REFLEXIONS SUR
L’étude en cours d’un sujet extrêmement riche
et passionnant, le stress aigu et chronique dans
Pas un seul article mondial valable sur la
globalité de ce sujet, même en remontant sur les trente-quarante dernières
années.
(Voir résultat requête tout en bas)
Pour le diabète, les publications vont bon
train, pour l’hypertension artérielle chronique aussi.
Mais la recherche avancée ou la recherche
boléenne utilisant les termes stress et Parkinson, si elle donne des centaines
de références, ne correspond qu’à deux sujets :
-
le stress….oxydatif cellulaire dans
-
le stress et son management…pour les conjoints et accompagnants de
MP
Le constat est clair…..
Cette préoccupation de l’entourage immédiat des
personnes malades est très louable mais est révélatrice de la mentalité d’une
« société » :
Le stress bien réel et même fantastique des
malades n’intéresse pas, pire, on n’imagine même pas de le
« manager » et on l’ignore, c’est tellement plus simple. Certes,
on le connaît, mais il est inhérent à la maladie….alors on admet sans broncher
que les « malades vivent avec » (ils sont malades, non ?).
Le stress des accompagnants bien portants est par contre pris en charge…pour
les soutenir à rester bien portants….parce que nos sociétés soutiennent pour
mieux se protéger ceux qui ne sont pas (encore) malades, alors qu’elles
excluent facilement en les « parquant », sans jamais s’en rendre
compte, ceux qui sont « atteints ».
Toutes les déclarations de bonne intention et
toutes les lois d’éthique médicale ou scientifique cachent ce réel comportement
aux yeux-mêmes de ceux qui font perdurer ce système inadéquat.
Mais « revenons à nos
moutons » :
Le stress, c’est quoi me direz-vous ? De
l’anxiété et de l’angoisse, non ?
Et bien non, pas du tout :
Le rôle principal du système nerveux central
(SNC) est de permettre à un individu de vivre physiquement et
psychointellectuellement en équilibre stable dans son environnement : cela
s’appelle le « maintien de l’homéostasie » (= équilibre interne).
Le SNC reçoit ainsi continuellement des
informations concernant les variations des paramètres biologiques ainsi que
celles provenant des activités somatiques et viscérales ; il corrige en
permanence de nombreuses données biologiques (taux hormonaux p.ex.) et physiques
(mouvement, tonus de repos et d’effort p.ex) afin de maintenir l’état global de
l’organisme dans « ses normes ».
Tous ces facteurs « agressifs »,
internes ou externes, sont regroupés sous le terme de « stress », qui
signifie « tension, contrainte » en anglais.
Le stress est constant, normal,
« physiologique », nécessaire à cette adaptation vitale.
Par contre, lorsque des informations lui
parviennent de façon anormalement abondantes et/ou répétées, spécialement
lorsque ces informations sont « hors norme », nécessitant une
régulation bien plus complexe, on passe alors de réactions physiologiques
normales à un état pathologique.
Le stress, dans sa forme pathologique, est
responsable de toute une série de symptômes qui, s’additionnant à ceux de
Tous ces éléments sont mal ou non pris en charge
par la médecine « traditionnelle » car celle-ci utilise avant tout la
pharmacologie comme réponse thérapeutique, et que les médicaments ne peuvent
répondre à tout et qu’on ne peut pas en prescrire à l’infini !
Un important nombre de symptômes, soit facteurs
agressifs de stress soit signes consécutifs au stress répondent à des
thérapeutiques non médicamenteuses comme la bonne hygiène de vie, le
régime alimentaire adapté, et/ou sont souvent, partiellement ou totalement, de
façon transitoire ou plus durable, soulagés par les thérapies dites
« alternatives » (là où elles se devraient d’être
complémentaires) : approche psychointellectuelle (Feldenkrais,
Alexander..), relaxation, médecine chinoise, acupuncture, tai-chi et bien
d’autres.
