Uganda Clinical Guidelines 2003 - National Guidelines on Management of Common Conditions: 10. Central nervous system / Psychiatric conditions: 10.9 PARKINSONISM (Parkinson’s disease)

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Abbreviations


	Uganda Clinical Guidelines 2003 - National Guidelines on Management of Common Conditions (NDA, WHO; 2003; 523 pages)
		Abbreviations
		Units of measurement
		Foreword
		Preface
		Acknowledgements
		Presentation of information
		References
		How to diagnose & treat in primary care
		Communication skills in the consultation
		How to make time for quality care
		Evidence-based guidelines
		Chronic care
		Prescribing guidelines
			1. Ten-point Prescribing Checklist
			2. Prescribing of Placebos
			3. Prescription Writing
			4. In-patient Prescriptions
			5. Guide to Quantities of Medicines to be Supplied
			6. Controlled drug prescriptions
			7. Adverse Drug Reactions (ADRs)
			8. Paediatric Prescribing
			9. Drug interactions
			10. Patient counselling
		1. Infections
			1.1 BRUCELLOSIS
			1.2 CANDIDIASIS
			1.3 CHICKEN POX
			1.4 LEPROSY
			1.5 MEASLES
			1.6 MENINGITIS
			1.7 SYSTEMIC MYCOSES
			1.8 PLAGUE
			1.9 POLIOMYELITIS
			1.10 RHEUMATIC FEVER
			1.11 SEPTICAEMIA (before sensitivity results are known)
			1.12 TETANUS
			1.13 TYPHOID FEVER (Enteric fever)
			1.14 TYPHUS FEVER
		2. Parasitic diseases
			2.1 ASCARIASIS (Roundworm)
			2.2 DRACUNCULIASIS (Guinea worm)
			2.3 ECHINOCOCCOSIS (Hydatid disease)
			2.4 ENTEROBIASIS (Threadworm)
			2.5 HOOKWORM
			2.6 LEISHMANIASIS
			2.7 MALARIA
			2.8 ONCHOCERCIASIS (River blindness)
			2.9 PEDICULOSIS
			2.10 SCHISTOSOMIASIS (Bilharziasis)
			2.11 STRONGYLOIDIASIS
			2.12 TAENIASIS (Tapeworm infestation)
			2.13 TRICHURIASIS (Whipworm infestation)
			2.14 HUMAN AFRICAN TRYPANOSOMIASIS (Sleeping sickness)
		3. Respiratory diseases
			3.1 ASTHMA
			3.2 BRONCHIOLITIS
			3.3 ACUTE BRONCHITIS
			3.4 CORYZA (Common cold)
			3.5 ACUTE EPIGLOTTITIS
			3.6 INFLUENZA (‘Flu’)
			3.7 LARYNGITIS
			3.8 ACUTE LARYNGOTRACHEOBRONCHITIS
			3.9 LUNG ABSCESS/ASPIRATION PNEUMONIA
			3.10 PERTUSSIS (Whooping cough)
			3.11 PNEUMONIA (Pyogenic)
			3.12 TUBERCULOSIS (TB)
		4. Gastrointestinal conditions
			4.1 AMOEBIASIS
			4.2 APPENDICITIS (Acute)
			4.3 BACILLARY DYSENTERY (Shigellosis)
			4.4 CHOLERA
			4.5 CONSTIPATION
			4.6 DIARRHOEA
			4.7 GASTRITIS
			4.8 GIARDIASIS
			4.9 HAEMORRHOIDS (‘Piles’)
			4.10 PEPTIC ULCER
			4.11 PERITONITIS
			4.12 REFLUX OESOPHAGITIS
			4.13 PANCREATITIS
		5. Injuries and trauma
			5.1 BITES
			5.2 FRACTURES
			5.3 BURNS
			5.4 WOUNDS
			5.5 HEAD INJURIES
		6. Endocrine system conditions
			6.1 ADDISON’S DISEASE
			6.2 DIABETES MELLITUS
			6.3 DIABETIC KETOACIDOSIS
			6.4 HYPERTHYROIDISM (Thyrotoxicosis)
			6.5 HYPOTHYROIDISM (Myxoedema)
		7. Nutritional and haematologic conditions
