Parkinson's disease and link with suicide

Qn. “Why do many patients diagnosed with Parkinson's disease become suicidal? I have documented a high number of such cases that have been reported in the media.”

Our physics teacher in high school had Parkinson’s disease. A rather rotund man, he was pleasant and precise to a fault. The children we were, failed to understand that this was a disease over which he had no control, and we often laughed at him, even trying to imitate some of his behaviour and actions. As a practising psychiatrist, I come across patients with this disease, and as though to make up for my foolish ways as a schoolboy, I have taken a great deal of interest on its treatment and can confirm that it is an easy condition to diagnose and even easier to treat!

I can still see our teacher, Mr Beeby, as he entered the classroom. He walked in with his head tilted forward. In other words, his head entered the classroom before the rest of his body. He walked in short quick steps, as though he was trying to catch up with his head which was way ahead of him. I was later to learn that this typical parkinsonian gait is described as the “shuffling gait”.

His face was totally expressionless. You could not tell if he was sad, happy or had any other emotion. It was impossible to tell what mood he was in on any day. It was as though he was wearing a mask.

As he taught, his movements were all slow and he had no swing to his arms as he moved around the classroom. He also demonstrated a fine tremor to his hands. At first only his left hand trembled, but in time both hands became tremulous. In time, his head and the rest of the body shook.

As he wrote on the blackboard, his handwriting started off as large visible letters or formulae but as the lesson proceeded, his handwriting became smaller and smaller and eventually became impossible to read. Sadly, his voice followed a similar pattern. At first we could hear him but as the lesson went on, his voice became softer and softer and eventually would become slurred and inaudible.

I do not know what happened to our teacher in the end, but if he were around today, much can be done for him, either by way of medication, or even highly specialised surgical treatment. How life has changed in the last 50 years!

Common diseases

So far, no mention has been made of the nature of Parkinson’s disease, or indeed where the name came from. Let us correct this. The condition was first described in an essay in 1817, by a British physician called James Parkinson. He wrote an essay titled “An Essay on the Shaking Palsy.” He had “discovered” a new disease and it was thus given his name! this was a common practice in medicine. Other diseases known by the names of those who first described them include, Alzheimer’s (affects the brain), Addison’s disease (adrenal gland) and Leigh's disease, named after an old teacher of mine, Sir Dennis Leigh.

In Parkinson’s disease, the tremor usually starts in a limb and is often the hand or the fingers. The slow movement exhibited by my teacher are known by the fancy name of bradykinesia. For him, simple movements like writing or getting up from a chair were slow and time consuming. In general one’s self-esteem receives a beating as the condition worsens. These often embarrassing symptoms could lead to findings of deep sadness and depression.

Indeed, suicide is twice as common in people with Parkinson’s disease compared to the general public.

Other distressing symptoms include muscle rigidity which limit full use of limbs which may in addition become painful. The rigidity of the muscles is described as cog-wheel because it gives way like a cog wheel (deep medical school jargon)!

Given all the foregoing disabilities, it will come as no surprise to know that 40 percent of patients with Parkinson’s disease meet the criteria for a depressive illness, itself a risk factor for suicide.