Attempted Suicide in a Parkinsonian Patient Treated with DBS of the VIM and High Dose Carbidopa-Levodopa

Introduction. Parkinson’s disease (PD) is a complex disease that is often treated with dopaminergic medications such as carbidopa-levodopa and now with innovative interventions such as deep brain stimulation (DBS). While PD frequently presents with depression and apathy, research must elucidate whether its treatment modalities have an additive or synergistic effect that can lead to an increased suicide risk. DBS has been associated with depression, behavioral changes, and suicidality while dopaminergic treatment has also been shown to cause behavioral changes such as hypersexuality and impulsivity. Considering the now frequent practice of utilizing both DBS and carbidopa-levodopa to treat PD, it is crucial to understand how to properly manage PD patients who are displaying this overlap in symptomology. Case Report. A 56-year-old Caucasian male with a 6-year diagnosis of PD who was being treated with high dose carbidopa-levodopa and left DBS of the ventral intermediate nucleus (VIM) presented after a suicide attempt. The patient was found to be severely depressed and had exhibited behavioral changes in the weeks leading up to the attempt. Imaging was performed to assess positional changes of DBS and carbidopa-levodopa dosage adjusted while under close observation in the inpatient unit. The patient was started on fluoxetine to treat the depressive symptoms and was eventually discharged with close monitoring. Discussion. With PD and DBS being associated with behavioral changes and depressive symptoms and carbidopa-levodopa therapy being linked to behavioral changes such as impulsivity, it is important that these patients be closely monitored and research analyzes how these factors may interact and lead to an increased risk of suicide. Furthermore, when symptoms appear, a clear protocol must be established on managing these patients. We therefore recommend an approach that utilizes imaging to assess any changes in DBS placement, dose management of carbidopa-levodopa, and behavior monitoring in an inpatient setting

‘Purity lies in the incompletion’ Oikos-logy – The place of Mankind.

This contribution by an architect and teacher of architecture to a conference organised in a school of architecture aims to bring a moment more of reflexion about: ‘What has architecture it self to do with ecology?’ It pones almost the question ‘is architecture oikos-logy?’ And what are the consequences of that position. The paper will argue that the ecological crisis requires to rethink the place of mankind. The place of mankind is, for sure, an architectural question in all her ethic. It is not the question of where mankind has to place itself, but it is to interrogate how does the human being has to hold it self in and with ‘nature’? It is so really a question of structure of this place in and with ‘nature’. Great question of architecture itself. Till now, in the humanistic way of thoughts, mankind was sure to be outside nature as a superior exception and lived just in front of ‘nature’ and apart of ‘nature’ in a sort of purity of his perfect and sufficient exception. The architectural paradigms of that are numerous. But by the need that we have to live ‘in and with’ nature (and not in front of nature of apart of nature) because we need nature in all her diversity to live, we have to think us as not sufficient or not completed, even in structure. ‘Purity lies in the incompletion’, citation of the architect Louis I Kahn, gives us a new sense of the structure of our place. This contribution will suggest an analysis of the architectural consequences of this incompletion till, of course, in the necessary spatial structures of the cities, interpreting the Lobe-city of Tjallingii but having also a few suggestive words for the signs of un-humanistic structure in some important architecture of the recent time