			7.1 BLOOD: GUIDELINES FOR APPROPRIATE USE
			7.2 ANAEMIAS
			7.3 PROTEIN ENERGY MALNUTRITION (PEM)
			7.4 VITAMIN A DEFICIENCY
		8. Cardiovascular diseases
			8.1 DEEP VEIN THROMBOSIS (DVT)
			8.2 INFECTIVE ENDOCARDITIS
			8.3 HEART FAILURE
			8.4 HYPERTENSION
			8.5 ISCHAEMIC HEART DISEASE (Coronary heart disease)
			8.6 PERICARDITIS
			8.7 PULMONARY OEDEMA
			8.8 RHEUMATIC HEART DISEASE
		9. Skin diseases
			9.1 BOILS (Furunculosis)
			9.2 CARBUNCLES
			9.3 CELLULITIS and ERYSIPELAS
			9.4 ECZEMA (Dermatitis)
			9.5 FUNGAL SKIN INFECTIONS
			9.6 HERPES SIMPLEX
			9.7 HERPES ZOSTER (SHINGLES)
			9.8 IMPETIGO
			9.9 PEMPHIGUS
			9.10 PSORIASIS
			9.11 SCABIES
			9.12 SKIN ALLERGY/URTICARIA
			9.13 TROPICAL ULCER (TU)
		10. Central nervous system / Psychiatric conditions
			10.1 DRUG & SUBSTANCE ABUSE DISORDERS
			10.2 ANXIETY
			10.3 DEPRESSION
			10.4 DELIRIUM (Acute confusional state)
			10.5 DEMENTIA
			10.6 EPILEPSY
			10.7 MANIA
			10.8 MIGRAINE
			10.9 PARKINSONISM (Parkinson’s disease)
			10.10 POSTNATAL PSYCHOSIS
			10.11 SCHIZOPHRENIA
			10.12 SUICIDAL BEHAVIOUR
		11. Eye conditions
			11.1 CATARACT
			11.2 CONJUNCTIVITIS
			11.3 FOREIGN BODY (FB) in the EYE
			11.4 KERATITIS
			11.5 OPHTHALMIA OF THE NEWBORN
			11.6 STYE (Hordeolum)
			11.7 TRACHOMA
			11.8 UVEITIS
			11.9 XEROPHTHALMIA
		12. Ear, nose and throat conditions
			12.1 EAR CONDITIONS
			12.2 NASAL CONDITIONS
			12.3 THROAT CONDITIONS
		13. Genito-urinary diseases
			13.1 ACUTE CYSTITIS
			13.2 ACUTE GLOMERULONEPHRITIS
			13.3 NEPHROTIC SYNDROME
			13.4 ACUTE PYELONEPHRITIS
			13.5 RENAL COLIC
			13.6 RENAL FAILURE
		14. HIV/AIDS and sexually transmitted infections
			14.1 HIV INFECTION / ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)
			14.2 SEXUALLY TRANSMITTED INFECTIONS
		15. Obstetric and gynaecological conditions
			15.1 ANTENATAL CARE (ANC)
			15.2 PREGNANCY AND HIV INFECTION
			15.3 ANAEMIA IN PREGNANCY
			15.4 MALARIA IN PREGNANCY
			15.5 POSTPARTUM CARE
			15.6 NEWBORN RESUSCITATION
			15.7 ANTENATAL & POSTNATAL MEDICATION
			15.8 HIGH RISK PREGNANCY (HRP)
			15.9 VAGINAL BLEEDING IN EARLY PREGNANCY
			15.10 PREMATURE RUPTURE OF MEMBRANES (PROM)
			15.11 AMNIONITIS
			15.12 MASTITIS
			15.13 BREAST ABSCESS
			15.14 DYSMENORRHOEA
			15.15 HYPEREMESIS GRAVIDARUM
			15.16 ECTOPIC PREGNANCY
			15.17 PELVIC INFLAMMATORY DISEASE (PID)
			15.18 PUERPERAL SEPSIS
			15.19 ANTEPARTUM HAEMORRHAGE (APH)
			15.20 POSTPARTUM HAEMORRHAGE (PPH)
			15.21 RETAINED PLACENTA
			15.22 RUPTURED UTERUS
			15.23 ECLAMPSIA
			15.24 SEVERE PRE-ECLAMPSIA
			15.25 OBSTRUCTED LABOUR
		16. Musculoskeletal conditions and joint diseases
			16.1 PYOGENIC ARTHRITIS (Septic arthritis)
			16.2 RHEUMATOID ARTHRITIS
			16.3 GOUT
			16.4 OSTEOARTHRITIS
			16.5 OSTEOMYELITIS
			16.6 PYOMYOSITIS
			16.7 TUBERCULOSIS of the SPINE
