The Impact of Deep Brain Stimulation for Parkinson's Disease on Couple Satisfaction: An 18-Month Longitudinal Study.

Patients with Parkinson's disease (PD) may benefit from deep brain stimulation (DBS) to improve motor and medication-induced symptoms. Yet mixed evidence regarding the outcome of successful DBS on couple satisfaction has been highlighted in the literature. Thirty patients diagnosed with PD were included in a study investigating couple satisfaction (MSS-14), depression (HAD-D) and anxiety (HAD-A) at four measurement times: before DBS and 6, 12, and 18 months post-surgically. Sixteen spouses/partners were included as well. Couple satisfaction from the patient perspective was never associated with depression or anxiety. However, poor marital adjustment (i.e., difference and absolute difference between patients and spouses/partners MSS-14 scores) predicted patients' pre-operative depressive mood. Longitudinal analyses showed that couple satisfaction (n = 9) worsened at 12 months and 18 months compared to pre-DBS scores, F(2.047, 16.378) = 8.723, p = .003, and despite concomitant motor improvement. Growth curve analyses showed that couple satisfaction worsening occurred between 6 and 12 months post-operatively (b = 2.938, p < .001). Thus, couple satisfaction did not increase along with motor improvement and deteriorated after the adjustment period following DBS.

[Obsessive compulsive disorder and deep brain stimulation, a future so close]. / Trouble obsessionnel compulsif et stimulation cérébrale profonde, un futur si proche.

The obsessive compulsive disorder (OCD) is a psychiatric disorder with a high prevalence (2­3 %), frequently causing a disabling condition. Drug and psychotherapeutic treatment is generally effective. However about 1/3 of the patients are treatment-resistant, suffering from chronic psychological distress with important sociofunctional repercussions. The identification of dysfunctional neural networks in this disease opens the door to the use of neuromodulation techniques, as deep brain stimulation (DBS). We discuss the clinical results of subthalamic nucleus DBS and the involvement of this nucleus in the pathophysiology of OCD. We emphasize the importance to confirm these results with a larger number of patients and to determine the benefits regarding the quality of life of implanted patients.

Le trouble obsessionnel compulsif (TOC) est une maladie psychiatrique fréquente (prévalence : 2­3 %) et invalidante. Le traitement pharmacologique et psychothérapeutique est globalement efficace. Un tiers des patients s'avèrent toutefois résistants, avec persistance de souffrance psychique et retentissement fonctionnel importants. L'identification précise de réseaux neuronaux dysfonctionnels dans cette maladie ouvre les portes à l'utilisation de techniques de neuromodulation, comme la stimulation cérébrale profonde (SCP). Nous discutons les résultats de la SCP du noyau sous-thalamique et l'implication de ce noyau dans la physiopathologie du TOC. Il est nécessaire de confirmer les premiers résultats de cette thérapeutique avec un nombre plus élevé de patients et de déterminer le bénéfice attendu en termes de qualité de vie.

[The obsessive compulsive disorder]. / Le trouble obsessionnel compulsif.

The obsessive compulsive disorder (OCD) is a frequent disease with a high comorbidity. The usual treatment is a combination of pharmacological and psychotherapeutic treatment. However, 30% of patients still have persistent and severe symptoms, with an important functional impact. These last years, the integration of the new neuroanatomical, neurochemical, neuropsychological, genetic and phenomenological data, allows a better understanding of the physiopathology and the development of new treatments for OCD, as neuromodulation for the severe and refractory cases.

[OCD: when limbic systems start looping...]. / Troubles obsessionnels compulsifs: quand les systèmes limbiques se mettent en boucle....

Obsessive Compulsive Disorder (OCD) is a disease that affects 2-3% of the population with high comorbidity and a negative impact on the person overall functioning. About 30% of patients have severe and persistent symptoms despite the combination of pharmacological and psychotherapeutic treatments. In these cases, deep brain stimulation (DBS) of the subthalamic nucleus allows both the reduction of symptoms severity and the improvement in overall functioning. A clinical case is presented by integrating the latest data research to show not only the result of DBS therapy but also its contribution to a better understanding of the pathophysiology of OCD.

Assessing preoperative hope and expectations related to functional neurosurgery: a new questionnaire.

