great can i put it on our web site, www,].parkinsons.org.pk        haroon

On 4/12/09, Jim Slattery <[log in to unmask]> wrote:
> Here is my personal view of apparent personality disorders in PD, from my 25
>  years of having PD, and 10 years of  intensive research. I am not a doctor
>  of medicine and anything I say here is my personal opinion only.
>
>  1. I prefer to use the term "parkinsonism" to avoid needless petty argument
>  as to whether or not a particular group of symptoms is "true IPD"
>  (idiopathic Parkinson's Disease). If it looks like a duck, walks like a duck
>  and quacks like a duck, it probably is a duck, though not necessarily an
>  Anas platyrhynchos. Strange when you think about it, since "idiopathic"
>  means "arising from an unknown cause". However, PD is quicker, so lets stick
>  to that.
>
>  2. If you look up the drugs used to treat PD and/or its side-effects, you
>  will find they many of them are "psychotropic" (affecting the mind or mood
>  or other mental processes). For example selegeline metabolises in the body
>  to meth-amphetamine, hard to explain if you get pulled over for a traffic
>  bust!
>
>  3. One of the most often quoted side-effects is "depression" (chemically
>  induced in this case, although it often rides on top of depression arising
>  out of the circumstances of the PWP and family).
>
>  4. Most PWPs have the so called Parkinson's "facies" (a facial appearance
>  typical of a particular disorder). A psychologist or psychiatrist might say
>  they have a "flat aspect", often attributing it to depression, whereas it is
>  brought about by lack of muscle tone as a direct consequence of PD.
>
>  5. Most PWPs have, at one time or another (often on and off throughout the
>  day), "anarthria", a partial or total loss of articulate speech, directly
>  arising from loss of muscle tone in the organs of speech. Paradoxically, the
>  PWP often thinks they are speaking in a reasonable tone and volume.
>
>  6. The above two symptoms can give rise to a feeling that the PWP is
>  "disinterested" or "uncaring" about family or personal matters, whereas they
>  themselves may think they are acting perfectly normally. Children especially
>  are prone to believe that "Gran doesn't love us anymore."
>
>  7. Again checking the manufacturer's own data, a combination of symptoms
>  from medication may give the appearance of dementia, or even Alzheimer's
>  Disease. If this is suspected, a doctor may recommend a "drug holiday"
>  where, under strict professional supervision, the PWP is taken off all
>  medication, and they are re-instituted one at a time in small increasing
>  doses. This is known as drug "titration". This process can be very dangerous
>  if mishandled, and should only be undertaken by a doctor skilled in the
>  process.
>
>  8. The difference between dementia or Alzheimer's from natural causes, and
>  that chemical induced, is that the former is irreversible, where, with care
>  and skill, the later usually disappears when the causative agent is removed.
>
>  9. Common or garden variety constipation can be very detrimental in PD,
>  rendering some medication partially or totally ineffective. For example
>  l-dopa, the principal ingredient of dopamine-replacement medication, has a
>  half-life of 30-45 mins. It is induced into the blood stream by absorbtion
>  from the small intestine, so any delay amounting to more than about 22 mins
>  between swallowing and absorption may render that dose useless. Without
>  going into too much detail, PD affects "motility" (movement of food through
>  the digestive system), the muscle tone of the rectum walls, the anorectal
>  flap, and the anal sphincter. If constipation persists, the PWP can become
>  seriously undermedicated.
>
>  10. PWPs seem loath to drink sufficient fluids during the day. Chronic
>  dehydration can have deleterious effects on the chemical processes within
>  the brain.
>
>  11. PWPs can descend into a mental "fugue", a dream-like state of altered
>  consciousness that may last for hours or even days unless the PWP is forced
>  out of it. This might involve definite eye-contact and physical
>  intervention.
>
>  12. Dopamine, the substance in short supply in PD, is a member of the
>  "catecholamine" chain of neuro-transmitters which contains, among others,
>  adrenaline, of which dopamine is a precursor, so any excessive stress can
>  severly deplete the supply of dopamine. The details of these processes are
>  too complex to go into here.
>
>  So, all in all, the business of balancing the salutary effects of medication
>  against the deleterious side-effects, coupled with the symptoms of the
>  disease, is no easy process, and it is useful to have some knowledge of the
>  complexities, whether medical practicioner or carer.
>
>  Dr James F. Slattery PhD Soc Sc
>
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>


-- 

Haroon Basheer

Tel: +92300 8220196

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