(NB :
je n’aime pas le terme de « médecine alternative » quand
il ne s’agit ni de médecine, ni d’alternative à un traitement classique dit
« allopathique », et encore moins le mensonger « médecine
douce » qui taxe de facto « ma » médecine de « dure »
ce qui n’est pas ce que j’écris ici ; par contre, ce sont de vraies
« thérapies » car elles soulagent les maux).
On peut se poser la question du pourquoi d’une
aussi grande ignorance des problèmes posés par cette « deuxième
maladie » dans
Les conséquences de cette ignorance sont
importantes en tout terme :
§
en terme de « souffrance » :
-individuelle, les douleurs
physiques et psychologiques induisent le mal-être des personnes atteintes,
d’autant que la majorité, il faut bien le dire, ne trouve rien à redire
puisque, elle aussi, est convaincue que cela fait partie du « lot à
accepter sans rechigner ».
-familial, le mal-être de
l’un rejaillissant sur les siens, à tous les niveaux d’implication possible.
§
en terme financier :
- individuel, la personne atteinte ayant
recours à des méthodes thérapeutiques autres à ses frais
- collective : l’administration « larga
manu » de thérapeutiques antiparkinsoniennes a un coût extrêmement élevé,
bien supérieur à celui de la prise en charge
du stress, les complications de la levodopathérapie aussi, l’indication
neuro-chirurgicale d’autant plus rapidement posée encore
§
en terme intellectuel :
- individuel : la non reconnaissance d’une
pathologie intriquée à une autre la fait admettre comme inévitable et donc
acceptable
- collectif : la non-reconnaissance d’une
symptomatologie clinique, biochimique et biologique connue et décrite dans de
nombreuses publications régulières (*voir plus bas) jette un grand trouble sur
la crédibilité de la coordination des recherches menées ça et là sur les
pathologies chroniques,
Un grand et long travail est actuellement en
cours, initié et réalisé par quelques personnes atteintes par la maladie.
Un de ses buts est de faire le point sur tous ces
facteurs de stress, leurs conséquences, les possibles aides thérapeutiques
réellement intéressantes hors « médecine conventionnelle », les voies
de recherche non exploitées.
Tout témoignage à ce propos aura une valeur,
seuls les personnes atteintes de MP pouvant raconter ce que d’autres ne peuvent
ni voir, ni sentir…et souvent ni croire, ni chercher à connaître.
********************************************************************************************
* Revues périodiques sur le stress :
Health and stress ; International journal of stress management ; stress, and coping ; Stress medicine ; Journal of traumatic stress ; Journal of thermal stresses , etc…
**
Pourquoi une aussi grande ignorance des problèmes posés par cette « deuxième
maladie » dans
C’est en réfléchissant à cette question que la réflexion est allée…plus
loin… et a débordé le sujet :
Les rapports des médecins occidentaux avec toutes
les thérapies dites alternatives sont, à la base, mauvais, même si certains
commencent à s’y intéresser à titre personnel et la recherche médicale,
menée par des médecins, n’abonde pas en travaux à ce propos. Pourquoi cette
attitude des médecins ?
De multiples réponses existent à cette question :
-
D’abord,
parce que c’est ce qu’on leur a enseigné, et pour un
médecin, renier ses études et ses maîtres, c’est un peu comme couper soi-même
son cordon ombilical avant qu’il ne tombe : cela fragilise…
La médecine n’est pas une science exacte, chaque
médecin le sait plus ou moins confusément, alors les certitudes apprises voire
les dogmes inculqués lui sont nécessaires pour supporter le poids de sa
réflexion, pour raisonner au mieux dans le but d’aider et de soigner, pour
décider de la stratégie à adopter et, enfin, pour convaincre le consultant de
la validité de toute cette série d’actes intellectuels qu’est une consultation.
Certes, on ne lui a pas expliqué que les méthodes
« alternatives » sont, preuves « scientifiques » à l’appui,
mauvaises. Non, mais on lui a fait comprendre que seul ce qui était enseigné
était LA vérité, et toutes ces « machin-choseries de rebouteux » ou
de « traitement chinois pratiqué par un non-médecin » ne lui ont pas
été enseignées : conclusion, « cela n’a donc aucune valeur ».
