a psychiatrist or therapist they trust, and there is no reason to disrupt that relationship. Where a patient is being evaluated for neuromodulation, our team coordinates with existing providers rather than replacing them — sharing the evaluation, agreeing who manages what, and confirming who is responsible for ongoing psychiatric care after treatment.