		17. Miscellaneous conditions
			17.1 ANAPHYLACTIC SHOCK
			17.2 DEHYDRATION
			17.3 FEBRILE CONVULSIONS
			17.4 HYPOGLYCAEMIA
			17.5 PAIN
			17.6 VACCINATION SCHEDULE for CHILDREN
			17.7 FLUID & ELECTROLYTE IMBALANCE
		18. Poisoning
			18.1 Acute organophosphate poisoning
			18.2 Paraffin & petroleum products poisoning
			18.3 Aspirin poisoning
			18.4 Paracetamol poisoning
			18.5 Iron poisoning
			18.6 Carbon monoxide poisoning
			18.7 Barbiturate poisoning
			18.8 Narcotic analgesic poisoning
			18.9 Warfarin poisoning
			18.10 Methyl alcohol (methanol) poisoning
			18.11 Alcohol poisoning
			18.12 Other chemical/drug poisoning
			18.13 Food poisoning
		19. Dental and oral conditions
			19.1 DENTAL ABSCESS
			19.2 DENTAL CARIES
			19.3 GINGIVAL INFECTIONS and PERIODONTITIS
			19.4 STOMATITIS
		20. Hepatic and biliary diseases
			20.1 ACUTE CHOLECYSTITIS
			20.2 CIRRHOSIS
			20.3 VIRAL HEPATITIS
		21. Childhood illness
			21.1 Sick Child (Age 2 months to 5 years)
			21.2 Sick young infant (Age 1 week -<2 months)
		22. Family planning (FP)
			1. Provide information about FP to different groups
			2. Counsel clients at high-risk of pregnancy complications to accept/use FP services
			3. Counsel clients to make informed choice of FP method
			4. Obtain and record client history
			5. Perform physical assessment
			6. Perform pelvic examination
			7. Manage client for chosen FP method
		Appendix 1: Anti-TB drug intolerance guidelines
		Appendix 2: HIV/AIDS health worker safety & universal hygiene precautions
		Amendment form
		Glossary
		Notes

10.9 PARKINSONISM (Parkinson’s disease)

A movement disorder resulting from degeneration and malfunction of the CNS common in old age

Causes

Primary Parkinsonism:

• Cause is unknown

Secondary Parkinsonism:

• Infections, eg. sleeping sickness, syphilis
• Poisoning, eg. manganese, carbon monoxide
• Drugs, eg. chlorpromazine, haloperidol
• Hormone disorders, eg. phaeochromocytoma
• Vascular disorders
• Degeneration of basal ganglia
• Intracranial tumour
• Trauma

Clinical features

• Mainly in males
• Intentional tremor
• Excessive salivation
• Vacant facial expression (mask face)
• Muscle rigidity
• Walking with short quick steps (shuffling gait)
• Urinary incontinence (sometimes occurs)

Differential diagnosis

• Any causes of tremor
• Thyrotoxicosis
• Dementia

Investigations

Good history and clinical examination

Management (adults)
HC4

benzhexol 2-15mg daily in 1-3 divided doses
or benzatropine 1-2mg IM or IV
- repeat if symptoms reappear

Caution

Benzhexol, benzatropine: use lower doses in the elderly as they may otherwise cause confusion as a side-effect

Prevention

• Only for secondary type
• Avoid antecedent causes

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Abbreviations

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