Juvenile-HD

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SECTION 1 - AT RISK
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SECTION 2 - GENETIC TESTING
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SECTION 3 - JHD
Coping With The Early Years
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HD - What Kids Are Saying
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SECTION 4 - SYMPTOM RECOGNITION
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Anxiety/Apathy/Irritability~HD
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-Read If Your Child Is On Antidepressant
Disgust - Impaired Recognition in HD
Dissociative disorders
Driving - Physician's Guide
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Dyslexia Resources
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-Seizures ~Special Populations
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Fevers, sweating & menstural cycles in HD
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Hand muscle reflexes in HD
Hypothalamus - A Personal Theory
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Irritability~Temper Outburst Physician's Guide
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Mood Disorder Rate In HD
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Panic Disorder
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Prosody - Social Impairment
Sexuality~Physician's Guide
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Smoking-Physician's Guide
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Tremors
Why Certain Symptoms Occur
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SECTION 5 - COMMUNICATION
Communication Resources
Communication Problems
Communication Strategies For HD~Jeff Searle
SECTION 6 - EATING/SWALLOWING/NUITRITION
Hints For Weight Loss in HD
HD & Diet~HSA Fact Sheet 7
Nutrients: Some Possible Deficiency Symptoms
Nutrition and HD~Anna Gaba (Recipes)
Nutrition Information In HD~Naomi Lundeen
Speech & Swallowing~Lynn Rhodes
Swallowing & Nutrition Physician's Guide To HD
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Swallowing Warning Signs
5 Swallowing Problems
Taste changes in HD
Weight Gain
Resources-Drinks/Shakes
-Feeding Tubes~Advanced Stages of HD
-Feeding Tube~Jean Miller
-Feeding Tubes: One More Word ~Jean Miller
-Feeding Tubes & Baby Foods
-Feeding Tube~Dental Care
-Feeding Tube Instructions~Jean Miller
-Feeding Tube Resources
SECTION 7 - THERAPIES
Finding a Therapist - Behavoir
What Is A Physiotherapist?
Physical Therapy In HD
Speech-Language Therapy
Therapy Descriptions
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SECTION 8 - MEDICATIONS
HD Treatments
Medications-Movement Disorders
Medication/Emergency Info Forms
Cutting Prescriptions
Drugs-Look 'Em Up
-Adolescents Under 25
-Antidepressant Adverse Effects
-Anti-psychotic
-Anxiety-Antidepressant
A-Z Mental Health Drugs
-Creatine
-EPA~Fish Oil
-Haldol/Haloperidol - Clinical Sheet
-Haldol~Clinician Description
-Haldol & HD
-Haldol/HD Patient Experiences
-Haldol~ Patient Handout
-Mood Stabilizers: ASK 3 Questions
-Neuroleptic Malignant Synd WARNING
-Olanzipine-Risperidone/blood tests
-Celexa/Luvox/Paxil/Prozac/Zoloft
-Psychiatric Drugs & Children
Sertraline ~Zoloft
-Spasticity Meds/Treatments
-SSRI Medications
-Tardive Dyskinesia WARNING
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-Sites/Help the Medicine Go Down
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SECTION 9 - SURGERIES
Surgery-Movement Disorders
o Surgery Resources
SECTION 10 - PROCEDURES
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Swallowing Tests
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SECTION 11- ALCOHOL/DRUGS
Alcohol-Parent's Guide
Alcohol-Talking To Your Child
Drugs-What To Do?
Drugs-Talking To Your Child
Disciplining-Ages 0-13 & Up
SECTION 12- SUICIDE
Straight Talk On Suicide
Teen Suicide-You Need To Know
o Suicide Resources
SECTION 13 - DIVORCE
Divorce & Child Stress
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SECTION 14 - DISABILITY ISSUES
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Child Long Term Illness
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Special Needs Camp - About
Special Needs Camp - Finding One
SECTION 15 - ASSISTIVE TECHNOLOGY
Child Assistive Technology
Adaptive Equipment Resources
Products
SECTION 16 - EMOTIONAL ISSUES
Signs of Unhealthy Self-Esteem
Emotional Behavior Links
o Emotional Support Resources
SECTION 17 - GRIEF
Helping Child Deal With Death
o Grief Addtional Resources
SECTION 18 - ADD/ADHD
ADD & Teens
Conduct Disorders
FAQS & Related Info
Understanding AD/HD
What Is AD/HD?
Research Articles
Resources
SECTION 19 - HD SUPPORT GROUPS
HD Support Groups
National Youth Association
SECTION 20 - HD LINKS
HD Links
Related Resources
Tips For Friends
SECTION 21 - BENEFITS/INSURNACE
HD Disability
Benefits Check UP - See What You Can Get
Medical Insurance Bureau's Facts On You!
Medicare-Medicaid
Medicare Rights-Home Health & Hospice
Medicare Rights Center Resources
No Insurance? Try This!
Prescription Drug Cards Part I
Prescription Drug Cards Part II
Social Security-Children With Disabilities
SECTION 22 - ARTICLES/JHD
JHD and ADD
SECTION 23 - CAREGIVING
Articles-Resources
Caregiver Self-Assessment
Caregiver's Handbook
"First Shift With A Person With HD"
Getting Respite Care/Help At Home
Helpful Forms-Info
Home Emergency Preparations
Symptom Management
Ten Tips
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SECTION 24 - BIO
Our Personal Experience
Coping At The End
Kelly E. Miller
Song & Verse
Letter From My Heart
GUESTBOOK
Sexuality~Physician's Guide

