Juvenile-HD

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INDEX Page
Tools For Viewing
10 The Most Commonly Asked Questions
Clinical Trials & Research
Huntington's Disease~WeMove Info
Advocacy/Donations/Press Info
Clinical Definition & Search
Facing HD~Family Handbook
JHD Handbook-Chapter 1
JHD Info-Stanford Univ.
Physician's Guide To HD
Caring for People with HD
Physical & Occupational Therapy In HD
Understanding Behaviour in HD-Dr. Jane Paulsen
Understanding Behavioral-Dr. Edmond Chiu
Advanced Stages Caregivers Handbook
First Shift-Certified Nursing Assistants
Activities of Daily Living-HD
Unified HD Rating Scale (UHDRS) Motor Section
Westphal Variant
SECTION 1 - AT RISK
Age & Probability Chart
At Risk For HD-What Next?
At-Risk Checklist
Best Interest of Child?
Crystal Ball?
Food For Thought
Parent Hasn't Tested?
Q&A On Risk of Inheriting JHD
Testing Children
SECTION 2 - GENETIC TESTING
Genetic Disorders & Birth Defects
Genetic Testing for HD
Genetic Counseling-In General
Psychological Impact
Intro: Genetics/Genetic Testing
Prenatal & Preimplanation
Prenatal Testing-In General
o Genetic Testing Resources
o Personal Stories
SECTION 3 - JHD
Coping With The Early Years
Age of HD Appearance
Age of Onset-Historical
Family-HD Underestimated
Children of Parents With HD
Child~Parent Ill
Clinical Description JHD
HD - What Kids Are Saying
HD & Me
JHD-Duration of Illness
JHD-Clinical and Research
JHD Symptoms
Parenting With HD
Patients/Families Coping
Talking With Children About HD
5 Stages of HD
JHD Resources
SECTION 4 - SYMPTOM RECOGNITION
Parent Resources
8 Fears of A Chronic Illness
Anxiety/Apathy/Irritability~HD
Anxiety, Fears & Phobias
Apathy-Physician's Guide
Ataxia
Attention-Perceptual/Unawareness Physician's Guide
Bed/Pressure Sores
Bed/Pressure Ulcer Guideline
Behavior Management
Bi-Polar Disorders
Botulinum toxin therapy
Bradykinesia
Caring Tips
Child Abuse-Reconizing Signs
Chorea-Physician's Guide
Chorea
Cognitive/Decision Making/Impulsivity
Cognitive-Short Tips
Contractures~Joints Locking
Dehydration-Physician's Guide
Dehydration
Delirium
Denial of HD
Depression~Physician's Guide
Depression-Understanding It
Depression-How To Help
Depression - Treatment Resistant Patient
Depression-Other Resources
-Read If Your Child Is On Antidepressant
Disgust - Impaired Recognition in HD
Dissociative disorders
Driving - Physician's Guide
Dyslexia
Dyslexia Resources
Dystonia
Dystonia/Rigidity & Spasticity Physician's Guide
Dystonia-Predominant Adult-Onset HD
Epileptic Seizures and Epilepsy
Epilepsy-Seizures~PG
-Seizures ~Special Populations
Falling~Safety
Falling - Subdural Hematoma Risk
Fevers - Unexplained
Fevers, sweating & menstural cycles in HD
GERD (Stomach)
HD Principle Treatments
Hallucinations/Psychosis~PGHD
Hand muscle reflexes in HD
Hypothalamus - A Personal Theory
Insomia ~Physician's Guide
Irritability~Temper Outburst Physician's Guide
Learning Disability
Mania/OCD~Physician's Guide
Mood Disorder Rate In HD
Myoclonus (Movements)
Nails-What To Look For
Night Terrors
Obsessive Compulsive OCD
Panic Disorder
Personality disorders
Pneumonia
Pneumonia-Advanced Stages
Pneumonia - Aspirated (Inhaled)
Prosody - Social Impairment
Sexuality~Physician's Guide
Skins Sensitivity
Sleep Disorders
Smoking-Physician's Guide
Spasticity
Stress
Tremors
Why Certain Symptoms Occur
Symptom & Treatment Resources
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
Swallowing & Nuitrition Resources
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
Therapy Resources- Easter Seal
Therapy Resources
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
-Weight Gain Medications
-Sites/Help the Medicine Go Down
-Vitamin & Mineral Deficiencies
SECTION 9 - SURGERIES
Surgery-Movement Disorders
o Surgery Resources
SECTION 10 - PROCEDURES
Clinic Visits-How To Prepare
CT Scans, MRI's etc.
Swallowing Tests
Tests Commonly Used
o Procedures Resources
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
Tips For Divorcing Parents
SECTION 14 - DISABILITY ISSUES
Guides To Disability Issues
Caring-Child & Medical Technology
Caring for a Seriously Ill Child
Child Long Term Illness
Disability-Special Education Plan
IFSP Early Intervention Process
Disability Resources
Financial Planning
Wishes Can Come True-Children's Wish Foundations
Special Needs Resources
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
Useful Tools
SECTION 24 - BIO
Our Personal Experience
Coping At The End
Kelly E. Miller
Song & Verse
Letter From My Heart
GUESTBOOK
-Haldol/Haloperidol - Clinical Sheet

