Tasmanian Times

Health

Insight is lost

image
Terry Martin, second left

I hope it is clear to readers of this string* that I am in no way making light of the dreadful experience that a very young girl has had.

My purpose for writing about this is because I think it is helpful to know that there is such a condition as impulse control disorder (ICD) induced by dopamine agonist drugs used for treating Parkinson’s Disease. My hope that other people suffering the disorder can be identified and helped and that a more understanding and compassionate view can be promoted.

The striking thing about interviewing someone who is experiencing an ICD is that insight is lost. Even if the patient’s spouse is in the room and expressing distress about the uncharacteristic and destructive behaviour the person with ICD typically just can’t get what the fuss and concern is about. That is the nature of the cognitive and behavioural change associated with distortion of the reward/punishment systems of the brain which use dopamine as a chemical messenger. Intelligence, stability of personality, and moral fibre are not reliable protectors from developing these medication side-effects.

Once one is able to discontinue or reduce the dose of the offending drug the behaviour will resolve over a course of days to weeks.

If the previously affected person (recovered from ICD) is interviewed then they will express disbelief that they could have behaved so badly and will show genuine remorse for the suffering that others have endured as a result of their behavior.

I hope that some day Terry Martin, and others who have had a drug induced ICD, are able to tell their stories to audiences prepared to have open minds and to listen very carefully in order to gain a better understanding of the reality of the problem.

*Here: Terry Martin became a different person …

Woman charged over Martin attack

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12 Comments

12 Comments

  1. Merk

    March 5, 2012 at 8:06 pm

    Frank I appreciate your follow up on the comments made in this thread. I agree with most of your points, but there is one which I must take issue with.

    You say that you consider it reasonable to prescribe these drugs ‘if we can identify very early those getting the problem responses’. Do you specifically ask your patients if they have developed addiction to sex, gambling, shopping or binge-eating? Given the stigma associated with these problems – and your own remarks that it is possible those with an ICD may lose appreciation of right and wrong – can you seriously expect an honest response?

    The notion that ‘community awareness’ is the panacea for medically-induced ICD strikes me as unrealistic. With respect to your expertise, I would argue that the only 100% effective way of protecting the community from medically induced crimes like Mr Martin’s in future is simply to end the prescription of these dangerous medications.

  2. frank nicklason

    February 26, 2012 at 11:59 am

    Bronwyn, #2, I don’t think I am any less distressed about what happened to a very young girl, and how it happened, than you are.
    I too wonder if it might be possible for more of the participators to be held to account. (I did read the DPP’s statement on that matter, I am simply not in a position to make a call on that).
    I have restricted my comments to something I do have experience of and that is the issue of ICD associated with dopamine agonist drugs.
    These side-effects are very well described in an international literature and are well known to the Therapeutic Goods Authority (TGA).
    There is a very great responsibility which goes with prescribing of these drugs. Whilst there is a warning in the product information about such potential side-effects this is clearly insufficient as it appears as just another problem at the end of a very long list.
    My practice is to reserve the use of this category of drugs to PD patients who are still substantially troubled despite the use of first line drugs (eg. madopar, kinson and sinemet). If I prescribe these drugs then I make sure that I have a responsible other in the room as I emphasise the possible unwanted effects. At each subsequent visit I inquire about problems. The responsible other is questioned on their own.
    We are lucky in Tasmania to have 3 PD nurse specialists (for the South, the North, and the North West). The most damaging cases of ICD I have seen (including Terry Martin’s case) predate the PD nurse specialist roles. As well we have an active chapter of Parkinsons Australia. These people all act as case finders and sources of information, advice, and advocacy.
    The question arises as to whether drugs with such potentially destructive side-effects should be used. Remember that around 80-90% of PD patients don’t get these troublesome unwanted effects and many of those will benefit greatly. If we can identify very early those getting the problem responses then I believe it is reasonable to prescribe these drugs.
    It is legitimate to ask whether a person under the influence of these powerful side-effects knows right from wrong. A person experiencing the most severe end of the spectrum of ICD can be regarded as having a serious addiction problem, whether it be to sex, gambling, shopping, or binge eating.
    We are well aware of the destructiveness of illicit drug addiction and problem gambling and the frequently associated criminal activity.
    Clearly a lot more attention needs to be given to how we can reduce harm from serious addictive behavior. Better community understanding of addictive behavior seems a logical starting point.

  3. Phillip

    February 23, 2012 at 4:12 pm

    As someone who has Parkinsons disease, I applaud Dr Nicklason from the rooftops for his courage and compassion. ‘Courage’ for publicly stating his beliefs, and ‘compassion’ for not only the 12 year old girl but also for Terry Martin who had little, if any, control over what he did. Hopefully time and support will enable both these people to move on in their lives.