-
Ensuite,
parce qu’il n’y connaît rien : pourquoi
voudriez-vous qu’il ait lu et travaillé ces choses-là ? Vous croyez
vraiment qu’il en a le temps ? Alors, sauf intérêt particulier, le médecin
ne connaît pas, donc il craint le pire et, comme « primum non
nocere », il ne conseille pas, voire déconseille même franchement, ce dont
il n’a entendu parler, comme tout le monde, que dans Gala, Paris-Match ou à la
télévision (vous ne croyez pas NON PLUS que les médecins ne lisaient que le
Lancet ou l’American Journal of… Non,
non, non, les revues citées sont dans les salles d’attente des cabinets
médicaux, et le « docteur » a inévitablement jeté un coup d’œil sur
l’information apportée, ne serait-ce que pour savoir ce dont vont lui parler
ses consultants).
-
Ensuite
et encore, parce que le médecin ne sait pas traiter autrement qu’avec des
médicaments, hormis la chirurgie :
« La
chirurgie, hors traumatologique ou aigue n’est que l’échec de la médecine
(ie : du traitement médicamenteux) », m’a très justement appris un
médecin-chirurgien intelligent, aux doigts de magicien, au cœur en or et à
l’esprit suffisamment ouvert et tolérant pour se poser continuellement des questions :
mon Papa à moi.
L’essor et les résultats de l’industrie
pharmaceutique, avec ses fantastiques outils de soulagement et de guérison, ont
été tels que rien d’autre n’a vraiment compté en thérapie. C’est une réalité
« vraie » pour beaucoup de maladies, toutes les aigues en
particulier, mais « bien moins vraie » dans les pathologies
chroniques.
-
Enfin,
parce que les médecins ont appris à séparer le corps de l’esprit,
le somatique du psychique, le neurologique du psychologique et du
psychiatrique. D’ailleurs, les médecins non psychiatres et les psychiatres
vivent dans deux mondes extrêmement cloisonnés (oui, oui, il y a de grands
progrès actuels, mais ils restent très ponctuels), et on pourra encore diviser
le monde psychiatrique entre celui qui traite avec des médicaments (et rien
d’autre) et celui qui traite l’esprit avec les psychothérapies et le
psychanalyses (et surtout pas de « chimie »).
-
De ce fait, considérant le stress pathologique
non pas comme une réelle pathologie mais comme une « mauvaise qualité ou
capacité de réponse psychique de l’individu à l’environnement», prônant que le
psychosomatique est l’apanage de « dérangé(e) s du cerveau qui s’autocréent des
symptômes pour se faire –délibérément bien sûr, même si inconsciemment- du
mal », il ne peut être question d’envisager les problèmes sous un aspect
autre qu’en réagissant :
§
En « balançant » une phrase blessante, « pour
fouetter l’esprit » : « faites
un effort », « et comment font les autres ? »,
« pensez à protéger votre famille », « vous n’êtes pas assez
discipliné dans votre vie quotidienne » ou, encore, « et si vous
aviez une SLA, qu’est-ce que ça serait, alors ? ».
§
en augmentant les traitements
médicamenteux de
§
en faisant « taire » les
« réactions déplacées » par l’administration de médications
anxiolytiques, antidépressives
§
en
envoyant « chez le psychiatre », sans souvent le moindre conseil sur
la technique d’aide à choisir ni de recommandations sur le spécialiste à voir,
ou en adressant, très exceptionnellement, la personne à une nébuleuse
« thérapie de groupe »….
§
en
éludant la question des thérapies complémentaires possibles d’un « si vous
voulez perdre votre argent avec un non-professionnel de santé » ou un
« faites ce que vous voulez, je ne veux pas en entendre
parler » : c’est ainsi que 60% de ceux qui « vont aussi
ailleurs » le cachent à leur médecin. Cela en dit long sur la confiance en
l’écoute…
Mais en réalité, ces pauvres médecins que
j’écorche un peu (la vérité n’est pas toujours bonne à lire) ne sont réellement
pour pas grand-chose voire pour rien dans leur propre comportement : ils
ne sont « que » ce qu’on leur a enseigné d’être, ce qu’ils ont acquis
comme « réflexe médical » et ils le sont très généralement
honnêtement, avec toute leur foi dans leur art, toute leur passion dans la
médecine et tout leur dévouement. Ce ne sont ni des saints, ni des grands
humanistes, ce sont des hommes et des femmes très hauts techniciens d’une
santé…qu’on leur a apprise.