INDEX Page

 
Chapter 5-Physician's Guide To Management of HD
 

Sexual Disorders

Many patients with HD become uninterested in sexual activity. Others may continue to enjoy healthy sexual activity well into the course of the illness. Occasional patients may desire and pursue excessive sexual activity or engage in inappropriate sexual behaviors, such as public masturbation, or voyeurism.

The spouse, usually the wife, may be distressed and fearful because the individual with HD may become aggressive if sexual demands are not met. Spouses may be afraid to talk about the problem unless interviewed alone.

Interventions are difficult in these circumstances, probably because of the patient's impaired judgement and the strength of the drive. Open communication about sex between the doctor and the family can help to destigmatize this sensitive topic. With open discussion among the parties, distressing sexual behaviors can sometimes be adapted into more acceptable acts.

Patients engaging in these behaviors should be assessed and treated for comorbid conditions, such as mania. We have found antiandrogenic therapy helpful in a few of these cases.

_________________________________________________________

=======================================================
Antidepressant Induced Sexual Dysfunction
See Also  Erectile Dysfunction Causes
http://www.fpnotebook.com/URO23.htm
http://www.fpnotebook.com/PSY149.htm

Causes
    See Medication Induced Sexual Dysfunction
http://www.fpnotebook.com/PSY172.htm
    Tricyclic Antidepressants http://www.fpnotebook.com/PSY157.htm
    MAO inhibitors http://www.fpnotebook.com/PSY151.htm
    Selective Serotonin Reuptake Inhibitor (SSRI) http://www.fpnotebook.com/PSY162.htm
        Fluvoxamine (Luvox)  (54% http://www.fpnotebook.com/PSY166.htm Incidence sexual dysfunction)
        Sertraline (Zoloft)  (56%
http://www.fpnotebook.com/PSY167.htm Incidence sexual dysfunction)
        Paroxetine (Paxil)  (65%
http://www.fpnotebook.com/PSY165.htm Incidence sexual dysfunction)

Management: Approach
    Observe for 4 to 6 weeks for adverse effects to subside
    Adjust current Antidepressant dosing
        Decrease Antidepressant dosage
        Alter timing of daily dose
        Consider 2 day drug holiday
            Sertraline (Zoloft)
            Paroxetine (Paxil)
            Not effective for Fluoxetine (Prozac)
    Consider adjunctive therapy (see below)
    Substitute another Antidepressant
        Minimal to no sexual dysfunction
            Nefazodone (Serzone)
http://www.fpnotebook.com/PSY155.htm
            Bupropion (Wellbutrin) http://www.fpnotebook.com/PSY153.htm
            Mirtazapine (Remeron) http://www.fpnotebook.com/PSY152.htm
    Low risk of sexual dysfunction (10-15%)
        Fluvoxamine (Luvox)
http://www.fpnotebook.com/PSY152.htm
        Citolopram (Celexa) http://www.fpnotebook.com/PSY163.htm
        Venlafexine (Effexor) http://www.fpnotebook.com/PSY156.htm

Management: Adjunctive therapy to improve sexual function
    Approach to specific sexual dysfunction problems
        Orgasm: all of the agents below
        Libido: Amantadine, Buspar, Periactin, Yohimbine
        Erection: Amantadine, Buspar, Periactin, Yohimbine
    As Needed dosing
        Amantadine 100 to 400 mg PO prn 2 days before coitus
                Amantadine-Rimantadine
http://www.fpnotebook.com/ID117.htm
        Bupropion 75-150 mg PO prn 1 to 2 hours before coitus
        Buspar 15-60 mg PO prn 1 to 2 hours before coitus
        Periactin 4-12 mg PO prn 1 to 2 hours before coitus
        Dexadrine 5-20 mg PO prn 1 to 2 hours before coitus
        Yohimbine 5.4-10.8 mg prn 1 to 2 hours before coitus
            Erectile dysfunction
http://www.fpnotebook.com/URO76.htm
    Daily Dosing
        Amantadine 75-100 mg PO bid to tid
        Bupropion 75 mg PO bid to tid
        Buspar 5-15 mg PO bid
        Dexadrine 2.5 to 5 mg bid to tid
        Pemoline 18.75 mg PO qd
            Pemoline Cylert (ADHD)
http://www.fpnotebook.com/PED143.htm
        Yohimbine 5.4 mg PO tid
===============================================

