Patrice Guex

Effect on mood of subthalamic DBS for Parkinson's disease: a consecutive series of 24 patients.

A series of 24 consecutive PD patients were prospectively studied prior to and within 6 months postoperatively for mood, motor, and cognitive status to investigate the effects on mood of subthalamic deep brain stimulation (DBS) in PD. In six patients (25%), mood state worsened significantly, and three were transiently suicidal despite clear motor improvement. Caregivers and patients should be educated about the potential impact of this neurosurgical procedure on mood.

A prospective study of predictors of poststroke depression

Objective: To investigate the association between early depressive behavior after stroke onset and occurrence of poststroke depression (PSD) at 3- and 12-month follow-up evaluations. Methods: The study prospectively included 273 patients with first-ever single uncomplicated ischemic stroke. In the stroke unit, nurses scored crying, overt sadness, and apathy daily using an observational method to include patients with comprehension deficits. The Barthel Index was used to assess disability. Follow-up evaluation at months 3 and 12 included psychiatric assessment based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Results: Crying (19.8%), overt sadness (50.5%), and apathy (47.6%) were observed. Of the patients observed crying, 4 showed pathologic crying, 19 emotionalism, and 12 catastrophic reactions. Crying and overt sadness, but not apathy, were associated with a subjective experience of depression (p < 0.05). Thirty of 52 (58%) patients observed crying, 12 of 19 (63%) patients with emotionalism, and 5 of 12 (41%) patients with catastrophic reactions developed PSD within the first year. Multiple logistic regression analysis showed that only severe functional disability (odds ratio [OR], 4.31; 95% CI, 2.41 to 7.69), crying behaviors (OR, 2.66; 95% CI, 1.35 to 5.27), and an age <68 years (OR, 2.32; 95% CI, 1.30 to 4.13) were (p < 0.05) predictors of late PSD development (13% of the variance). Conclusions: In the stroke unit, crying and overt sadness are more reliable indicators of depressed mood than apathy. In patients with first-ever stroke, crying behaviors soon after stroke, a younger age, and severe disability are predictors of poststroke depression occurrence within the first year after stroke onset.

The PsyCoLaus study: methodology and characteristics of the sample of a population-based survey on psychiatric disorders and their association with genetic and cardiovascular risk factors

BackgroundThe Psychiatric arm of the population-based CoLaus study (PsyCoLaus) is designed to: 1) establish the prevalence of threshold and subthreshold psychiatric syndromes in the 35 to 66 year-old population of the city of Lausanne (Switzerland); 2) test the validity of postulated definitions for subthreshold mood and anxiety syndromes; 3) determine the associations between psychiatric disorders, personality traits and cardiovascular diseases (CVD), 4) identify genetic variants that can modify the risk for psychiatric disorders and determine whether genetic risk factors are shared between psychiatric disorders and CVD. This paper presents the method as well as sociodemographic and somatic characteristics of the sample.MethodsAll 35 to 66 year-old persons previously selected for the population-based CoLaus survey on risk factors for CVD were asked to participate in a substudy assessing psychiatric conditions. This investigation included the Diagnostic Interview for Genetic Studies to elicit diagnostic criteria for threshold disorders according to DSM-IV and algorithmically defined subthreshold syndromes. Complementary information was collected on potential risk and protective factors for psychiatric disorders, migraine and on the morbidity of first-degree relatives, whereas the collection of DNA and plasma samples was already part of the original CoLaus survey.ResultsA total of 3,691 individuals completed the psychiatric evaluation (67% participation). The gender distribution of the sample did not differ significantly from that of the general population in the same age range. Although the youngest 5-year band of the cohort was underrepresented and the oldest 5-year band overrepresented, participants of PsyCoLaus and individuals who refused to participate revealed comparable scores on the General Health Questionnaire, a self-rating instrument completed at the somatic exam.ConclusionDespite limitations resulting from the relatively low participation in the context of a comprehensive and time-consuming investigation, the PsyCoLaus study should significantly contribute to the current understanding of psychiatric disorders and comorbid somatic conditions by: 1) establishing the clinical relevance of specific psychiatric syndromes below the DSM-IV threshold; 2) determining comorbidity between risk factors for CVD and psychiatric disorders; 3) assessing genetic variants associated with common psychiatric disorders and 4) identifying DNA markers shared between CVD and psychiatric disorders.

