Depression, psychosis and dementia - Impact on the family

Similar to the setting of other chronic, debilitating diseases, considerabl e psychoeducational support of the patient's family and other caregivers re presents an often-overlooked component of appropriately thorough care. Near ly three of four persons caring for an individual with PD report psychologi cal stress and anxiety, which are exacerbated by concerns about progression of the disease. Counseling for PD caregivers can be dispensed particularly effectively through individual psychological counseling as well as PD supp ort and community self-help groups that assist caregivers in sharing concer ns and promote a sense they are understood by others. Through such I-measur es, which may be delivered effectively by nurse practitioners, PD caregiver s can develop effective coping strategies for disease: related stressors. E mpirical results show the most common stressors are: anxiety, concern about the future, impatience or intolerance, loss of autonomy, sleep disturbance s, diminished time and opportunity for recreation and social contact, and a nger. These sequelae often ensue when the PD patient evidences depression, advanced dementia, or psychosis, each of which can severely constrain commu nication. Caregivers often must also contend with two other adverse psychol ogical phenomena: cognitive dissonance surrounding placement of the patient in a nursing home and learned helplessness, which may predispose to depres sive states. Other often unmet needs of the "hidden victims" of PD include compromised immune function, social stigmata, and financial difficulties, R espite care may be useful in reducing the stress associated with these and other problems frequently affecting caregivers.