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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 > > ---------------------------------------------------------------------- > To sign-off Parkinsn send a message to: > mailto:[log in to unmask] > In the body of the message put: signoff parkinsn ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn