THE STRANGE EVOLUTION AFTER DRUG THERAPY IN A SUBJECT WITH OPPOSITE CONDUCTS AND ATTENTION DEFICIT DISORDER WITH HYPERKINESIS

THE STRANGE EVOLUTION AFTER DRUG THERAPY IN A SUBJECT WITH OPPOSITE

CONDUCTS AND ATTENTION DEFICIT DISORDER WITH HYPERKINESIS.

Renato COCCHI, a neurologist and a medical psychologist.

Summary.

A 17 years old young man showed opposite conducts from possible troubles of the half-brain dominance and presence of an Attention Deficit Disorder with Hyperkinesis (ADDH). After nine months of drug therapy improved the symptoms of the ADDH, - according to the aim of the prescribed drug therapy -, but even clearly reduced the opposite conducts.

Since, surprisingly, he showed also a better change as for the people's type he usually frequented and as for his dressing in less "alternative" way. So, we can suggest that these two opposite conducts may be related to a possible reverse half-brain dominance for particular functions. The judgment on the half-filled glass and the fact that the left-handedness is mostly present in subjects with early brain damages are things whose analogy is surely suggestive.

Key words: reverse brain, opposite behaviour, half-brain dominance, ADHD, adrenergic compensation, depression, drug therapy.

Cases

Theoretical bases

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The strange evolution of a case I recently reported on Internet (Cocchi, 2002) has deserved a resumption of the same, for several theoretical implications that come from it.

The case history.

I report here the case history like in the original article, with some later learned on integration, in square brackets.

"Case 2: [15.10.2001] A boy of 17 years at first consultation. The current family adopted him when he was about five. He has school learning problems, and he failed the first year of the junior high school and the first year of the high school. Now he is attending a private school with the aim to make up for the failed years. Being a hyperkinetic one, he cannot rest even sitting, and his legs are moved as if they trembled In the classroom he has an attention deficit and uses to disturb his classmates.

His mother denies pregnancy and delivery complications, the same for neurovegetative symptoms in the first year of life. Nevertheless, he was bedwetting till 5-6 years of life, and he was speaking during his sleep, showing also episodes of pavor nocturnus. He has still a light convergent squint. Usually, he goes sleeping very late, because he uses going out every evening, and so he wakes up closely to noon. He drinks much beer and three times he gets drunk. As for diet, he tastes salted stuff, but he normally likes sweets and meat broth, although he usually does not eat broth since it is rarely made in his family. When he early gets up, he does not have any hunger. He reported some fits of colic spasms.

Moreover, he does not stand the light up, but he is well with noise or mess. He has armpit sweating. In sporting, he thinks to possess quickly reflexes. Perhaps he has intrusive thinking. An EEG check showed trains of sharp waves in right temporal-occipital area. Often, he has provoking attitudes and opposite behaviour. When asked to say the opposite of Red, he answered: Blue.

He suddenly needs to blaspheme or to say dirty words. When at home, he has aggression against the objects and sometimes against the parents too. Moreover he had unmotivated episodes of destroying personal effects like cutting his clothes or t-shirts, or destroying his Playstation (TM). He is aware that something is going wrong and he is willing to take drugs."

The drug therapy I prescribed in that occasion was (daily doses): amantadine 100mg; viloxazine 50mg, diazepam 5mg.

01.02.2002: The "tremor" to the legs reduced. He needs continual auditory stimulation (mainly music). At school he did not improve. As in the past, he always abused of beer but he did never get drunk. The oversweating did not change. He usually assumed the diazepam at 2:30 AM, and I advised him that this is not going well. Opposite conducts are going on. His ideas are all unreal.

Therapy variation (daily doses): Amantadine 150mg; viloxazine 100mg; slow release diazepam (to be assumed at dinner time) 10mg.

29.07.2002: Now he goes a little better. At night, he went home early, even towards 11:30 PM, but he not goes however to bed before 2:00 AM. Every day he goes in gym and he feels more tired. He runs contests, obviously under the gym supervision. In the morning, he wakes up earlier, towards 10 AM, while he usually got up to 12-13 o'clock. As awaked he feels tired, and he needs a half-hour to be in good form. Sometime he has breakfast in the morning. Perhaps he stands better the sunlight. Some "tremor" in the legs appeared. It is not clear if he has modified his ovesweating, but perhaps he sweats less.

The aggressive language, to blaspheme or to say dirty words, is more refrained. Less opposition in family, he not sends more to the devil his mother, if she asks him to do something. First he looked for the clash with his mother, which he exasperated deliberately. Now he is less watching at the television and uses less videogames. As for the beer, he always likes, but perhaps he is less drinking of it. There was not any drunkenness episode.

The intrusive thought is less present, and there is reduced need to cut or to destroy personal objects. Sometimes, he steals little objects; For his mother he does not own any moral sense. In his private school has gone better, as his mother reported. He pays more attention and he displays greater memory ability. When he opens the books to study, he does it hiddenly. Now he frequents less debatable and more reliable people. Sometime he wears normal suits, for those he considered as more suitable to a "contra" (against) or "alternative" young man. As a typical fact, he resumed wearing normal shirts. Not more opposite conducts, even if he doesn't always do all what he was requesting for. Off home he always behaved well.

