Thank you for your important insights.

Lottie Hillard
----- Original Message ----- 
From: "Jim Slattery" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, April 12, 2009 4:36 AM
Subject: Psychiatric aspects of PD


> 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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