Mood prevention
 
This is useful and mentions ondansetron, as well as early intervention and
progression from mild to serious probles, which is my aim. Cutting back on L-
dopa and mild sedation with 10 mg of tryptanol or 2mg of valium  seems to work
if one's mind is starting to race. It is easy to recognise the early signs of
euphoria, especially for carers, but the need is for a plan of action. I have
at last found a psychiatrist who is trying to devise a long term solution. My
children say I am back to being myself, the person I was before PD, but I am
seriously undertreated mobility wise.   As yet the abstract is all I have.
 
TI: Parkinson's disease: drug-induced psychiatric states.
AU: Factor-SA; Molho-ES; Podskalny-GD; Brown-D
AD: Albany Medical College, Department of Neurology, New York 12208.
SO: Adv-Neurol. 1995; 65: 115-38
ISSN: 0091-3952
PY: 1995
LA: ENGLISH
CP: UNITED-STATES
AB: Drug-induced psychiatric states occur frequently in PD. In the prelevodopa
era, depression and other psychiatric disorders were described in PD, but in
untreated patients psychosis was rare. Since the development of levodopa and
other pharmacological treatments for PD, however, psychotic symptoms have
become much more common (10-50%). In some individuals these problems can be
more disabling than the motor features of PD and, as a result, pose a serious
threat to the patient's ability to maintain independence. The drug-induced
psychoses consist of several distinct psychiatric syndromes that can be
divided broadly into those occurring on a background of a clear sensorium and
those which are accompanied by confusion and clouding of consciousness. Benign
organic hallucinosis is the most common of these syndromes (30%). It usually
occurs on a background of a clear sensorium and may not be a particularly
troublesome problem if the patient is able to retain insight into the nature
of these symptoms. More disabling syndromes usually include delusional
thinking that is frequently paranoid, confusion and even frank delirium.
Although all these psychotic syndromes can occur in isolation, there is a
tendency for mild symptoms to progress to more disabling ones if adequate and
timely treatment is not instituted. Abnormal dreaming and sleep disruption
often precede these difficulties by weeks to months and may provide an
important early clue to their onset. The mechanisms responsible for
drug-induced psychotic symptoms in PD are unknown, but dopaminergic
(especially mesolimbic) and serotoninergic systems are likely to be involved.
The treatment of the drug-induced psychoses in PD should be undertaken in a
stepwise manner. A detailed discussion of this approach, including the use of
anti-PD medication adjustment, clozapine, and other medications (neuroleptic
and nonneuroleptic) and ECT is provided (see Fig. 1). Although drug-induced
psychoses are the most important of the drug-induced psychiatric states,
mania, anxiety, and hypersexuality may also occur. Depression is also common
in PD, but it is unlikely to occur as a side effect of antiparkinsonian
medications.
MESH: Aged-; Anxiety-etiology; Clozapine-adverse-effects;
Clozapine-therapeutic-use; Depression-etiology; Electroconvulsive-Therapy;
Lisuride-analogs-and-derivatives; Manic-Disorder-etiology;
 Ondansetron-therapeutic-use; Parkinson-Disease-complications;
Parkinson-Disease-psychology; Psychoses,-Substance-Induced-psychology;
Psychoses,-Substance-Induced-therapy; Psychosexual-Dysfunctions-etiology
MESH: *Levodopa-adverse-effects; *Parkinson-Disease-drug-therapy;
*Psychoses,-Substance-Induced-etiology
TG: Case-Report; Human; Male; Support,-Non-U.S.-Gov't
PT: JOURNAL-ARTICLE; REVIEW; REVIEW,-ACADEMIC
RN: 0; 18016-80-3; 37686-84-3; 5786-21-0; 99614-02-5
NM: Levodopa; Lisuride; dironyl; Clozapine; Ondansetron
AN: 95176970
UD: 9506
 The following is a much more severe example of the moodswings that standard
sinemet caused me.
                                 MEDLINE (R) 1986                        1 of
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                                                           Marked in Search:
#39
TI: "On-off" phenomena and manic-depressive mood shifts: case report.
AU: Keshavan-MS; David-AS; Narayanen-HS; Satish-P
SO: J-Clin-Psychiatry. 1986 Feb; 47(2): 93-4
ISSN: 0160-6689
PY: 1986
LA: ENGLISH
CP: UNITED-STATES
AB: A patient with idiopathic Parkinson's disease and "on-off" phenomena is
described. A consistent relationship existed between the "on" (dyskinetic)
phases and mania and between the "off" (akinetic) phases and depression. The
heuristic interest of this case and its indirect support of the dopamine
hypothesis of affective disorder are discussed.
MESH: Adult-; Manic-Disorder-physiopathology
MESH: *Bipolar-Disorder-physiopathology; *Dopamine-physiology;
*Parkinson-Disease-physiopathology
TG: Case-Report; Human; Male
PT: JOURNAL-ARTICLE
RN: 51-61-6
NM: Dopamine
AN: 86111656
UD: 8605
 
I, too, was non bipolar. Mania must be one of the most stigmatizing non
politically correct words I know. Try it sometime 'I have appendicitis' 'I
have mania'
 