  4. Jeremy Charleton

    February 23, 2012 at 2:27 pm

    Robin Halton…You obviously don’t mind the fact that ALL of the others have been let go scot free???

  5. Robin Halton

    February 23, 2012 at 11:18 am

    Frank, thank you for the information re ICD, its sounds if there is a Pandora’s Box that could be unleased creating more headaches for the community and challenges for legal system versus medical professionals opinions?
    One thing is for sure I never ever want to see Terry Martin back in Tasmania to “tell his story to audiences prepared to have open minds ect”.

  6. Merk

    February 23, 2012 at 2:53 am

    Medicine does not and should not exist in a bubble, separate from community standards and mores. I wonder if Dr Nicklason’s declarations would be more sympathetically received if he were to announce to the TT readership that he will be submitting the case of Mr Martin’s ICD to a peer-reviewed journal, and/or the Therapeutic Goods Administration.

    It is surely prima facie evidence of the hazard of these drugs, both to the individual and the community. I believe the argument needs to be forcefully made that in the treatment of Parkinson’s, this particular remedy is worse than the disease. Primum non nocere, Dr Nicklason?

  7. Alpal

    February 22, 2012 at 9:46 pm

    No Bonni #1 – OCD does not stop your ability to control yourself. If it did it would amount to an insanity defence – an inability to not commit crimes due to mental disease (even if caused by medication) is the very definition of insanity in that sense.
    I do not understand that Martin attempted to use that as his defence. It was simply that his culpability was diminished, not removed.

  8. Jane Bennett

    February 22, 2012 at 6:10 pm

    I can see your point about the ICD, but clearly they still know right from wrong. If he had started to have impulses he would have known they were wrong. I find it interesting that the key point is having an open mind. Personally I hope he never tells his story, I don’t care to hear how he was sick and misguided when molesting a young girl.

    I note that in another case a 23 yr old is sentenced to 7 months gaol and placed on the sex offenders register for 5 years for having sex with a 15 year old. How is it equitable that he gets off almost free after having sex with a 12 year old and posessing child pornography. Shows that in our legal system there are penalties for some and no penalties for others depending upon who you are and how good your defence lawyer is.

  9. Jeremy Charleton

    February 22, 2012 at 6:01 pm

    I’d like to know who are the ones being protected. I think all of the ‘hoo ha’ about Terry Martin is supposed to make us forget that there could be as many as 100 pedophiles in our midst.

  10. Judith King

    February 22, 2012 at 5:38 pm

    #2 Bronwyn…yes Terry Martin does need our compassion and understanding…you don’t have to forgive what he did…it was wrong but there were extreme and tragic circumstances. He will punish himself for the rest of his life.

    No-one disputes the horror about what happened to the young girl and everyone will agree with you that something is terribly wrong with the system that allows this to happen.

    However Dr Nicklason is an expert in his field of Parkinson’s Disease treatment. We need to read what he is explaining about this medical condition and associated medication side effects on human behaviour.

    #1 Bonni is right that the OCD behaviour cannot be controlled. Since ceasing the medication Terry Martin’s behaviour is as the man he previously was and it has been reported that he is horrified by what he has done.

    General practitioners and people with relatives or friends suffering from neurodegenerative conditions like Parkinson’s need to learn about these behaviours as families and friends can help recognize changes to prevent what has happened on this occasion.

  11. Bronwyn Williams

    February 22, 2012 at 2:57 pm

    Dr Nicklason, your information about Impulse Control Disorder arising as a side effect of dopamine agonist medication for Parkinson’s Disease is interesting, and educational, but your choice of example is poor.

    The child victim in the Martin case was prostituted to more than 100 men over the course of two months, whilst under the ‘care and protection’ of the State. Citizens inhabiting a civilized society should be appalled by such a crime. And yet, only one of the criminals was charged, and that person, with the aid of well-paid lawyers, was able to escape ANY custodial consequences.

    Despite his behaviour, and his conviction on charges of underage sex and possession of child pornography, Martin was given a very generous hearing by the court – he received wholly suspended gaol sentences, and his name was not placed on a sex offenders’ register.

    Do you think he deserves any further sympathetic consideration?

  12. Bonni Hall

    February 22, 2012 at 12:21 pm

    Several comments on an earlier thread on the Terry Martin cases have expressed the belief that, as an intelligent man, he would have known right from wrong. Surely, the whole thing about any obsessive or hyper activity is that the person has no control over their obsession? Surely someone suffering from OCD knows that it ridiculous to wash their hands so frequently or to spend hours checking that light switches etc. are off. The whole point is that it cannot be controlled and the same must surely apply to a medically induced obsession.

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