Si autrefois ils avaient compétence clinique,
savoir universitaire et connaissance de la pharmacologie, actuellement, la
recherche scientifique et les stratégies des consensus thérapeutiques réduisent
les possibilités de l’acte médical :
§
la
recherche scientifique fondamentale est venue s'insérer entre le malade et le
médecin, dont la culture est devenue tributaire des hypothèses et des
expériences élaborées en laboratoire, c'est à dire dans des espaces du savoir
situés en amont de l'interrogatoire
du malade et de la démarche diagnostique du médecin.
§
De
même, les progrès de la chimie et, plus récemment, de la biologie moléculaire
et de la virologie ont conduit les laboratoires pharmaceutiques à élaborer des
stratégies thérapeutiques qu'il appartient à présent au médecin de prescrire
dès lors que le tableau clinique et le cortège des informations radiologiques
ou biologiques en valident l'indication si bien qu' en aval le médecin se trouve aussi dépossédé de toute
autonomie décisionnaire et le plus
souvent réduit à admettre l'illusion de choix fictifs entre des produits
équivalents.
********************************************************************************************************
Exemple de recherche :
REQUETE «Parkinson’s Disease
and stress » sur le Pubmed du NIH
1: NeuroRehabilitation. 2003;18(3):209-14.
Impairments in activities of
daily living in Parkinson's disease:
implications
for management.
Bhatia S, Gupta A.
Department of Psychology,
Gargi College, University of Delhi, New Delhi-110049, India.
bhatias@nde.vsnl.net.in
Parkinson's disease (PD) is
a neurodegenerative disorder with progressive impairment in motor and cognitive
functioning. A review of past research shows that individuals experience not
only physical discomfort brought on by the illness, but also considerable
psychological distress. Increased dependency on a caregiver due to impairments
in activities of daily living (e.g., walking, eating, dressing) may bring on
feelings of being a burden and strain relationships. However, since PD is a
chronic illness, it necessitates family caregiving throughout the life-span.
This has implications for the family members who need to redefine their roles
within the family to manage the circumstances brought on by the illness. Such
strains may include finances, threats to employment, social isolation or health
strain. Thus, it becomes imperative to provide unrelenting support to the
affected family and individual, to enable them to refocus and learn to manage
new illness-related, task-oriented, and affective roles. This enhances the
integrity and self-esteem of the patient and helps the family's adjustment to
illness of a member.
This
paper outlines, the role of
mental health professionals in providing counseling and psychoeducational
approaches to helping patients and their families.
PMID: 14530586 [PubMed -
indexed for MEDLINE]
2: Physiol Behav. 2002 Dec;77(4-5):527-31.
Stress-induced Parkinson's
disease: a working hypothesis.
Smith AD, Castro SL, Zigmond
MJ.
Department of Neurology,
University of Pittsburgh, S-526 Biomedical Science Tower, 15212, Pittsburgh,
PA, USA.
Some cases of Parkinson's
disease (PD) can be attributed to genetic mutations, others to specific
environmental factors; yet the cause of a great majority of cases is unknown.
Physical and emotional traumas were once briefly considered as factors in the
pathophysiology of this disorder. With increasing evidence that stress can
indeed increase neuronal loss in some brain regions, this hypothesis deserves
to be reexamined. Stress increases the extracellular availability of
glucocorticoids (GCs), dopamine (DA), and glutamate in the striatum as well as
other brain regions. These factors undoubtedly can serve to enhance the
functions of the striatum. However, each also has the capacity to be
neurotoxic.
Moreover, they can act
synergistically to promote neuronal loss. Thus, we propose that stress might,
indeed, be a key factor in the loss of DA neurons that underlies PD.
