Psychiatric symptoms in adult patients with cerebral palsy: A cohort study.

Background: Patients with cerebral palsy (CP) have an increased risk of developing mental health disorders. Aims: This paper is aimed to investigate the occurrence of psychiatric symptoms in adults with CP and to explore the relation between clinical and psychosocial variables. Methods and procedures: We included 199 adults with a diagnosis of CP. The chi-square and the Mann-Whitney U tests were used to compare clinical and psychosocial variables, the level of perceived disability, and the type of observed parental style in patients with and without psychiatric symptoms. Logistic regression analysis was used to identify variables that could predict the occurrence of mental health disorders. Outcome and results: Anxiety and psychosis were the most represented disorders. Age, living status, assumption of drugs, motor, manual, and global impairment were significantly different between patients with and without psychiatric symptoms. Similarly, a different parental style was observed between the two groups. Logistic regression indicated that living status, prescribed drugs, parental style, and the perceived disability in getting along with others predicted the occurrence of psychiatric symptoms. Conclusions and implications: Results suggest that patients with and without psychiatric symptoms have different clinical and psychosocial characteristics. Some variables should be considered as potentially affecting the mental health of patients with CP.

Becoming a young adult with cerebral palsy.

AIMS: This paper aims to describe the functioning profile of a clinical sample of patients with Cerebral Palsy at the time of transition. METHODS AND PROCEDURE: For this retrospective observational study, we considered data concerning 389 patients born from 1967 to 1997 with a diagnosis of CP and discharged at the age of 18 ±â€¯3 from "La Nostra Famiglia" Children Care Centres. We reported data concerning: identifiable risk factors, the type of CP, the level of motor, manual and communication abilities, the occurrence of associated impairments and environmental factors, and examine the trends over the decades. OUTCOME AND RESULTS: The disorder was mainly bilateral (86%): 57% of patients had quadriplegia and 43% had diplegia. Most of patients had a spastic disorder (86%). Comorbidities were frequent, mainly intellectual developmental disorder (63.5%). One fifth of patients showed a severe impairment of motor, manual and communicative skills in addition to a severe intellectual development disorder. Over decades, the outcome as expressed by the motor functioning profile improved but the outcome as expressed by the global functioning profile worsened because of the growing number of severe multi-disabilities. CONCLUSION AND IMPLICATION: Knowledge about the functioning profile of young adults with cerebral palsy can support health services in the provision of developmentally appropriate care.

Benefits of Centralized Scheduling in a Postacute Residential Rehabilitation Program for People With Acquired Brain Lesions: A Pilot Study.

OBJECTIVE: To determine whether the use of a designated staff person to coordinate and schedule therapy services in a postacute residential rehabilitation program for people with acquired brain lesions results in (1) a higher-intensity treatment and a reduced length of stay; (2) reduced rehabilitation costs; and (3) increased patient and staff satisfaction. DESIGN: This nonrandomized retrospective study from 2009 through 2012 uses data collected relative to 2 different methods of scheduling: (1) self-planning, in which each single team member makes appointments that are then displayed on a shared board; and (2) managed planning, in which appointments are made by a designated staff person. SETTING: A residential center for people with postacute acquired brain lesions. PARTICIPANTS: Patients (N=20) with acquired brain lesions who had similar clinical and demographic characteristics comprised the managed planning group (n=10) and the self-planning group (n=10). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Organizational measures (length of stay in rehabilitation, number of treatment hours, total cost of rehabilitation), clinical outcome scales (Disability Rating Scale, FIM, and Barthel Index), perceived quality of treatment by patients (questionnaire), and perceived satisfaction of team members (Job Descriptive Index). RESULTS: All patients improved on all clinical rating scales at the time of discharge (all effect sizes are large). In the managed planning group, the number of treatment hours increased (Cohen's d=2.15), resulting in reduced length of stay (Cohen's d=.95) and cost of rehabilitation (Cohen's d=1.22). In addition, the quality of treatment perceived by the patients and their families increased, while team member satisfaction did not change. CONCLUSIONS: The use of a designated staff person to manage therapy services improves efficiency and efficacy of a patient-centered health care system. The proposed scheduling system results in a remarkable cost saving for the National Health System.

A Long Term Effects of a New Onset Psychosis after DBS Treated with Quetiapine in a Patient with Parkinson's Disease.

Deep Brain Stimulation represents a therapeutic option for PD patients. In this paper, we present and discuss a case of acute delirium and psychosis manifesting after DBS in a 58-years-old man affected by Parkinson's Disease. We highlight the importance of an exhaustive psychiatric evaluation in candidates for DBS and we underline the severity and non-reversibility of some adverse events associated with the implantation, suggesting the use of Quetiapine in the management of these effects. Acute psychosis may be listed as a potential severe adverse event associated with DBS, even in patients without a clear cut previous history of psychiatric disorders.