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Youngseok (pseudonym) is a 60-year-old man and the CEO of a mid-sized company. The company is running soundly and relationships between family members are good. But one day, while Mr. Young-seok was looking at the company bulletin board, he happened to see a post that seemed to be gossiping about him. Although it did not mention Youngseok’s real name, it said that incompetent management should be replaced immediately. Mr. Youngseok was enraged that a salaried employee was pointing a knife at him and became very angry, demanding that the employee who posted the post be found immediately. When he got angry, he felt his hands shaking differently than before. When we eventually found the employee who wrote the article and asked him why he did it, the employee explained that the article was not an attack on Youngseok. However, Mr. Young-seok became convinced that there was a systematic slander in the company to oust him. After that, he often checked the company bulletin board every day and became enraged. When employees said, ‘Mr. Young-seok seems different from before,’ Mr. Young-seok thought that they were part of the forces that were slandering him.

One day, while Youngseok was resting at home on the weekend, he saw a messenger ringing repeatedly on his wife’s smartphone, which she had left on the desk. At first glance, it said things like ‘Come quickly’ and ‘See you in the chat room’. When Youngseok asked his wife, ‘Who sent it?’, her wife responded that it was a spam message. It seemed to Youngseok that his wife was very surprised by her own words. Youngseok began to suspect that his wife was up to something she didn’t know about. Suspicious that she might be seeing another man, she constantly checked the black box in her wife’s car and secretly checked her smartphone while she was sleeping. Her suspicions grew. Youngseok has become much sharper than before. He felt like people around him were trying to destroy him. He was so depressed and low on motivation that he didn’t even want to go to work. About a month ago, unlike before, I felt like my overall body movements were very slow. His hands also began to tremble slightly. My right hand trembled more than my left, and when I made payments in front of employees, I was very worried that my hand would be seen shaking violently. My gait also started to lean forward, and my stride became narrower than before, making me walk often. Especially on rainy days, my movements became slower, my hands trembled, and my depression and doubts deepened. Youngseok started to think something was wrong with him and went to a mental health clinic with his wife. As a result of the psychological test, Mr. Young-seok was assessed as having severe depression and low motivation and a sense of victimization. Brain magnetic resonance imaging showed mild atrophy in the frontal lobe of the brain, but no signs of dementia were observed. No abnormalities were found in the blood test. Even during the test, when I was nervous, my hands would shake a lot and I would feel anxious. The specialist in charge diagnosed Youngseok with ‘major depression with psychotic symptoms.’ At the same time, it was determined that she needed to consult a neurologist because she suspected she had Parkinson’s disease. In the end, Youngseok was diagnosed with early-stage Parkinson’s disease.
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Parkinson’s disease is a neurodegenerative disease that occurs most frequently after Alzheimer’s disease. Parkinson’s disease is named after James Parkinson, who first reported a case of the patient in his paper in 1817. Parkinson’s disease occurs when dopamine neurons are lost in the substantia nigra of the brain. Dopamine is an important neurotransmitter that acts on the basal ganglia of the brain to refine body movements. Parkinson’s disease is a condition in which movement disorders occur due to a lack of dopamine. About 1% of people over 60 years of age suffer from this disease. Additionally, 35% of Parkinson’s disease patients experience depression, and depression is often experienced as an early symptom. Depression seen in Parkinson’s disease is often accompanied by suspicion and delusions of persecution. Parkinson’s disease is caused by a decrease in dopamine production in the substantia nigra of the brain, and the main symptom is hand tremors caused by the difference between the left and right substantia nigra. If the nerve cells in the left substantia nigra are atrophied, tremors will occur in the right hand. Conversely, if the neurons in the right substantia nigra are atrophied, tremors will appear in the left hand. In the beginning, I feel more nervous when using chopsticks while eating or writing. Many people do not know that depression that predates hand tremors and a sense of victimization are all related. If you do not know your condition, your depression and sense of victimization will increase, as will misunderstandings around you. Mr. Youngseok heard from his doctor that he had depression and Parkinson’s disease and accepted it. She decided to no longer suspect her employees or her wife. As I was treated with medication for depression and Parkinson’s disease, my doubts began to decrease and I began to act faster. My hands were shaking so I used to cover my hands when signing documents to prevent others from noticing, but now my symptoms have improved so much that I no longer need to do that. The stiff expression on his face that seemed angry to his family relaxed and his expression became much softer. Laughing happened often. In fact, Youngseok’s smiling face once disappeared due to depression and Parkinson’s disease. Due to the incoordination of her facial muscle movements, she is unable to express emotions through facial expressions, and as a result she appears to be wearing a mask, which is called a ‘masked face’. Youngseok is now running his company while receiving treatment well. Many misunderstandings with her family were also resolved. Now, when doubts or feelings of victimization arise again, she first considers her depression to be worsening. In the end, accepting her own problems and evaluating them objectively through an expert is the beginning of solving them.
Professor, Department of Psychiatry, Samsung Seoul Hospital