Publication Types:
Review
Review, Tutorial
PMID: 12526994 [PubMed -
indexed for MEDLINE]
3: Clin Rehabil. 2002 Nov;16(7):717-25.
Short-term effectiveness of
intensive multidisciplinary rehabilitation for people with Parkinson's disease
and their carers.
Trend P, Kaye J, Gage H,
Owen C, Wade D.
Royal Surrey County Hospital,
Guildford, UK.
OBJECTIVE: To evaluate the
short-term effectiveness of an intensive multidisciplinary rehabilitation
programme for people with Parkinson's disease and their carers. DESIGN:
Observational, with assessments before and after intervention. SETTING: An
elderly care day unit in a district general hospital in south-east England.
SUBJECTS: One hundred and eighteen people with Parkinson's disease and no
cognitive impairment, and their carers.
INTERVENTION:
Participants attended the
day hospital in groups of six patients with their carers for one day per week
over six consecutive weeks. After assessment, they received individual
treatment from a specialist team. Weekly group activities included relaxation
and talks from experts. OUTCOME MEASURES: Patients and carers were assessed
for: health-related quality of life, psychological well-being, social services
need, perceptions of the programme. Patients were additionally assessed for
mobility, gait and speech. Carers were assessed for strain. RESULTS: After
treatment significant improvements were recorded in patients' mobility and gait
(p < 0.05), speech (p < 0.001), depression (p = 0.029), health-related
quality of life (p = 0.001). People with more advanced disease at baseline
gained significantly more from treatment (p < or = 0.04).
Carers were less depressed
and had higher health-related quality of life than patients at baseline (p <
0.001) and no improvements in these indicators were recorded after treatment. A
high unmet need for social services was identified in 31% of participants, and
10% of carers were found in danger of being unable to continue caring.
Participants reported knowledge gains and high levels of satisfaction with both
individual therapies and group activities.
CONCLUSIONS:
This intensive co-ordinated
programme provided immediate benefits to people with Parkinson's disease and
their carers.
PMID: 12428820 [PubMed -
indexed for MEDLINE]
4: Psychol Psychother. 2002 Mar;75(Pt 1):93-9.
Made of stone: a view of
Parkinson 'off' periods.
Matson N.
Department of Clinical
Psychology, North & East Devon Partnership NHS Trust, UK.
Parkinson's disease is a
neurological condition, managed symptomatically by medications aimed at the
underlying dopaminergic deficit. After several years of treatment, some
sufferers experience marked fluctuations in symptom control, including akinetic
or 'off' periods. A sample of 15 Parkinson disease sufferers who experienced
off periods participated in a small-scale study examining their experience and
the coping strategies used. There was a trend for those experiencing
significant levels of distress to make more frequent use of 'attempted
activity' coping strategies, responses that may inadvertently exacerbate distress.
Clinical implications for adjuvant psychological techniques are discussed.
PMID: 12006202 [PubMed -
indexed for MEDLINE]
5: J Gerontol Nurs. 2000 Nov;26(11):6-16.
Stressors, social support,
coping, and health dysfunction in individuals with Parkinson's disease.
Backer JH.
Indiana University School of
Nursing, Indianapolis 46202-5107, USA.
The purposes of this
descriptive correlational study were to describe the illness-related stressors
of individuals with Parkinson's disease and to report the extent to which
social support and coping responses predict physical and psychosocial health
dysfunction. The sample consisted of 70 men and women, age
44 to 80, residing in the
community. Participants reported a variety of illness-related stressors, most
of which occurred on a daily basis and involved some loss in functional
abilities. Less perceived availability of social support, more evasive coping,
and more confrontive coping predicted greater health dysfunction, suggesting
that these factors may be important to consider when assessing individuals with
Parkinson's disease and designing interventions for individuals with functional
declines.
PMID: 11883622 [PubMed -
indexed for MEDLINE]
6: Mov Disord. 2001 Nov;16(6):1171-4.