Therapy variation (daily doses): Amantadine 200mg; slow release diazepam 10mg; paroxetine 10mg; pyridoxine 150mg. The effect of this last drug variation did not still have any checkup.

Discussion.

Already I have previously written (Cocchi, 2002) that thoughts or opposite conducts, do not appear as isolated symptoms, but they stay in a condition leading to a precise psychiatric diagnosis. In this boy there is an Attention Deficit Disorders with Hypekinesis.

The alcohol abuse is one previewed exit of the ADDH and compensates the mood alteration. The verbal aggression (the need to blaspheme or to say dirty words) and a true aggression against the objects and sometimes against his parents, seems also a compensation symptom. His night arousal due to many adrenergic compensations (verbal and physical aggression, among the first ones) is responsible of the altered sleep-wake cycle.

As for the ADDH, I noted at least the attention deficit, the psychomotor instability, and being spiteful to his classmates. Depression does not evidently appear. Nevertheless, his answer Blue, as the opposite of the Red, and the alcohol abuse could signal a mainly somatic primarily depression of which the young man did not have some awareness of it until this time.

However, since the first consultation I prescribed viloxazine, as an antidepressant. As for neuropsychopathological antecedents in infancy, with possible alteration of stress thresholds, the mother denied anything, because lacking information on his adopted son. On the other hand, symptoms such as ADDH, bedwetting, pavor nocturnus, light convergent squint, and EEG alterations lead to infer the presence of neuropsycho-pathological antecedents with high probability.

This young man had opposite behaviour as provoking the others and groundless aggression with episodes of unmotivated destroying personal effects, with suits or shirts cut or destruction of his Playstation. Ex post factum, being symptoms modified following the drug therapy, it seems I should add to the previous ones, the wearing in the so-called "alternative" way and the frequenting people generically "contra" (against), if not marginal ones at all.

This young man had somehow perceived as unusual such symptoms or opposite behaviour, being available in taking the therapy. A first amazing datum, which does much to think, is that the assumed therapy did not have the aim, in any way, of modifying the opposite behaviour. In spite of that it occurred a reduction of these conducts, in general, and the choice to frequent more amenable persons and to resume the opportunity to dress in a more normal way.

This leads me to think that some opposite conducts, although they seem selected as a personal style of life, perhaps are less spontaneous than we think about. As for me, I believe that the possible prevalence, in some function, of the opposite half-brain dominance con force them.

In the first theoretical article on the temporary, stabilized or stable reversed half-brain dominance (Cocchi, 1994 ), I wrote as it follows: "What happens in adolescents and young men, leads one to believe in the possibility of a mechanism of temporary defective hemispheric dominance in subjects who are already normally lateralised. During the sexual development stage there is a strong increase in the actions of the sexual hormones, of the gonadotropines and their releasing factors that could, in some way, make up a temporary cerebral "intoxication".

Could an explanation for incomprehensible adolescent contrariness be found in this fact? It does not always occur, but psychology [when it is a science] is a statistical science." This case may be fit to prove this hypothesis, with its mixing of brain noradrenergic, partially obviated from central and peripheral adrenergic compensations, and with the increasing, in pubertal and adolescent age, of the sexual hormones, of the gonadotropines and of their releasing factors.

Conclusions.

A young man with opposite conducts from possible troubles of the half-brain dominance and presence of an ADDH, after nine months of drug therapy improved the symptoms of the ADDH, and even clearly reduced the opposite behaviours. Surprisingly, he showed also a better choice as for the people's type he usually frequented and as for his dressing in less "alternative" way.

Then, we can suppose that these two opposite behaviours may relate to a possible reverse half-brain dominance for particular functions. The judgment on the half-filled glass and the fact that the left-handedness is mostly present in subjects with early brain damages (Bishop, 1983; Batheja and McManus, 1985) are things whose analogy is surely suggestive.

References.

Batheja M., McManus I.C.: Handedness in the mentally handicapped. Devel. Med. Child Neurol. 1985, 27: 63-68.

Bishop B.M.V.: How sinister is sinistrality? J. Royal College Physicians 1983, 17: 161-162.

Cocchi R.: Defective hemispheric dominance and cognitive behaviour: Speculative considerations. lt. J. lntellect. lmpair. 1994, 7: 19-27.

Cocchi R.: lntrusive opposite emotional thinking in a chronic "schizoid-affective" woman. A stabilízed ínverse half-brain dominance of a specific function? lt. J. lntellect. lmpair. 1996, 9: 163-168.

Cocchi R.: Opposite half-brain dominance of specific functions? Another case in a Down child under drug therapy It. J. lntelled. lmpair. 1998. 11: 151-156.

Cocchi R.: Temporary reverse dominance of some brain function in a man aged forty-six. On www.reversebrain.net, 2001.

Cocchi R.: A girl aged ten with Smith-Magenis syndrome and possible reverse brain dominance of some brain functions. On www.reversebrain.net, 2001.

Cocchi R. Three young persons with problems of reverse half-brain dominance. On www.reversebrain.net, 2002.

Author's address: Dr Renato Cocchi, via Rabbeno, 3

42100 Reggio Emilia

renatococchi@libero.it

Testo in italiano

Cases

Theoretical bases

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