BACKGROUND: Despite successful functional neurosurgery, patients suffering from epilepsy or Parkinson's disease may experience postoperative psychological distress and social maladjustments. Difficulties in coping with postoperative changes, even positive ones, have shown to be related to patients' presurgery cognitive representations (i.e., expectations, hope). The aim of this study was to develop an instrument assessing various key features of surgery outcomes' representations, namely the Preoperative Hope and Expectations Questionnaire (PHEQ). METHODS: Participants were patients (n = 50) diagnosed with Parkinson's disease (n = 25) or epilepsy (n = 25), candidates for functional neurosurgery (i.e., Deep brain stimulation, anterior temporal lobectomy). Two to three weeks before the planned surgery, they were administrated items assessing their actual state, preoperative expectations, and hope regarding surgery outcomes. They also completed measures assessing optimism, quality of life and mood. RESULTS: Exploratory analysis resulted in a 14-item version of the PHEQ composed of two factors (abstract representations, including psychological well-being and concrete representations, such as direct surgery outcomes). The PHEQ demonstrated high internal consistency and good convergent validity. Patients were more prone to express postoperative improvements in terms of hope rather than expectations. They generally focused on concrete rather than abstract features, although patients with Parkinson's disease had higher abstract future-oriented representations. CONCLUSIONS: The PHEQ presents satisfactory psychometric properties and may be considered as a reliable instrument for research and clinical practice.

Illness Representations and Coping Strategies in Patients Treated with Deep Brain Stimulation for Parkinson's Disease.

There is a debate on possible alterations of self-identity following deep brain stimulation for neurological disorders including Parkinson's disease. Among the psychological variables likely to undergo changes throughout such a medical procedure, illness representations and coping strategies have not been the target of much research to this day. In order to remedy this, we investigated the dynamics of illness representations and coping strategies in an 18-month longitudinal study involving 45 patients undergoing deep brain stimulation for idiopathic Parkinson's disease. Two research hypotheses were formulated and investigated through repeated measures of ANOVAs and structural equation modelling with full information maximum likelihood and Bayesian estimations. Representations of Parkinson's disease as a cyclical condition and perception of control over the disease diminished after surgery. Use of instrumental coping strategies was not modified after deep brain stimulation. These changes were identified by SEM but not ANOVAs; their magnitude was nevertheless relatively small, implying general stability in representations. These findings suggest that psychological variables do not undergo major changes after deep brain stimulation for Parkinson's disease.

The burden of normality as a model of psychosocial adjustment after deep brain stimulation for Parkinson's disease: A systematic investigation.

OBJECTIVE: Deep brain stimulation (DBS) has become a well-established treatment that significantly improves the motor symptoms of Parkinson's disease (PD). Patients may nevertheless experience psychosocial maladjustment after surgery, as reported by an increasing body of research. Yet, no comprehensive theoretical approach has been proposed to account for this. Initially conceptualized for postsurgical epilepsy, the burden of normality (BoN) may be viewed as a model that is potentially applicable to psychosocial maladjustment after PD-DBS. METHOD: We systematically examined the literature to verify this assumption by scrutinizing the 3 theoretical levels of the BoN, specifically, precursory conditions for the applicability of the model, clinical manifestations of psychosocial maladjustment, and 2 mediating variables: expectations and discarding the roles associated with the pretreatment condition. RESULTS: The applicability of the BoN to PD-DBS found support for the first 2 of these 3 levels in 88 scientific articles included in the review. The number of studies that addressed the mediating variables was nevertheless insufficient to draw any definitive conclusion. The degenerative condition of PD further limits the distinction between symptoms pertaining to psychosocial maladjustment and disease progression. CONCLUSIONS: Considering psychosocial maladjustment through the lens of the BoN is complementary to the traditional medical perspective of PD-DBS and illuminates the potential contribution of specialists from multiple disciplines in clinical rehabilitation. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Tackling psychosocial maladjustment in Parkinson's disease patients following subthalamic deep-brain stimulation: A randomised clinical trial.

BACKGROUND: Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for the motor and non-motor signs of Parkinson's disease (PD), however, psychological disorders and social maladjustment have been reported in about one third of patients after STN-DBS. We propose here a perioperative psychoeducation programme to limit such social and familial disruption. METHODS: Nineteen PD patients and carers were included in a randomised single blind study. Social adjustment scale (SAS) scores from patients and carers that received the psychoeducation programme (n = 9) were compared, both 1 and 2 years after surgery, with patients and carers with usual care (n = 10). Depression, anxiety, cognitive status, apathy, coping, parkinsonian disability, quality-of-life, carers' anxiety and burden were also analysed. RESULTS: Seventeen patients completed the study, 2 were excluded from the final analysis because of adverse events. At 1 year, 2/7 patients with psychoeducation and 8/10 with usual care had an aggravation in at least one domain of the SAS (p = .058). At 2 years, only 1 patient with psychoeducation suffered persistent aggravated social adjustment as compared to 8 patients with usual care (p = .015). At 1 year, anxiety, depression and instrumental coping ratings improved more in the psychoeducation than in the usual care group (p = .038, p = .050 and p = .050, respectively). No significant differences were found between groups for quality of life, cognitive status, apathy or motor disability. CONCLUSIONS: Our results suggest that a perioperative psychoeducation programme prevents social maladjustment in PD patients following STN-DBS and improves anxiety and depression compared to usual care. These preliminary data need to be confirmed in larger studies.