Rivastigmine in the
treatment of parkinsonian psychosis and cognitive
impairment: preliminary
findings from an open trial.
Reading PJ, Luce AK, McKeith
IG.
Department of Neurology,
Regional Neurosciences Centre, Newcastle General Hospital, Newcastle upon Tyne,
United Kingdom.
This open study assessed the
ability of rivastigmine to treat the neuropsychiatric complications of advanced
Parkinson's disease. In a group of 12 patients, hallucinations, sleep
disturbance, and carer distress were all improved and cognitive performance
significantly enhanced by the drug.
Copyright
2001 Movement Disorder
Society.
Publication Types:
Clinical Trial
PMID: 11748755 [PubMed -
indexed for MEDLINE]
7: Mov Disord. 2001 Nov;16(6):1123-5.
Predictors of depressive
symptoms among spouse caregivers in Parkinson's disease.
Fernandez HH, Tabamo RE,
David RR, Friedman JH.
Department of Clinical
Neurosciences, Brown University School of Medicine, Providence, Rhode Island,
USA. FernandezH@pol.net
The objective of this work
was to determine the predictors of depressive symptoms among spouse caregivers
of Parkinson's disease (PD) patients.
Little is
known about the strain in
giving care to PD patients and how the motor, cognitive, and behavioral
complications of PD contribute to depression among spouse caregivers.
Forty-five consecutive PD patients and their spouse caregivers agreed to be
evaluated after a routine clinic visit. Patient demographic data and the
presence of hallucinations, delusions, incontinence, and sleep disturbances were
obtained. The patients were assessed using the Unified Parkinson's Disease
Rating Scale (UPDRS-motor section), Hoehn and Yahr
(H&Y) staging, and the
Mini-Mental State Examination (MMSE). Depressive symptoms were assessed using
the 17-item Hamilton Depression Scale (HAMD-17) and the Beck Depression
Inventory-II (BDI-II) on patients and spouses. Thirty men and 15 women had a
mean age of 71.5 years (range 53-85), average PD duration of 10 years (range
1-26), a mean "on" H&Y stage of 2.8 and an MMSE mean score of
26
(range 13-30). There was
good correlation between the HAMD-17 and the BDI-II scores in both patients (r
= 0.69, P = 0.001) and spouses (r = 0.66, P < 0.001).
A moderate correlation was
noted between the spouse HAMD-17 score and the patient UPDRS-motor score (r =
0.34; P = 0.02), the age of PD onset (r = 0.33; P = 0.02) and patient HAMD-17
scores (r= 0.29; P = 0.05). A stronger correlation was noted between spouse
HAMD-17 scores and the years of PD duration (r= 0.43; P = 0.003). There was a
significant difference in the mean spouse HAMD-17 scores among PD patients with
sleep disturbances versus those who did not (10.2 vs.
6.4; P = 0.04). However, on
stepwise regression analysis, only the duration of PD remained significant
(adjusted r = 0.17; P = 0.003). No difference was noted with hallucinations,
delusions or incontinence. We concluded that the duration of PD appears to be
the strongest predictor of depressive symptoms among spouse-caregivers in this
small cohort. Copyright 2001 Movement Disorder Society.
PMID: 11748746 [PubMed -
indexed for MEDLINE]
8: Anglican Theol Rev. 1994 Fall;76(4):509-23.
Ethical implications of
fetal tissue cell research and therapy.
Ferguson MB.
PMID: 11660681 [PubMed -
indexed for MEDLINE]
9: Christ Today. 1990 Nov 19;34(17):24-8.
Brave new harvest.
Simons A.
PMID: 11659929 [PubMed -
indexed for MEDLINE]
10: Gerontologist. 2000 Oct;40(5):568-73.
Does type of disease matter?
Gender differences among Alzheimer's and Parkinson's disease spouse caregivers.
Hooker K, Manoogian-O'Dell
M, Monahan DJ, Frazier LD, Shifren K.
