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 2 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. 1 of 2 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