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There are checkpoints between G DNA is damaged, cell division can be stopped by the action of tumour suppressor genes (also known as suppressor oncogenes). A damaged cell may be repaired and if that fails, the cell would normally self-destruct by a process known as apoptosis. Apoptosis is genetically programmed cell destruction that removes old, redundant and abnormal cells. This guards against mutations surviving and cells becoming malignant.

It is thought that GABA normally moderates the activity of serotonin-containing neurons and that in anxiety syndromes some of this moderation is lost due to changes in receptor sensitivity, or due to overactivity of a natural inhibitor of GABA. An inhibitor of GABA has not been identified, but it has been tentatively called GABA modulin. It is possible that the RAS can be activated through pathways from the cerebral cortex if a situation is perceived as being threatening. Sleep is complicated and involves the brain stem RAS. When the RAS is switched off sleep is possible.

Before leaving the hospital, Mrs Howes consultant prescribed several drugs, including analgesics and laxatives. Despite her age and current frailty, Mrs Howe is mentally very alert but she is worried about how she will remember to take all her drugs at the right time. What advice can you offer her about how to make sure she remembers when to take the various drugs she has been prescribed. Considering she is taking Mrs Howe also tells you that she has noticed an itchy skin rash that was not there before she left hospital. She wonders whether it could be due to the complex mixture of drugs she is taking and asks you what she should do about it.

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Environmental factors that may play a role in the aetiology of Parkinsons disease include: living in a rural environment; using well water; exposure to pesticides; a diet high in animal fats or carbohydrates; or low consumption of foods rich in antioxidants such as vitamin C and E. Rarely, Parkinsonism can also follow head injuries, cerebral tumours and cerebral ischaemia. At post-mortem, brains of patients with Parkinsons disease are found to contain Lewy bodies. Lewy bodies are intra-neuronal inclusions and can be found throughout the brain and cerebral cortex.

Normally, binding of acetylcholine to its receptor triggers muscle contraction. These drugs produce a short-lasting paralysis that can be reversed by anticholinesterase drugs. They have no sedative action or analgesic effects. Examples of non-depolarizing neuromuscular blockers are pancuronium and atracurium.

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