Oregon State University,
Human Development and Family Sciences, Corvallis 97331-5102, USA.
hookerk@orst.edu
PURPOSE OF STUDY: Mental
health outcomes are widely reported among spouse caregivers, with wives
generally faring worse than husbands. We hypothesized that gender differences
would not be as strong in a cognitively intact group because caring for
cognitively intact spouses may involve less severe reciprocity losses. We also
examined gender differences in coping strategies within each group. DESIGN AND
METHOD: 175 spouse caregivers for patients with Alzheimer's disease (AD; n =
88) and Parkinson's disease (PD; n = 87) were interviewed. Participants
completed perceived stress (PSS), depression (CES-D), state anxiety (STAI, Form
Y), and coping strategies (WCCL-R) measures.
RESULTS:
Wives in the AD group
reported significantly worse mental health outcomes than husbands, while wives
and husbands in the PD group showed no differences. AD caregiving wives were
less likely than husbands to use problem-focused coping strategies. There were
no significant gender differences in either group for social support or
emotion-focused coping. IMPLICATIONS: Loss of reciprocity in marital relationships
may affect women more negatively than men. Future studies that address
underlying mechanisms of gender differences and focus on similar caregiving
situations and contexts deserve attention.
PMID: 11037935 [PubMed -
indexed for MEDLINE]
11: Hastings Cent Rep. 2000 Jul-Aug;30(4):28-33.
The 18th of October
Gonzalez-Ramos G.
PMID: 10971891 [PubMed -
indexed for MEDLINE]
12: Nervenarzt. 2000 Apr;71(4):275-81.
[Coping behaviors in
Parkinson's disease]
[Article in German]
Haltenhof H, Krakow K, Zofel
P, Ulm G, Buhler KE.
Abteilung Sozialpsychiatrie
und Psychotherapie, Medizinische Hochschule Hannover.
Haltenhof.Horst@MH-Hannover.de
In 45 patients with
Parkinson's disease, we investigated coping behavior and its correlations to
demographic and disease-related data, locus of control, depression, and
psychosocial adaptation. Active, problem oriented, and self-reorganizing
strategies were predominantly used and regarded as especially helpful by the 27
men and 18 women (age: 56 years; duration of illness: 9 years). While age and
sex were not associated with coping, external locus of control correlated
positively to "depressive coping" and duration of illness correlated
negatively to "distraction and self-affirmation." Coping strategies
regarded as maladaptive and a small degree of internal locus of control
correlated to unfavourable results for depression and satisfaction.
PMID: 10795094 [PubMed -
indexed for MEDLINE]
13: Gerontologist. 2000 Feb;40(1):53-63.
Coping with disease-related
stressors in Parkinson's disease.
Frazier LD.
Department of Psychology,
Florida International University, Miami 33199, USA.
frazier@fiu.edu
This study examines three
categories of disease-related stressors (i.e., physical, cognitive,
psychosocial), differential coping, and mental and physical health outcomes in
individuals with Parkinson's disease (PD). Findings show that tremors, lack of
mental energy, and being dependent on others were the most stressful symptoms
in each category. Although there was evidence that PD patients match coping
efforts to types of stressors, emotional regulation was the most common coping
strategy. Hierarchical regression analyses show that disease-related variables
influence every domain of quality of life, whereas the effects of coping are
more selective. Specifically, the use of distancing was related to poorer
mental and physical health outcomes. Findings focus attention on the
disease-related stressors that create the experience of being chronically ill.
PMID: 10750313 [PubMed -
indexed for MEDLINE]
14: Elder Care. 1999 Jun;11(4):34-6.
Psychological aspects of
Parkinson's diseases.
Handley J.
Poole Hospital NHS Trust.
PMID: 10614275 [PubMed -
indexed for MEDLINE]
15: Med Clin North Am. 1999 Mar;83(2):499-508, viii.
Nonpharmacologic management
strategies.
Wright JC.
Parkinson's Disease and
Movement Disorders Center, University of Pennsylvania Health System,
Pennsylvania Hospital, Philadelphia, USA.
Nonpharmacologic management
strategies for Parkinson's disease should focus on educating the patient and
family, empowering them to take control over the disease through physical,
occupational and speech therapy, exercise, and good nutrition. An educated
understanding of psycho-social resources will enable the patient and family to
develop strategies to cope with life style changes encountered in the
successful management of Parkinson's disease.