INTERMED - An assessment and classification system for case complexity - Results in patients with low back pain

STUDY DESIGN Cross-sectional investigation and follow-up of patients with low back pain. OBJECTIVES To evaluate the capacity of the INTERMED--a biopsychosocial assessment and classification system for case complexity--to identify patients with a chronic, disabling course of low back pain and to predict treatment outcome. SUMMARY OF BACKGROUND DATA An impressive number of biologic and nonbiologic factors influencing the course of low back pain have been identified. However, the lack of a concise, comprehensive, reliable and validated classification system of this heterogeneous patient population hampers preventive and therapeutic progress. METHODS The INTERMED was used to assess patients with low back pain, who participated in a functional rehabilitation program (n = 50) and patients with low back pain who applied for disability compensation (n = 50). Patients of the rehabilitation program were observed to assess the effects of treatments. RESULTS The INTERMED distinguished between patients in different phases of disability and provided meaningful information about the biopsychosocial aspects of low back pain. In hierarchical cluster analysis two distinct clusters emerged that differed in the degree of case complexity and treatment outcomes. CONCLUSIONS This first application of the INTERMED indicates its potential utility as a classification system for patients with low back pain.

Emotional behavior in acute stroke: the Lausanne emotion in stroke study.

Objective:To study emotional behaviors in an acute stroke population. Background:Alterations in emotional behavior after stroke have been recently recognized, but little attention has been paid to these changes in the very acute phase of stroke. Methods:Adult patients presenting with acute stroke were prospectively recruited and studied. We validated the Emotional Behavior Index (EBI), a 38-item scale designed to evaluate behavioral aspects of sadness, aggressiveness, disinhibition, adaptation, passivity, indifference, and denial. Clinical, historical, and imaging (computed tomography/magnetic resonance imaging) data were obtained on each subject through our Stroke Registry. Statistical analysis was performed with both univariate and multivariate tests. Results:Of the 254 patients, 40% showed sadness, 49% passivity, 17% aggressiveness, 53% indifference, 76% disinhibition, 18% lack of adaptation, and 44% denial reactions. Several significant correlations were identified. Sadness was correlated with a personal history of alcohol abuse (r = P < 0.037), female gender (r = P < 0.028), and hemorrhagic nature of the stroke (r = P < 0.063). Aggressiveness was correlated with a personal history of depression (r = P < 0.046) and hemorrhage (r = P < 0.06). Denial was correlated with male gender (r = P < 0.035) and hemorrhagic lesions (r = P < 0.05). Emotional behavior did not correlate with either neurologic impairment or lesion localization, but there was an association between hemorrhage and aggressive behavior (P < 0.001), lack of adaptation (r = P < 0.015), indifference (r = P < 0.018), and denial (r = P < 0.045). Conclusions:Systematic observations of acute emotional behaviors after stroke suggest that emotional alterations are independent of mood and physical status and should be considered as a separate consequence of stroke.

Subjective experience and behavior in acute stroke The Lausanne Emotion in Acute Stroke Study

Objective: To assess subjective experience in acute stroke and to correlate it with stroke features, acute emotional behavior, and impact on seeking of medical care. Methods: The authors studied patients with acute first-ever stroke prospectively. During the first 4 days they rated subjective experience (happiness, sadness, irascibility, and fear); behavioral reactions, using a specifically designed scale; and mood (Hamilton anxiety and depression). Fifty-three patients (30 men, 23 women; age, 60 ± 19 years) completed the 3-month follow-up. Results: Seventeen patients failed to seek medical care spontaneously. Sixteen patients presented behavioral reactions of overt sadness, 20 presented indifference, 12 presented aggressiveness, 20 presented disinhibition, and 16 presented denial. Eight patients were anosognosic and 12 were anosodiaphoric. Twenty-four patients expressed happiness, 20 expressed sadness, 7 expressed anger, and 11 expressed fear. Ten patients with aphasia could be interviewed, but four required delayed questioning. Denial reactions and anosognosia were independent. Acute denial reactions were not dependent on the side of stroke, but were more frequent after deep lesions (p < 0.010). Patients with a denial reaction had a tendency to present less subjective experience of fear (p < 0.078) and a higher occurrence of delayed depression (p < 0.02). Intergroup comparison of all measures showed that lack of seeking care was related to reactions of indifference (p < 0.007), a tendency toward a less subjective experience of fear (p < 0.078), poor recall of the acute event (p < 0.001), decreased nosognosia (p < 0.001), and right-side lesions (p < 0.035). Conclusions: Patients with acute behavioral denial had a decreased occurrence of subjective experience of fear and a more frequent occurrence of delayed depression. These denial reactions were independent of anosognosia. A subjective experience of fear was related to appropriate care seeking. An impaired subjective experience of fear may contribute, as with anosognosia, to an increased delay in consultation. All other emotional reactions were dissociated from the patients’ subjective experience.

