Rehabilitation improves dyskinesias in Parkinsonian patients: a pilot study comparing two different rehabilitative treatments.

GOAL AND OBJECTIVES: The present study was devised: (a) to test whether an intensive (60 hours in 4 weeks) multidisciplinary rehabilitation treatment (involving physiotherapy, exercises to improve gait and balance using treadmill and stabilometric platform, occupational therapy) for Parkinsonian patients is effective in improving dyskinesia and motor performance compared to a control group undergoing a non-intensive non multidisciplinary rehabilitation treatment (30 hours in 4 weeks involving physiotherapy only); and (b) to verify whether rehabilitation may lead to a reduction in levodopa dosage. MATERIAL AND METHODS: Forty Parkinsonian patients suffering from dyskinesias were admitted to study: 20 for an intensive multidisciplinary (Group1) and 20 for a non-intensive non multidisciplinary rehabilitation treatment (Group2). The rating scales used for the clinical evaluation were: Unified Parkinson's Disease Rating Scales (UPDRS) II, III, IV, Parkinson's disease disability scale (PDDS), Abnormal Involuntary Movement Scale (AIMS). RESULTS: All outcome measurements improved in both groups of patients, but patients Group1 presented better results: UPDRS II was reduced by 33% in Group1 and by 22% in Group2, UPDRS III 29% vs. 22%, UPDRS IV 74% vs. 10%, PDDS 18% vs. 12%, and AIMS 71% vs. 8%. A different behaviour was observed for levodopa dosage at baseline and after treatment: dosage decreased by an average value of 210 mg (p< 0.0001) in Group1 and was virtually unchanged (30 mg reduction, p=0.08) in Group2. CONCLUSION: Our findings suggest that a rehabilitation protocol should be considered as a valid non-invasive therapeutic support for patients who show dyskinesias and that there are better results when the treatment is intensive.

Community integration and associated factors among older adults with schizophrenia.

OBJECTIVE: Community integration has been increasingly recognized as an important element in recovery. There is a paucity of data on community integration for older adults with schizophrenia. This study compared community integration for older persons with schizophrenia with their age peers in the community and examined factors associated with community integration in the schizophrenia group. METHODS: The schizophrenia group consisted of 198 community-dwelling persons aged 55 and older who developed schizophrenia before age 45. A community comparison group (N=113) was recruited by randomly selected block groups. Wong and Solomon's 2002 conceptual framework was used to develop a 12-item community integration scale with four components: independence, psychological integration, physical integration, and social integration. Moos' ecosystem model was used to examine 15 personal and environmental factors associated with community integration. RESULTS: Compared with the general community group, the schizophrenia group had significantly lower total community integration scale scores and lower scores on each of the four components. Within the schizophrenia group, regression analysis showed that seven variables were significantly associated with community integration: being female, higher personal income, lower depressive symptoms, lower positive symptoms, lower Abnormal Involuntary Movement Scale score, higher CAGE lifetime scores, and greater control of one's life. The model was significant and explained 49% of the variance. CONCLUSIONS: The data confirmed that older persons with schizophrenia had a lower level of community integration than their age peers in the community and that the model for community integration can identify potentially ameliorable clinical and social variables that may be targets for intervention research.

Acoustic analysis of parkinsonian speech I: speech characteristics and L-Dopa therapy.

This paper reviews the literature pertaining to Parkinson's disease (PD) and the speech dysfunction typically associated with PD, including the effects on respiration, phonation, articulation, resonance, and prosody. The effect of treatment with the drug L-Dopa is also examined, along with the effect of L-Dopa treatment on Parkinsonian speech. This paper is the first of a two-part series. Part two examines the literature pertaining to the fluctuations that can occur during treatment with L-Dopa, the speech changes associated with these fluctuations, and methodological issues affecting the examination of fluctuations and PD speech.

Acoustic analysis of parkinsonian speech II: L-Dopa related fluctuations and methodological issues.

The drug L-Dopa is used in the treatment of Parkinson's disease (PD), and patients often experience fluctuations in performance after a period of time taking L-Dopa. This paper reviews the literature pertaining to these fluctuations. While a number of researchers have examined L-Dopa related fluctuations in general, these fluctuations have rarely been addressed in speech research. To examine the effect of L-Dopa related fluctuations a number of methodological issues need to be addressed including time of day, anxiety level, disease stage, and drug regimen differences. Strategies are proposed for addressing these methodological issues in studying the effects of L-Dopa fluctuations on PD speech. This paper is part two of a two part series; Part one examined PD and PD speech in general, along with L-Dopa treatment, and the effects of L-Dopa treatment on speech.

Psychiatric disorder and disability in New Zealand long-stay psychiatric patients.

A study was undertaken of the prevalence of physical disease, psychiatric disorder and deviant behaviour in a sample of 137 long stay psychiatric patients at Porirua Hospital near Wellington, New Zealand. Patients were in the main male, single, middle-aged to elderly and of European descent. Schizophrenia was the most common diagnosis. Psychiatric symptoms were moderately severe, the most common being unusual mannerisms and posturing, anxiety, blunted affect, tension, unusual thought content and somatic concerns. Known physical disorders were present in 66 patients. Levels of neuroleptic medication were high and tardive dyskinesia was observed in almost 60% of patients. Frequency of deviant behaviour was low in absolute terms but nonetheless problematic. The frequency of deviant behaviour was similar to those reported for British patients.

Clinical factors associated with better quality of life in a seriously mentally ill population.

Improving the quality of life of persons with chronic mental illness is becoming an important treatment goal. In this study, 101 former acute care psychiatric inpatients with serious mental illness who were living in Mississippi communities were interviewed using portions of Lehman's Quality of Life Interview. A particular focus was whether clinical characteristics, such as medication compliance and social skills, that could be changed by interventions were associated with patients' ratings of their quality of life. Self-reports of better quality of life were associated with fewer depressive symptoms, fewer medication side effects, and better family interactions. Results indicate that clinical interventions to improve quality of life in this population should include family psychoeducational programs and better detection, evaluation, and treatment of both depressive symptoms and side effects of medication.

Tardive dyskinesia and hospital discharge.

Two hundred ninety-three schizophrenic inpatients were rated for dyskinetic movements on the Abnormal Involuntary Movement Scale (AIMS). Two years later, discharge status on 265 of these patients was related to the AIMS ratings. Results indicated that the discharge group had significantly lower AIMS ratings than the nondischarged group. The effect was not an artifact of age but was evident across nearly all age groups. The groups were also different on length of current hospitalization, age at time of first psychiatric hospitalization, and time since first psychiatric hospitalization. Possible reasons for the results are discussed, including the development of functional deficits, stigmatization, and tardive psychosis, as well as the possible association between tardive dyskinesia, discharge, and treatment refractoriness.