Depression, psychosis, and dementia: impact on the family.

Similar to the setting of other chronic, debilitating diseases, considerable psychoeducational support of the patient's family and other caregivers represents an often-overlooked component of appropriately thorough care. Nearly three of four persons caring for an individual with PD report psychological 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 support and community self-help groups that assist caregivers in sharing concerns and promote a sense they are understood by others. Through such measures, which may be delivered effectively by nurse practitioners, PD caregivers can develop effective coping strategies for disease related stressors. Empirical results show the most common stressors are: anxiety, concern about the future, impatience or intolerance, loss of autonomy, sleep disturbances, diminished time and opportunity for recreation and social contact, and anger. These sequelae often ensue when the PD patient evidences depression, advanced dementia, or psychosis, each of which can severely constrain communication. Caregivers often must also contend with two other adverse psychological phenomena: cognitive dissonance surrounding placement of the patient in a nursing home and learned helplessness, which may predispose to depressive states. Other often unmet needs of the "hidden victims" of PD include compromised immune function, social stigmata, and financial difficulties. Respite care may be useful in reducing the stress associated with these and other problems frequently affecting caregivers.