The Movement Disorders Prescriber’s Guide to Parkinson’s Disease provides a comprehensive and succinct guide for all clinicians and health professionals involved in the treatment of people with Parkinson’s disease. The guide provides practical information for use by clinicians and healthcare practitioners at all levels.

The chapters are alphabetical and follow the same format to enable quick retrieval of required information. Clinical experience of place in therapy and practice vignettes are included in each chapter.

Although movement is largely generated from the primary motor cortex, what movement to make and how to make it is influenced from the entire brain. External influences from the environment come from sensory systems in the posterior part of the brain, and internal influences, such as homeostatic drive and reward, from the anterior part. A movement is voluntary when a person’s consciousness recognizes it to be so because of proper activation of the agency network. Behavioral movement disorders can be understood as dysfunction of these mechanisms. Apraxia and task specific dystonia arise from disruption of parietal–premotor connections. Tics arise from a hyperactive limbic system. Functional movement disorders may also have an origin in abnormal limbic function and are believed to be involuntary due to dysfunction of the agency network. In Parkinson’s disease, bradykinesia comes from insufficient basal ganglia support to the anterior part of the brain.

Exercise is an essential ‘all-rounder’ benefiting brain, cognition, mood, and physical health. It aids weight management, reduces obesity, and mitigates risks of heart disease, diabetes, and high blood pressure. Enhanced cardiovascular health and reduced stress levels are additional perks. Socially interactive activities like group workouts foster emotional wellbeing and reduce isolation. Aerobic and anaerobic exercises vary in intensity and benefits, with heart rate and METs helping gauge intensity. Studies suggest as little as 11 minutes of vigorous activity daily reduces mortality and disease risks. Exercise triggers endorphins, reducing depression and stress. It also influences serotonin levels, improving mood and wellbeing. Exercise enhances brain health and cognition by increasing neuroplasticity, cerebral blood flow, and hippocampal volume. It benefits individuals of all ages, preventing age-related cognitive decline. Integrating exercise into daily life routines positively impacts physical and mental health, promoting overall wellbeing and longevity. Regular, enjoyable exercise routines yield profound benefits for individuals and society alike

This book aims at providing the reader with an introduction to psychiatry and to the study of mental disorders. While still addressing basic theoretical concepts of importance for the understanding of psychiatry as a specific field of knowledge, its main focus is not an extensive discussion or a comprehensive review of research findings. Instead, whenever possible, the different topics are addressed from a practical point of view, allowing the reader not only to expand their base knowledge but, most importantly, to obtain a good picture of how patients experiencing these conditions usually present themselves in clinical contexts. Moreover, the treatment of mental disorders is addressed in an objective, straightforward way, based on the respective authors’ own clinical experience in the management of a high number of patients, in different settings.

Epilepsy is one of the most common neurological conditions affecting women and men of all ages. This chapter explores population-level data collected in women with epilepsy (WWE). It begins with an overview of the epidemiology of epilepsy and differences between males and females, then examines common epilepsy comorbidities (depression and anxiety). Finally, this chapter looks at special issues females with epilepsy may encounter through the lifespan starting with childhood and adolescence, running through the reproductive years and into the menopausal transition. The data first introduced in this chapter will be expanded upon in subsequent subject-specific chapters (these are highlighted in each section below).

Currently, there is a rapid, ongoing increase in our understanding of genetic neuromuscular disorders at the molecular level: many causative genes have been found, giving hope for targeted genetic treatments, already proven effective in some diseases. In immune-mediated neuromuscular disorders, pathogenetic mechanisms are better understood, and this enables the development of more precise immunotherapies. Increased knowledge has led to a refinement of classifications and has added numerous subtypes to the already hundreds of possible neuromuscular diagnoses. Patients can only benefit from future targeted therapies if an accurate diagnosis is made. Moreover, a diagnosis needs not only to be precise; the diagnostic trajectory needs to be swift, as current and future treatments will be aimed at the prevention or the restriction of irreversible damage.

The best way to diagnose a neuromuscular disease at this point is probably to recognize the phenotypical pattern, to know its differential diagnosis, and to proceed from there.

Cranial nerve IV, the trochlear nerve, is the smallest cranial nerve and has the longest intracranial path as it exits from the dorsal midbrain (at the level of inferior colliculus), crosses to the other side of the brainstem and travels along the lateral wall of the cavernous sinus, exiting the skull through the superior orbital fissure, and traveling all the way to the superior oblique muscle. Because of decussation of the intraparenchymal fibers after originating from the nucleus, the left trochlear nucleus eventually innervates the right superior oblique muscle and vice versa.

Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by loss of atonia that is normally present in REM sleep. In addition, patients often enact their dreams.

Shared decision making (SDM) is a collaborative process that allows patients, or their surrogates, and clinicians to make healthcare decisions together, taking into account the best scientific evidence available, as well as the patient’s values, goals, and preferences. This definition of SDM proposed by the Informed Medical Decisions Foundation [1] was endorsed by the American College of Critical Care Medicine (ACCM) and the American Thoracic Society (ATS) (Figure 1.1). Informed medical decision making may be used synonymously with SDM.[2] Critically ill patients may be too unstable or otherwise incapacitated (e.g., due to intubation, sedation), and may not be able to speak for themselves.

