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actions are unreasonable, this may suggest they are
incubating a dementia.
Obsessions and compulsions can start at any time,
from preschool age to adulthood. On average, people
with obsessions and compulsions see three to four doc-
tors and may spend many years seeking treatment
before they are diagnosed. Obsessions and compul-
sions tend to be underdiagnosed because people with
them may be secretive or lack insight about them.
Research suggests that obsessions and compulsions
involve problems in communication between your
frontal-orbital and cingulate lobes and your basal gan-
glia. These brain structures use the chemical messen-
gers dopamine and serotonin. It is believed that low
levels of serotonin are prominently involved in obses-
sions and compulsions. High, and paradoxically low,
levels of dopamine may also be involved. Drugs that
increase the brain concentration of serotonin often
improve obsessions and compulsions. Such drugs
include the selective serotonin reuptake inhibitors,
drugs such as Paxil, Prozac, and Zoloft, that are also
used to treat depression.
There is no test for OCD. Rather, the diagnosis is
made based on an assessment of the person s symp-
toms. A disorder associated with OCD is Tourette s
Syndrome. Tourette s Syndrome is characterized by
motor and vocal tic disorders. Tics are quick, involun-
tary, jerk-like movements. They include grimaces,
shrugs, grunts and snorts. Tourette s is thought to result
from high dopamine levels and resembles, in part, peo-
ple with PD who have dyskinesia. Depression and
OCD often occur together. Although stress can make
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OCD worse, most people with OCD report that their
symptoms may come and go unrelated to stress. People
with OCD may abuse drugs. This may occur in some
PD patients who become addicted to Sinemet, living
for their next on and dreading their next off.
57. What is the autonomic nervous
system (ANS)?
Autonomic nervous The autonomic nervous system (ANS), as its name
system (ANS)
implies, regulates the body s internal environment. The
the region of the
ANS is affected early in MSA and late in PD. If, origi-
brain and nervous
nally, you did not have ANS symptoms, but they have
system that regulates
the body s internal
appeared, this indicates PD has progressed: It has
environment.
involved cells outside the substantia nigra.
Shortly after you arrive in a doctor s office or an emer-
gency room, your vital signs are checked: temperature,
pulse rate, blood pressure, and rate of respiration. The
vital signs mirror your body s internal environment,
which mirrors your ANS. Your ANS does the follow-
ing:
" Maintains your temperature at 98.6 Fahrenheit. Your
temperature rises because of an infection from bac-
teria, or a virus; an inflammation of a joint, a mus-
cle, or a vein (phlebitis); a sauna, a steam bath, or a
sun burn. Your ANS rids your body of heat by shut-
tling blood from your internal organs to your skin,
and from here it radiates or evaporates. As a result
you feel flushed or feverish. If you re anxious, your
ANS can be subconsciously tricked into thinking
your temperature s up (when it s not) and you may
feel flushed or feverish. Your temperature drops
because of an underactive thyroid gland, or a dip in
the Arctic Ocean. Your ANS warms you by shut-
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tling blood away from your skin to your internal
organs. As a result, you may feel cold or turn blue. If
you have PD, or if you re anxious, fearful, or pan-
icked your ANS can be tricked into thinking your
temperature s down (when it s not) and you may feel
cold (when no one else does).
" Maintains your pulse, or heart, rate between 60 to 90
beats/minute. If your temperature, need for oxygen, or
metabolism increases; if you lose body fluids (by dehy-
dration or bleeding); or if you re in pain, then your
ANS, through a direct line to your heart, can make
it beat faster. If you have PD, or if you re anxious, your
ANS can be tricked into making your heart beat
faster and you may feel your heart pounding (or think
it s pounding). Or you may feel dizzy, or lightheaded,
or faint.
" Maintains your blood pressure between 95 140/50 90.
To maintain a stabile internal environment, blood
flow to critical organs must be adequate. Because
flow cannot be easily measured, blood pressure is
measured instead. The relationship is: Blood Pres-
sure = Blood Flow Resistance of the Blood Vessels.
Your tissues lose blood if your blood pressure falls
when you stand up quickly, if you re dehydrated, or
for other reasons. For flow to remain unchanged,
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