Beneficial effects of bilateral subthalamic stimulation on alexithymia in Parkinson's disease.

BACKGROUND AND PURPOSE: Subthalamic nucleus (STN) deep brain stimulation (DBS) improves quality of life (QoL) and motor and non-motor symptoms in advanced Parkinson's disease (PD). However, its effect on alexithymia and its relationship to other neuropsychiatric symptoms and QoL in PD is unclear. METHODS: In this prospective, observational study of 39 patients with PD undergoing STN-DBS, we examined the Parkinson's Disease Questionnaire-8 (PDQ-8), 20-item Toronto Alexithymia Scale (TAS-20), Hospital Anxiety and Depression Scale (HADS), Self-Report Manic Inventory (SRMI), Apathy Evaluation Scale (AES), Unified Parkinson's Disease Rating Scale (UPDRS) activities of daily living, UPDRS motor examination and UPDRS complications (UPDRS-II/-III/-IV) and levodopa-equivalent daily dose (LEDD) pre-operatively and at 5-month follow-up. Outcome changes were tested with Wilcoxon signed-rank or paired t-test when parametric tests were applicable and corrected for multiple comparisons. The relationship between outcome changes was explored with bivariate correlations. Additionally, partial correlations between PDQ-8 and TAS-20 were computed controlling for HADS, SRMI and AES change scores. Predictor analyses for PDQ-8 improvement were calculated for all baseline parameters. RESULTS: The baseline prevalence of alexithymia was 17.9%. We observed significant beneficial effects of STN-DBS on PDQ-8, TAS-20, HADS, UPDRS-II, -III and -IV scores and significant LEDD reduction. The correlation between TAS-20 and PDQ-8 improvements remained significant after controlling for all other aforementioned outcomes. Predictor analyses for PDQ-8 improvement were significant for PDQ-8 and TAS-20. CONCLUSIONS: This is the first report of beneficial effects of STN-DBS on alexithymia. Alexithymia was significantly associated with QoL outcome independent of anxiety, depression, mania and apathy. Our study highlights the importance of alexithymia for holistic assessments of DBS outcomes.

Psychological issues of infertility and assisted reproductive technology.

This article presents a model for conceptualizing the emotional consequences of infertility experienced by most couples with this problem. The article also discusses the need for patient preparation for alternative reproductive techniques with donor gametes and examines the main issues that need to be explored. Recommendations are made for physicians and couples challenged by infertility's intense and surprising emotional consequences.

Sperm donors: their attitudes toward providing medical and psychosocial information for recipient couples and donor offspring.

OBJECTIVES: To determine the willingness of sperm donors to provide in-depth medical and psychosocial information on their application forms and to share this information with recipient couples and their offspring. DESIGN: Sperm donors in two donor programs were asked to complete 12-page application forms. In addition to frequency tabulations of responses, chi 2 analyses were performed to compare responses from two programs. SETTING: The two donor programs were Baylor College of Medicine Sperm Bank Program, Scott Department of Urology, Houston, Texas, and Reproductive Resources, Metairie, Louisiana. MAIN OUTCOME MEASURES: Attitude toward providing in-depth medical and psychosocial information to recipient couples. RESULTS: Ninety percent of these donors are willing to complete lengthy application forms providing medical and psychosocial information. Ninety-six percent are willing to share this information in a nonidentifying manner with recipient families. Thirty-six percent say that they will be donors if anonymity cannot be guaranteed, and 60% indicate that they will meet or provide identifying information to the child at age 18. Seventy-two percent left personal messages to their potential offspring. CONCLUSIONS: Sperm donors are willing to provide in-depth nonidentifying information for recipient families. Permanent files with medical and psychosocial information on all donors should be developed, maintained, and made available to all recipients, whether they request donor information at the time or conception or not.

Assisted reproductive technology with donor gametes: the need for patient preparation.

There are certainly no definitive answers to the questions raised by the use of donor gametes in reproduction, as there are no definitive answers to any of life's most difficult questions. The loss of fertility is usually an unexpected, invisible, deeply painful wound for those couples who are considering the use of donor gametes. As they address the psychological issues of these techniques, they must also heal the wounds created by infertility. This type of grieving and examination of feelings takes time and information. The medical community needs to encourage each couple to resolve the issues around infertility and to use available personal, professional, and written resources to address the dilemmas raised by the use of donor gametes prior to embarking on this type of treatment. In so doing, the couple will reduce the likelihood that the means of conceiving their children will become a source of major conflict in their family. In 1932 Aldous Huxley prophesied the destructive consequences of scientific accomplishment without social involvement and psychological guidance. He said: "The sciences of matter can be applied in such a way that they will destroy life or make the living of it impossibly complex and uncomfortable...unless used as instruments by biologists and psychologists." It is our concern that the procedures for enabling infertile couples to become parents may, if not accompanied by acknowledgment of the unique challenges which they create for all participants in the process, make the living of life "impossibly complex and uncomfortable" for the very families we are trying to help.

Emotional factors and the in vitro fertilization and embryo transfer process.

In vitro fertilization is nearly always a treatment of a last resort. This fact, along with the treatment's multiplicity of procedures and intensity, place unique emotional demands on patients. The goal of this research was to describe both the acknowledged emotional state of patients at the time they began the in vitro fertilization and embryo transfer (IVF-ET) process and the emotional experience of the actual procedures themselves. The findings can be used to develop strategies for providing emotional support. Data were collected from self-administered questionnaires returned by 94 IVF-ET patients in three Houston programs during a 6-month period. At the time of the IVF procedure, 77% of the population reported that infertility was still a painful concern, not something with which they had learned to live. The loss of control, seen by most patients as infertility's most stressful dimension, left them vulnerable to the intense stresses of in vitro fertilization, less able to handle its multiple demands. Thus for many, the IVF-ET procedures were like an emotional roller coaster on which they experienced a wide range of feelings during a brief period of time. Not surprisingly, emotional strain was a major consideration influencing the decision whether or not to repeat IVF. Patients indicated specific services which the staff could provide to reduce the stress of the procedures.