Half of all mental health problems start by the age of 15 and the teenage and young adult years are particularly difficult for girls with high and increasing rates of anxiety, depression and self-harm. Many different factors contribute, including social media, peer pressures, focus on appearance, friends, relationships, schoolwork and, as Everyone’s Invited has recently highlighted, personal safety. There is tremendous pressure to conform with the expectations of others. Attitudes to women and girls seem to have gone into reverse during the author’s lifetime. It is too simplistic to view the problems of young women as a simply a ‘lack of self-esteem’. The difficulties they face in society are consistently underestimated and not taken seriously. Fast access to therapy is crucial. Bullying must be addressed effectively. Sexist and mysogynistic attitudes in school must be challenged and, given the easy access now to pornography, the issues of consent should addressed head on by both parents and schools. Using the example of Everyone’s Invited, women and girls need to reach out and support each other. The personal is still political.

• Body image is often defined as your thoughts and feelings about your body; these thoughts and feelings have far-reaching consequences.

• This book provides scientifically-based information to help you improve your body image, but also offers real people’s stories, common questions and their answers, myth-busting, and activities to help you develop a greater understanding of your body image.

• Having a positive body image doesn’t mean feeling good about yourself every second of every day, but it does mean that you respect and care for your body.

The process of how we get from gene to protein is one of the most intensely studied and best understood in biology. The reading of DNA, the generation of a messenger ribonucleic acid (mRNA) and the translation of that transcript into a protein through assembling chains of amino acids. But what we thought we knew about the gene pathway changed forever in 1993, when Gary Ruvkun and Victor Ambros discovered microRNAs. This chapter begins by explaining the basic biochemistry of genes and proteins before moving on to the seminal work of 30 years ago. The objective of those experiments was to understand which genes controlled the timing of animal development in a worm called Caenorhabditis elegans. That led to the realisation that a gene called lin−4, crucial for worms to transition from juvenile to adult stages, did not code for a protein; instead, its RNA acted by sticking to the mRNA of a protein-coding gene. Lin−4 was a gene silencer, working to lower the amounts of protein in cells. The finding of a new step on the journey from gene to protein would go on to transform our understanding of the biology of living organisms.

Alzheimer’s Disease International highlighted in 2016 the role of primary care in dementia. With overly specialised healthcare systems and stretched specialist workforce, dementia is currently under-diagnosed and under-managed. While various service models have been trialled in different parts of the world, several barriers remain; among them are a lack of a gatekeeping role for primary care in highly stretched healthcare systems and a perception that primary care is of a lower quality. In this chapter, we briefly review and outline the possible roles of primary care, including the gatekeeping role, based on the concepts and practices of task-shifting and task-sharing in dementia care. Examples of primary care models in dementia are given, followed by a basic overview of the work-up, diagnosis, and management related to simple, uncomplicated Alzheimer’s disease in line with gatekeeping and task-shifting/sharing. With this background, we then move on to the rationales and evidence of integrated health and social care services, with an example of community primary care-based integrated health and social care services, from which the cases provided in this book were drawn.

Mood disorders are among the most prevalent and potentially severe mental disorders. These conditions are associated with important psychological morbidity and functional impact, as well as elevated rates of suicide. While the past several decades have produced valuable contributions to the understanding of the pathophysiology of mood disorders, currently available treatments at times fail to produce full remission and restore patient’s premorbid level of function. Nevertheless, promising new agents and novel therapeutic targets are currently under investigation. The twenty-first century is looking at an individualized approach for the management of mood disorders, with the proper integration of evidence-based, effective biological and psychosocial therapeutic modalities.

How are the antidepressant effects of esketamine (Spravato) pharmacodynamically mediated?

The core foundation of excellent psychiatric treatment starts with obtaining a coherent history, preferably as a longitudinal narrative that follows a chronological timeline, with an emphasis on parsing relevant pertinent “positives” and “negatives” from that narrative. A simple organizing principle is to have patients present their concerns from a chronological perspective, in order for the clinician to develop a clear narrative. “When was the very first time you recall having any problems involving your mental health?” provides a good starting point, followed by “When was the first time you sought any kind of treatment for those problems?” A chronologically organized narrative gives some sense not only about the backdrop and longevity of a psychiatric disorder but, moreover, clues about the degree of distress and disruption caused by symptoms, the potential duration of untreated illness, and symptom severity as reflected by the kinds of interventions that previously occurred. A clinical timeline that starts with years of psychotherapy differs from one that begins with an involuntary psychiatric hospitalization or a suicide attempt; low-grade symptoms that persist for extended periods unnoticed by others, or cause no outward functional impairment, imply a different level of severity and debilitation, and possible prognosis, from those linked with more obvious outward signs of disability. For persistent problems, one always wonders why the patient is seeking help now and not a week or month or two ago.

An email with a black box warning! That’s what I got 11 years ago after Lois and I submitted saliva samples to a DNA testing service. Lois is the family genealogist, and she thought that DNA testing would be helpful in filling in some of the missing branches of our ancestral trees. In addition to lists of DNA relatives, the report included many risk genes for a variety of medical conditions, none of which were present for either of us. However, this locked black box contained two genes of neurological interest. A mutation in the LRRK-2 gene is the most common cause of hereditary Parkinson’s disease, and the APOE-4 allele is the most significant genetic risk factor for late onset Alzheimer’s disease.

A thorough knowledge of gross human neuroanatomy is important in understanding basic and clinical neuroscience. In this chapter we describe the key anatomical features of the human brain followed by a discussion on the main developmental processes and signaling mechanisms of neurogenesis and embryology. Finally, we introduce the reader to different model organisms commonly used in neuroscience research.