INDEX Page

Haldol/Haloperidol
- Clinical Medication Sheet
From:   Nurses - Clinical Medication Sheet: Haldol/Haloperidol

Actions
Blocks postsynaptic dopamine receptors in the brain

Contraindications                           Side Effects

CNS depression                               Rash
Coma                                               Blurred vision
Parkinsonism                                   Tardive dyskinesia
                                                       Neuroleptic malignant syndrome
                                                       Severe extrapyramidal reactions

Notes
Advise patient  to avoid alcohol while taking this drug.
Do not withdraw drug abruptly unless required by severe adverse reactions.
Drowsiness and dizziness usually subside after a few weeks.
Dry mouth may be relieved with hard candy or gum.
Warn patient  to avoid activities that require alertness or psychomotor
coordination until CNS effects of the drug are known.
===========================================================

A PHYSICIAN'S GUIDE TO THE MANAGEMENT OF HD
2nd EDITION

HD patients, like others with injuries to the brain, are highly vulnerable
to side effects, cognitive side effects, of medications. The physician should
begin with low doses and advance medicines slowly.

Polypharmacy should be avoided where possible. Many of the drugs used in treating symptoms of HD, such as neuroleptics and antidepressants, will not have immediate efficacy and patients need to be told that they may feel worse before they feel better, because they will experience the side effects, before the beneficial effects have appeared.

Three classes of medication are commonly used to suppress chorea in
Huntington's disease: neuroleptics, such as haloperidol and fluphenazine;
benzodiazepines, such as clonazepam and diazepam;  and dopamine depleting agents, such as reserpine and tetrabenazine.   Each class has its advantages and disadvantages.

The suppression of movement, regarded as a side effect when neuroleptics are used to treat psychosis,  is the desired effect when they are used to treat chorea. Therefore the most popular neuroleptic agents are the high potency drugs, which can also induce the most parkinsonism.

Haloperidol and fluphenazine  are most commonly prescribed. They should be started at a low dose, 0.5 to l mg once or twice a day, and  gradually increased to efficacy. Doses higher than 6-8mg per day have not generally been found helpful in treating chorea.

Patients starting neuroleptics should be warned about two unlikely, but
potentially serious adverse effects.  The first is tardive dyskinesia, a syndrome of involuntary movements often first noted in the face and mouth, that develops in some patients taking neuroleptics. Tardive dyskinesia is of concern because the symptoms are usually permanent, and will likely be hard to recognize in someone with HD.

The other serious problem is neuroleptic malignant syndrome, a rare, but
life threatening reaction characterized  by acute onset of delirium, rigidity, and fever, often accompanied by leukocytocis, and elevated CPK.   Families should know about this so that the patient can be given prompt medical attention if it develops.

Among the older neuroleptics, high potency agents such as haloperidol
(Haldol) or fluphenazine (Prolixin) tend to be less sedating, but cause more parkinsonism.
Lower potency agents such as thioridazine (Mellaril) may aid with overactivity and sleeplessness, but tend to be constipating and can cause orthostasis
=========================================================

INFORMATION OF INTEREST TO HD PATIENTS

9/4/97   Dr. Dubinsky wrote: Haloperidol is a non-selective dopamine
receptor blocker and can be used safely with sertraline and lorazepam. Decisions about medications are best made between a clinician who is experienced in the treatment of HD and a well informed patient and their well informed family.  While there are texts and scientific papers about the treatment of the symptoms of HD, they are not written on stone.
~~~~~~~~~~~
October 1997 a readers response:
"Contraindications- Comatose states and CNS depression due to alcohol or other depressant drugs; severe depressive states; previous spastic diseases; lesions of the basal ganglia; Parkinson's syndrome, except in the case of dyskinesias due to levodopa treatment; sensitivity to haloperidol; senile patients with pre-existing Parkinson-like symptoms."
http://www.mentalhealth.com/drug/

Lesions of the basal ganglia are common in HD.
Contraindications indicate when NOT to prescribe that particular
medication.   To the list of CNS effects reported to be associated with
haloperidol/haldol, we can add Tardive  Dystonia.

Tardive Dystonia is characterized by delayed onset of choreic or dystonic
movements, is often persistent, and has the potential of becoming irreversible.

In other words, it can establish a source or cause of choreic movements
(manifested later) in addition to HD being a source of choreic movements.

The caudate nucleus is part of the basal ganglia.   Lesions of the basal
ganglia are not just common in HD, they are essential to a final diagnosis of symptomatic HD.  If an autopsy is performed on someone whom everyone is positive died from a complication of advanced HD, and no lesions of the basal ganglia are found at least prior to the days of verification of the HD gene the doctors would conclude it might have been something similar to HD but it was other than HD.

Haloperidol/haldol is contraindicated for use with people who have lesions
of the basal ganglia which, by definition, are people who have symptomatic HD.
~~~~~~~~~~~

