People with PSP commonly have disinhibited behavior. It most commonly takes the form of attempting to perform physical tasks that are dangerous for them, such as getting up to walk unassisted, reaching for things beyond their grasp, overloading the mouth, speaking too loudly, constantly groaning, or repeating words or phases of speech unnecessarily. Rarely, disinhibited behavior can be sexual in nature, consisting of inappropriate remarks, touching oneself or others, or removal of one’ s clothes.
For both the sexual and non-sexual disinhibited behaviors, the caregiver should be careful not to react emotionally or to shout at the patient. Firmly but calmly correct the misbehavior, explain the problem, and redirect the patient’ s attention and activity. Sometimes antidepressant medication can help with this sort of behavior. Inappropriate sexual behavior may merely reflect a need for physical closeness that can be satisfied by a normal hug or backrub. Overloading the mouth can be avoided by cutting the food into small pieces or, if necessary, by feeding the patient. Disinhibited attempts to walk should not be controlled by seat belts or other strapping devices but by placement of a table in front of the seated patient or, even better, by an attentive aide. When the aide is not available, the patient can be put into a hospital bed with bedrails; however, creating a constant bedbound state is not an appropriate treatment for behavioral issues.
Dry Eye Syndrome and Visual Issues in PSP
Onur Melen, MD
Definition of Dry Eye Syndrome
Many people in the general population develop dry eye syndrome( also referred to as keratitis sicca). Left untreated, it can cause damage and roughness to the surface of the eyeball. If dry eyes are a problem, it is always best to consult an eye professional for advice and treatment. Dry eye syndrome is a common condition thought to affect approximately 60 million Americans. In some instances, the condition is characterized by dry, irritated eyes, caused by a lack of lubricating tears, which stems from an imbalance between tear production and tear volume drainage via the nasolacrimal ducts( NLD).
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Dry eye syndrome can also result from excessively watery eyes due to tears lacking the proper balance of mucus, water, and oil to coat the eyes properly. The tear film is made up of a mucus layer against the eye, a middle aqueous( water) layer, and an outer lipid( oily) layer. All three components are critical to a normal tear film. If any of the three layers of the tear film are deficient, the eye may suffer symptoms of dry eye.
There are two types of tears: lubricating and reflex. Lubricating tears protect the eyes against the elements. They are produced in a steady flow throughout the day and spread across the eye by the blink reflex. Reflex tears flood the eye suddenly whenever the eye is irritated. They can flow to such a degree that tears roll down the cheek. This excessive watering may occur when the eyes are irritated from smoke, smog, or other irritants like onions, or when the eyes lack proper protection from lubricating tears.
Symptoms of Dry Eye Syndrome
Symptoms of dry eyes may include burning, stinging, redness of the eyes, and tearing. The tearing seems paradoxical at first but is explained by the fact that an underlying dry eye may become irritated, perhaps sending a signal for increased tear production to flush out the eye. This response is physiologically equivalent to the presence of a foreign body such as a hair or a grain of sand in the eye.