Difficulties in activities of daily living are associated with stigma in patients with Parkinson's disease who are candidates for deep brain stimulation

Objective: Parkinson's disease (PD) is often accompanied by stigma, which could contribute to a worse prognosis. The objective of this study is to identify the variables associated with stigma in PD patients who are candidates for deep brain stimulation (DBS). Methods: We investigated sociodemographic and clinical variables associated with stigma in a sample of 54 PD patients indicated for DBS. The independent variables were motor symptoms assessed by the Movement Disorder Society‐sponsored revision of the Unified Parkinson Disease Rating Scale (MDS-UPDRS III), depressive symptoms measured by the Hospital Anxiety and Depression Scale, age, disease duration and the presence of a general medical condition. The Mobility, Activities of daily living and Emotional well-being domains of the 39-item Parkinson's Disease Questionnaire (PDQ-39) were also investigated as independent variables, and the Stigma domain of the PDQ-39 scale was considered the outcome variable. Results: After multiple linear regression analysis, activities of daily living remained associated with the Stigma domain (B = 0.42 [95%CI 0.003-0.83], p = 0.048). The full model accounted for 15% of the variance in the Stigma domain (p = 0.03). Conclusions: Although causal assumptions are not appropriate for cross-sectional studies, the results suggest that ADL difficulties could contribute to greater stigma in PD patients with refractory motor symptoms who are candidates for DBS.

Validity and screening properties of three depression rating scales in a prospective sample of patients with severe traumatic brain injury

Objective: To evaluate the validity and utility of the Hamilton Rating Scale for Depression (HAM-D), Beck Depression Inventory (BDI), and Hospital Anxiety and Depression Scale (HADS) as screening tools for depression after severe traumatic brain injury (TBI). Methods: Forty-six consecutive survivors of severe TBI were evaluated at a median of 15 months after injury. Receiver operating characteristic (ROC) analysis was performed using HAM-D, BDI, and HADS as predictors, and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) as gold standard. Results: The area under the curve (AUC) for HAM-D was 0.89, and the optimal cutoff point was 7 (sensitivity 92.9%, specificity 78.1%); for the BDI, the AUC was 0.946 and the optimal cutoff point was 14 (sensitivity 92.3%, specificity 96.7%); for the HADS, the AUC was 0.947 and the optimal cutoff point was 9 (sensitivity 100%, specificity 80.7%); and for the HADS depression subscale, the AUC was 0.937 and the optimal cutoff point was 6 (sensitivity 92.9%, specificity 83.9%). There were no statistically significant differences among the AUCs. Conclusion: Our findings support a high validity and utility for the HAM-D, BDI, and HADS as screening tools for depression in patients with severe TBI, without major changes in standard cutoff points. .

Personality changes and return to work after severe traumatic brain injury: a prospective study

Objective: To evaluate predictors of non-return to work (nRTW) among social, demographic, clinical, and psychiatric variables after severe traumatic brain injury (TBI) in a cohort of Brazilian patients. Methods: Prospective study. Forty-three community-dwelling individuals treated at a Level I trauma center at the time of TBI were evaluated 18 months after trauma. Measures included DSM-IV-TR criteria for personality changes after TBI and Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to assess psychiatric diagnosis. Hospitalization variables included Glasgow Coma Scale scores, pupil examination findings, associated limb trauma, Marshall computed tomography classification, and blood glucose levels. Results: After multiple logistic regression analysis, only the diagnosis of personality changes was found to be independently associated with nRTW, with an adjusted odds ratio of 10.92 (p = 0.02, 95% confidence interval 1.41-84.28). Conclusions: In this study, personality changes were an independent predictor of nRTW after severe TBI. Ways to predict risk factors associated with personality changes after severe brain injury could aid in identification of early and effective interventions that might ease the burden associated with this condition. .

A prospective study of 39 patients with trigeminal neuralgia treated with percutaneous balloon compression / Estudo prospectivo de 39 pacientes com neuralgia do trigêmeo tratados com compressão por balão percutâneo

OBJECTIVE: Trigeminal neuralgia is the most common facial pain. It may be treated with percutaneous balloon compression (PBC), which is considered to be a safe and efficient procedure. The purpose of this study was to review our results with PBC and to assess the factors influencing the outcome. METHOD: A multivariate analysis was used to study 39 patients during a 50-month postoperative period. RESULTS: There was predominance of the female gender (54 percent), the right side of the face (84 percent) and V2V3 roots of trigeminal nerve (33 percent). The mean age was 62.3 years. No major complications or deaths occurred. Among all variables, postoperative hypoesthesia was the single prognostic factor capable of positively influencing the results (p=0.02). Most patients (80 percent) were pain-free after 50 months with a 90 percent satisfaction rate. CONCLUSION: PBC was a safe procedure with low morbidity, no mortality, high approval ratings, and was an important improving on patients' quality of life.

OBJETIVO: A neuralgia do trigêmeo é a dor facial mais comum. Ela pode ser tratada através da compressão percutânea com balão, que é considerado procedimento seguro e eficaz. A proposta deste estudo foi avaliar nossos resultados e os fatores que influenciariam o seguimento. MÉTODO: Foi utilizada análise multivariada para estudar 39 pacientes submetidos ao procedimento, com seguimento de 50 meses. RESULTADOS: Houve predominância do sexo feminino (54 por cento), lado direito (84 por cento) e dos ramos V2V3 (33 por cento). A idade média foi de 62,3 anos. Não houve complicações maiores ou óbito. Dentre todas as variáveis, a única capaz de influenciar positivamente os resultados foi a hipoestesia pós-operatória (p=0,02). A maioria dos pacientes (80 por cento) estava livre da dor após 50 meses de seguimento, com 90 por cento de satisfação. CONCLUSÃO: Este procedimento foi considerado seguro, com baixa morbidade, sem mortalidade, com alta taxa de aprovação e representou melhora importante na qualidade de vida dos pacientes.