Excerpts from RxMed
a peer-reviewed website for primary care physicians
(parentheses are writers):

Pharmacology:
Haloperidol (or, generically, Haldol) is a butyropherone derivative with
antipsychotic properties that has been considered particularly effective in the management of hyperactivity, agitation, and mania.  Haloperidol is an effective neuroleptic and also possesses antiemetic properties; it has a marked tendency to provoke extrapyramidal effects.  (extrapyramidal effects = abnormal involuntary muscle movements)

Contraindications:
Comatose states and CNS depression due to alcohol or other depressant
drugs; severe depressive states; previous spastic diseases; lesions of the basal ganglia; Parkinson's syndrome, except in the case of dyskinesias due to levodopa treatment; sensitivity to haloperidol; senile patients with pre-existing Parkinson-like symptoms.   (As another contraindication, one might add HD and also senile patients with pre-existing HD-like symptoms.)

Warnings: Tardive Dyskinesia
Tardive dyskinesia is known to occur in patients treated with neuroleptics
with antipsychotic properties and other drugs with  substantial neuroleptic activity.
Although the dyskinetic syndrome may remit partially or completely if the medication is withdrawn, it is irreversible in some patients.  Since there is a significant prevalence in this syndrome associated with the use of neuroleptic drugs, and since there is no known treatment, chronic use of  these drugs should generally be restricted to patients for whom neuroleptics are known to be effective and for whom there is no alternative therapy available with better risk acceptability.
===============================================

Tardive dyskinesia
is a syndrome involving dysfunctional, involuntary movements associated with long-term, chronic use of neuroleptic medications, such as Haldol, Prolixin, and Thorazine. These drugs lead to apparent general calming or sedative effect on the individual and are considered major tranquilizers.

Tardive dyskinesia may appear anywhere from three months to several years after initial use of these medications, and withdrawal from neuroleptics often exacerbates the symptoms.

Common tardive dyskinesia movements include, but are not limited to:
facial tics, grimacing, eye blinking, lip smacking, tongue thrusting,
moving one's head back or to the side, foot tapping, ankle movements, shuffled gait, and head nodding.
 
Tardive dyskinesia may lead to very serious problems, such as
respiratory interference, inability to eat, oral ulcerations, and difficulty
standing/walking.


Tardive dyskinesia movements may be confused with stereotypy because of the repetitive nature of both behaviors.

Stereotypy refers to ritualistic, often complex behaviors, such as body and
head rocking, hand-flapping, and complex hand movement patterns. Stereotypy appears to be under voluntary control. In contrast, dyskinesia movements are less complex, less ritualistic, and are not volitional.

Long-term use of neuroleptics is ideal for controlling psychotic symptoms,
but it produces adverse effects some patients. The most notable of these is tardive dyskinesia (TD), a potentially serious side effect. TD is a syndrome of abnormal involuntary movements of the face, tongue, limbs and trunk.

Since there is no proven way to prevent TD in patients who need long term treatment with neuroleptics, the best strategy is to restrict these drugs to well-defined indications, use them in the lowest effective doses, and assess patients at frequent intervals for early signs of TD.

An estimated one-fourth of all patients treated long-term with neuroleptics
have it. A number of have associated an increased risk of TD with older age. In a current study, we found that the incidence of TD within a year of starting neuroleptic treatment was approximately 26 percent among patients aged 45 to 90, compared to the reported incidence of 4 to 5 percent among younger patients.

Time is a critical factor in the course of TD, with most studies reporting
that the symptoms improve gradually or stabilize over a period of years rather than within the first year of follow-up. This finding supports the view of TD as a syndrome that follows a continuum from resolved to persistent, rather than being either a reversible or irreversible condition.

Severe complications
While TD is usually mild, it can produce physical and psychosocial
complications.
 
Severe oral dyskinesia may result in dental and denture problems that can progress to ulceration and infection of the mouth, as well as unintelligible speech.
 
Gait disturbances due to limb dyskinesia may leave patients vulnerable to falls and injuries.