Comparison of the clientele of an anonymous HIV test centre and persons tested in the general population

This study compares the clientele of a Swiss anonymous test centre with the general population tested. Information was obtained through similar questionnaires submitted to two samples of HIV-tested people aged from 17 to 45 years: the first administered in the context of a general population telephone survey (n = 245) and the second completed during face-to-face interviews of the clientele of an anonymous test centre (n = 250). The test centre sample has higher proportions of younger and single people. Attenders for anonymous testing were more likely to have acquired a new regular partner during the year preceding the interview (48.0% versus 14.4%). These differences remain when controlling for age and gender. Decision to test comes mostly from the respondents own initiative, but suggestion from a doctor is more frequent in the general population (23.8% versus 0.8%), whereas suggestion from partner or friends is more frequent in the anonymous centre (44.4% versus 3.0%). The anonymous test centre clientele is not different from the general population tested except for the relational situation and origin of decision for testing. The test centre has become a place where the general population finds a response to a situation-specific need for HIV testing.

Family interactions in IVF families: change over the transition to parenthood

Objective: This article presents a study of the change over time in the family interactions of couples who conceived through in-vitro fertilisation (IVF). Background: Observational methods are rarely used to study family interactions in families who used assisted reproductive techniques, but these methods are crucial for taking account of the communication that occurs in interactions with infants. Methods: Thirty-one couples expecting their first child were seen during the fifth month of pregnancy and when the child was nine months old. Family interactions were recorded in pre- and postnatal versions of the Lausanne Trilogue Play situation. Measures of marital satisfaction and parent-to-foetus/baby attachment or ‘bonding’ were also used to assess family relational dynamics. Results: Results showed that family alliance, marital satisfaction and parental attachment scores in the IVF sample were all similar to or higher than those in the reference sample during pregnancy. However, at nine months postnatally, the family alliance scores were lower. While marital satisfaction decreased over the period and parent–baby attachment increased, the family alliance scores were unstable, as no association was observed between the pre- and postnatal scores. In addition, neither prenatal marital satisfaction nor parent–foetus attachment predicted the postnatal family alliance. Conclusion: The change in the family alliance over the transition to parenthood appears to be specific to our IVF sample. Given that postnatal family functioning could not be predicted by prenatal family functioning, our observational data underline the importance of offering postnatal support to these families.

Communication in cancer care: is there enough to talk about?

Looking through the first five manuscripts of this issue of Supportive Care in Cancer, one observes that they have one central topic in common; communication. Glaus et al. [4] in their special article use communication as their main research tool to approach the problem of fatigue and tiredness in cancer patients. Montazeri et al. [5] investigate different modes of communication in research and its possible influences on outcome. Carlsson and Strang [2] remind us with their study that psychosocial support structures cannot be implemented without first communicating with the patient. Buchanan et al. [1] point to another central aspect of communication by showing with their survey that a majority of the patients prefer collaborative consensus in clinical decision making. Fossil et al. [3] uncover in their investigation the perception discrepancy between patients and physicians with regard to somatic morbidity and psychosocial stress. Such differences will only decrease if communication increases. As illustrated in these manuscripts, research in clinical and psychosocial oncology has reached the

Monitoring the effects of adult psychotherapy in routine practice in Switzerland: A feasibility trial

Abstract Background: Several studies have been published on the effects of psychotherapy in routine practice. Complementing traditional views summarised as ‘dose-effect models’, Stiles et al. put forward data consistent with the responsive regulation model underlining the importance of the clients active participant role in defining length of treatment. One may ask what level of change reached by a patient is considered to be the ‘good enough level’ (GEL) and if it is related to the duration of psychotherapy. Aims: The main objective of the present feasibility trial was to monitor the patients session-by-session evolution using a self-report questionnaire in order to define the GEL, i.e. the number of sessions necessary for the patient to reach significant change. Method: A total of N=13 patients undergoing psychotherapy in routine practice participated in the study, completing the Outcome Questionnaire – 45.2 (OQ-45), which assesses the symptom level, interpersonal relationships and social role after e...