This is just a long shot, but it appears like drugs containing benzodiazepines, Amphetamines (Ritalin), or barbiturates all have the tendency to affect the patient's inhibitions. There are more I haven't found yet.

Is it possible the JHD patients are on drugs for other HD symtpoms which may contain any of these?  Have their doctor's analyzed the drugs they ARE on to determine what, if anything, may cause social inhibitions?

The below descriptions came from the Effects of Drugs on the Nervous System from the Neuroscience for Kids website.


Effects of benzodiazepines on the Brain
http://faculty.washington.edu/chudler/roof.html

EFFECT:
Drugs, like Rohyuponol, can produce amnesia (memory loss) and muscle relaxation and  make people lower their inhibitions. An inhibition is when you feel like you can't do something. When inhibitions are lowered, people feel as  if an obstacle has been removed. Therefore, they can talk more freely and feel less shy.

SCIENTIFIC REASON WHY
The benzodiazepines influence behavior by interacting with receptors
on neurons in the brain that use the neurotransmitter called GABA. When
GABA binds to receptors, it usually inhibits a neuron and acts to reduce
neuronal activity. When benzodiazepines attach to GABA receptors, they
increase GABA binding to other receptors. In this way, benzodiazepines
enhance the effects of GABA and reduce brain activity
.

The fact that there are receptors for benzodiazepines in the brain
suggests that the brain makes its own type of benzodiazepine. The brain
has been found to make its own morphine, the endorphins, but the brain's
own benzodiazepine has not yet been discovered.

Amphetamines
http://faculty.washington.edu/chudler/amp.html
include drugs like dextroamphetamine, benzedrine, Ritalin and many other chemicals. Amphetamines were originally developed as a treatment for asthma, sleep disorders (narcolepsy) and hyperactivity.

EFFECT:
Many of the effects of amphetamines are similar to cocaine. Addiction to
and withdrawal from amphetamines are both possible. Amphetamine use
also causes tolerance to its effects. This means that more and more
amphetamine must be used to get "high." Like cocaine withdrawal,
amphetamine withdrawal is characterized by severe depression and fatigue.

Users will go to extreme measures to avoid the "downer" that comes
 when the effect of amphetamines wears off.
-Feelings of happiness and power
barbiturates
http://faculty.washington.edu/chudler/barb.html
There are many different types of barbiturates. The names of some
common ones (and brand names) include Pentobarbital (Nembutal),
Secobarbital (Seconal), Amobarbital (Amytal) and Phenobarbital (Luminal
); slang names for these barbiturates include yellow jackets, reds, blues, Amy's, and rainbows.

EFFECT:
In low doses: barbiturates reduce anxiety; reduce respiration, reduce
blood pressure, reduce heart rate and reduce rapid eye movement
(REM)sleep. The barbiturate called pentobarbital is known as "truth serum."

In higher doses: barbiturates can actually increase some types of behavior
and act like a stimulant.
These effects may be caused by depressing
inhibitory brain circuits. In other words, barbiturates at these doses
act to remove inhibitory behavior.
==========================================
Young People With Sexual Misconduct
 
I applaud you both for speaking so honestly and open to this list as it's only through sharing our experiences that we can learn and hopefully help our loved ones with HD.

Inappropriate sexual behavior is a known, but rarely discussed potential aspect of HD that can be devastating to families, hindering finding appropriate treatment or care for this problem.

The only reference I recall on this has been the PGHD (above) and most literature only addresses the adultwhere as the course of action for a  young personmight need to be handled a lot differently.

These are young people who have been robbed of any opportunity to have a "normal" sex life because of HD, but that doesn't  stop them from thinking of or wanting intimate relationships and it's natural, when they see an attractive member of the opposite sex to vividly become acutely aware of those needs.

Kelly went through a period of what would be considered inappropriate sexual behavior, but hers was more on the line of the lack of self esteem/HD, alcohol and drugs all mixed together where she made some poor choices in her life.

I don't have any experience to offer any suggestions but am hopeful that other's who do will open up their hearts and write about what helped them in resolving inappropriate sexual behavior problems in HD, in particular with young adults.

Thank you, both, again for your bravery!