TI: Induction of mania by L-dopa in a nonbipolar patient.
AU: Harsch-HH; Miller-M; Young-LD
SO: J-Clin-Psychopharmacol. 1985 Dec; 5(6): 338-9
ISSN: 0271-0749
PY: 1985
LA: ENGLISH
CP: UNITED-STATES
AB: The authors present a case of mania associated with the prolonged
ingestion of large doses of L-dopa. Prior reports relating L-dopa therapy to
mania in patients with bipolar disorders are discussed. The induction of a
classic manic syndrome by catecholamine augmentation is possible in a
nonbipolar individual.
MESH: Adult-; Dopamine-metabolism; Levodopa-metabolism;
Levodopa-therapeutic-use; Parkinson-Disease-drug-therapy
MESH: *Levodopa-adverse-effects; *Manic-Disorder-chemically-induced
TG: Case-Report; Female; Human
PT: JOURNAL-ARTICLE
RN: 0; 51-61-6
NM: Levodopa; Dopamine
AN: 86060191
UD: 8603
 
  This most excellent Canadian study suggests that Alzheimer's in PD is
  about 8%, the same as the controls, and that confusion due to medication
  accounts for a further 8% called AD in other studies. Cognitive problems
  in PD were selective, rather than a general loss of ability, which
  hopefully means there are ways around a problem, like making lists if
  some sub type of short term memory loss occurs.
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TI: Frontal lobe dysfunction in Parkinson's disease. The cortical focus of
neostriatal outflow.
AU: Taylor-AE; Saint-Cyr-JA; Lang-AE
SO: Brain. 1986 Oct; 109 ( Pt 5): 845-83
ISSN: 0006-8950
PY: 1986
LA: ENGLISH
CP: ENGLAND
AB: This study investigates the hypothesis that, as a consequence of
Parkinson's disease, disturbed caudate outflow will lead to deficits in
cognitive functions dependent upon the integrity of the prefrontal cortex, the
cortical focus of caudatofugal signals. Since Parkinson's disease also
involves lesions in extra-striatal midbrain cells which reduce the extrinsic
supply of dopamine to this cortical region, such functions are at double risk.
Forty nondemented parkinsonian patients were drawn from a pool of 100
consecutive patients and matched with 40 normal control subjects according to
age, education, IQ, and sex. All patients were quantitatively rated on
neurological indices of disease. Neuropsychological assessment of the patient
and normal groups included tests of general intelligence, psychomotor skills,
memory, visuospatial and executive functions. No global cognitive decline was
observed in the parkinsonian group. Moreover, memory and visuospatial
abilities were generally intact. A small cluster of deficits emerged,
interpreted as reflecting impairment in the ability to spontaneously generate
efficient strategies when relying on self-directed task-specific planning. In
addition, several tests thought to be sensitive to frontal lobe function
distinguished patients with symptoms strongly lateralized to the right versus
left side of the body. Deficits in strategic planning were later investigated
in relation to severity of disease and to patient attributes including IQ and
age, both of which were relevant to performance on specific tasks. Results
were compared with previous investigations in parkinsonian patients and
discussed from the perspective of both animal and human studies involving
damage to the cerebral cortex and basal ganglia. As the prefrontal cortex is
thought to play a crucial role in self-directed behavioural planning, the
validity of an outflow model in predicting the consequences of caudate nucleus
dysfunction was supported.
MESH: Adult-; Aged-; Aged,-80-and-over; Cognition-physiology;
Corpus-Striatum-physiology; Laterality-physiology; Memory-physiology;
Middle-Age; Neuropsychological-Tests; Psychomotor-Performance
MESH: *Frontal-Lobe-physiopathology; *Mental-Processes-physiology;
*Parkinson-Disease-physiopathology
TG: Female; Human; Male; Support,-Non-U.S.-Gov't
PT: JOURNAL-ARTICLE
AN: 87050702
UD: 8703
SB: AIM
 
          Emotional lability, a rapid change of emotions, is described
  here, but mine were related to sinemet levels and stopped with sinemet
  CR.
2
TI: Parkinson's disease and depression. A critical re-evaluation.
AU: Taylor-AE; Saint-Cyr-JA; Lang-AE; Kenny-FT
SO: Brain. 1986 Apr; 109 ( Pt 2): 279-92
ISSN: 0006-8950
PY: 1986
LA: ENGLISH
CP: ENGLAND
AB: The possibility of an 'organically' based depression intrinsic to the
pathophysiology of Parkinson's disease (PD) and comparable to endogenous
depression (Major Depressive Episode) has been raised. It has also been argued
that signs of depression observed in PD are merely the natural reaction of the
patients to their progressive and inevitable physical limitations and loss of
independent function. Because conventional depression rating scales are
limited in scope, a psychometric investigation of depression in PD was
pursued. Based on the known impairment of short-term memory (STM) in
endogenous depression, which was confirmed in a group of psychiatric patients
in the present study, measures of STM were also obtained in groups of
depressed and nondepressed PD patients and in 15 normal control subjects.
Regardless of depression severity, PD patients performed as well as control
subjects and both these groups consistently obtained scores significantly
better than those of the endogenously depressed patients. A relative weakness
in the PD patients on order-dependent STM tests was further explored and
interpreted as an indication of mild frontal lobe dysfunction. It was
concluded that PD patients are frequently depressed when confronted with their
behavioural limitations and that this reaction may be exacerbated by a form of
emotional lability related to pathophysiological processes which may involve
prefrontal cortical areas.
MESH: Adult-; Aged-; Depression-psychology; Language-Tests;
Memory,-Short-Term; Middle-Age; Neuropsychological-Tests;
Parkinson-Disease-psychology; Psychometrics-methods; Wechsler-Scales
MESH: *Depression-complications; *Parkinson-Disease-complications
TG: Human
PT: JOURNAL-ARTICLE
AN: 86160756
UD: 8607
SB: AIM