Groves says that unlike with depression, in HD this irritability disappears within a few weeks on these medications. “Irritability in Huntington’s seems cleaner. It’s extreme, but it also melts away on the medications. Whereas the irritability in some of the other conditions, it’s more complex, especially for personality disorders or depression or bipolar disorder.” Psychiatrist Jon Silver has seen irritability evaporate in only few days in his traumatic brain injury patients.
There are other medications that Groves uses as well, such as propranolol, a beta-blocker, which is often prescribed as a blood pressure medication. “People use propranolol all of the time for performance anxiety. It prevents the adrenaline or norepinephrine surge that causes your blood pressure to go up, your heart rate to go up. So it’s very interesting that this would work. It’s not an antidepressant at all.”
Dopamine-blocking medications that are approved for autism are also sometimes used. And mood stabilizers—antiepileptic or antiseizure medications—are used as well, Groves says.
In addition to drugs, the other treatment for irritability is getting rid of annoyances. This seems relevant to anyone who suffers from irritability, not only to those with a disease. Here are some tips from the psychiatrists: skipping meals makes most people, healthy or ill, more irritable. Mark Groves says that he eats an energy bar before he goes home, so that he’s not irritable when he arrives. Sleep deprivation is another irritability inducer.
People are also more likely to become annoyed when they are faced with unforeseen situations, Karen Anderson says. We don’t do well with surprises, and that’s especially true for HD patients. “A lot of what we do with patients and families is making sure things are very structured. You prepare people ahead of time if there’s going to be a doctor’s visit or a visit from a family member they haven’t seen in a long time. A lot of it is scheduling and minimizing surprises. That’s something that I think can help anyone cut down on irritability on a day-to-day basis.”
Huntington’s patients indicate what happens to annoyance when the brain breaks down, but what accounts for annoyance in healthy brains?
13. The Annoyed Brain
It was 10:53 on a Tuesday morning, and Patti wasn’t going to make it to the lab on time. She’d stayed up late the night before and then slept through the alarm. The year was 2006, and Patti was a sophomore at the University of Southern California. It wouldn’t be unfair to call Patti a typical college sophomore. She wasn’t a star student, but she managed a B+ average, spiking the occasional A in English because she was a pretty good writer.
She hadn’t decided on a major but was leaning toward psychology. That’s why she’d signed up to be a subject in the psych experiment she was running late for. She was supposed to be at the cognitive neuroimaging center over by the SeelyMudd building at eleven to have her brain scanned.
Tom Denson, a graduate psych student, was running the experiment. Denson led one of the sections in Patti’s intro psych class. She saw an ad he had placed on the department’s Web site looking for participants in a study he was doing on cognitive ability and mental imagery.
Two weeks earlier, she had been to Denson’s office to answer a long set of questions. It was the kind of personality stuff she recognized from the intro psych course: Do you get along with others? Do you like to show off? Do other people misunderstand you? Do you worry about what people think of you? “He just wants to know how neurotic I am,” Patti thought.
Some of the agree-disagree items were a little more unexpected: I get into fights more than the average person. Sometimes I fly off the handle for no good cause. When things don’t go the way I plan, I take out my frustration on the first person I see. If I have had a hard day at work or school, I’m likely to make sure everyone knows about it. “What’s he getting at there?” she wondered at the time.
On this morning, however, she wasn’t thinking about those questions. All she was thinking about was getting to the imaging center by eleven, and she wasn’t going to make it. At ten past eleven, she blew in the front door and went to the room where Denson had told her to meet him. He was a thinnish, gangly man with glasses. He didn’t seem annoyed that she was late, but he was anxious to get started. He handed her a clipboard. On the clipboard was a list of words. Next to each word were the numbers 1 to 5. “Before we do the scanning stuff, I want to see how you’re feeling today. Rate your feelings on each of these words, where 1 is ‘not at all’ and 5 is ‘extremely.’”
There were about sixty-five words on the list, adjectives such as alert, angry, considerate, shaky, and sad. It took her about two minutes to jot down her ratings. “Right, let’s head over to the lab,” said Denson.
The lab was in the adjacent room. From the control room, Patti could see the magnetic resonance imaging machine through the open door. It resembled a huge, thick white donut. Sticking out of the hole in the center of the donut was a thin platform, like the gangplank into a ship.
Patti knew the basics of how an MRI worked. The device contained a huge, powerful magnet that produced a strong electromagnetic field. When the magnet was pulsed on and off, it caused the protons in water molecules to change their orientation, a change that the device could detect. By adjusting the orientation of the magnetic field, computers could build a three-dimensional picture of the tissue structure of whatever was in the scanner. Today, that tissue would be Patti’s brain.
She’d looked at the safety material Denson had sent her. She knew there was no health risk from getting the scan. The only real risk was if she got near the magnet with anything metal in her pockets or, even worse, anything metal inside her—say, a metal pin to hold a broken bone together. The magnet could rip that pin out of her body.
She remembered one caution that amused her: “It is a good idea not to wear eye makeup—tiny metal bits in mascara, for example, can move in the magnetic field and irritate your eyes.”{48} “One advantage of being late,” she thought. “No time for makeup this morning.”
“Here’s the drill,” Denson told her. “You’ll lie down in the machine. You’ll have on a pair of headphones. Try to keep your head as still as possible. You’ll be able to see a small screen above your head. Jumbled-up letters will appear on the screen. Your job is to tell me what word the letters spell when you put them in the right order.”
“So you want me to solve the anagrams?” she asked.
“Exactly,” said Denson. “There’s a microphone inside the MRI. I’ll be able to hear your answers. You have fifteen seconds to solve each anagram. If you don’t know the answer, just say ‘No answer.’ Clear?”
“Clear.”
“But before we start showing you the anagrams, we’ll take a baseline scan. All you have to do is lie there.”
“I think I can handle that,” Patti said.
“Then let’s get started.”
She put on the headphones and lay down on the gangplank. Her head was resting in a plastic cage with foam sides that helped keep her head from moving. Denson left the room and the gangplank retracted into the machine. It stopped when Patti’s entire torso was inside the machine, with only her legs sticking out.