PMID: 10093590 [PubMed -
indexed for MEDLINE]
16: Ann N Y Acad Sci. 1998 Jun 30;851:429-43.
Stress, aging, and
neurodegenerative disorders. Molecular mechanisms.
Busciglio J, Andersen JK,
Schipper HM, Gilad GM, McCarty R, Marzatico F, Toussaint O.
Department of Pharmacology,
University of Connecticut Health Center, Farmington 06030-6125, USA.
busciglio@nso1.uchc.edu
Publication Types:
Review
Review, Tutorial
PMID: 9668637 [PubMed -
indexed for MEDLINE]
17: Psychiatry. 1998 Spring;61(1):35-45.
Symptom study in context:
effects of marital quality on signs of Parkinson's disease during
patient-spouse interaction.
Greene SM, Griffin WA.
Prevention Research Center,
Arizona State University, Tempe 85287-1108, USA.
Hypokinesia, the inability
to initiate or maintain movement, represents one of the most disabling aspects
of Parkinson's disease (PD), and displays intriguing moment-to-moment
variability from environmental stressors. Correlates of orofacial hypokinesia
(characteristics of spontaneous eye blink and speech) were coded from
videotaped interactions for PD patients in maritally distressed and
nondistressed dyads. Significant changes occurred only for the patients in
distressed relationships on the two strongest neurophysiologic measures of
orofacial hypokinesia, rate and duration of spontaneous eye blink. Further
analyses suggest two possible explanations for these temporal symptom changes.
Distressed spouses may
exacerbate symptoms by exposing the patient to negativity. Alternately,
nondistressed spouses may compensate for the demands of the interactional task
by assuming a greater share of the conversation relative to the patient's
contribution. Results are linked to existing literature; the role of social and
familial support in chronic illness is discussed.
PMID: 9595594 [PubMed -
indexed for MEDLINE]
18: J Gerontol B Psychol Sci
Soc Sci. 1998 Mar;53(2):P73-85.
Personality counts for a
lot: predictors of mental and physical health of spouse caregivers in two
disease groups.
Hooker K, Monahan DJ, Bowman
SR, Frazier LD, Shifren K.
Syracuse University, USA.
hookerk@ucs.orst.edu
The purpose of this study
were to examine the influence of personality on mental and physical health of spouse
caregivers and to determine whether there were differences in such influences
depending on disease context. The disease contexts compared were Alzheimer's
disease (AD) and Parkinson's disease (PD; with no coexisting dementia)--both
chronic, degenerative diseases of later life.
It was predicted that
personality would be related to mental and physical health, directly and
indirectly, and that AD caregivers would have higher levels of perceived stress
and worse mental and physical health outcomes.
Participants
in the study were 175
caregivers (88 AD; 87 PD) living at home with their ill spouses. The data
provided an excellent fit to the hypothesized model of the relationships
between personality, disease group, social support, perceived stress, and mental
and physical health. Seventy-eight percent of the variance in mental health was
accounted for and 35% of the variance in physical health was explained.
Personality had significant direct and indirect effects on mental health and
significant indirect effects on physical health. As predicted, AD caregivers
had significantly worse mental health than PD caregivers; however, AD
caregivers had better physical health than PD caregivers, controlling for other
variables in the model. These results are discussed in relation to the existing
caregiving and behavioral medicine literature. Future research should include
different domains of personality--states and longer term self-regulatory
processes in addition to traits--to advance models of caregiving processes further.
PMID: 9520924 [PubMed -
indexed for MEDLINE]
19: J Am Geriatr Soc. 1997 Feb;45(2):194-9.
Sleep disturbances in
Parkinson's disease patients and spouses.
Smith MC, Ellgring H, Oertel
WH.
Dept. of Psychology,
University of Portsmouth, UK.
OBJECTIVES: The prevalence
of self-rated sleep disturbance in patients with Parkinson's disease (PD) and
their spouses was compared with healthy controls, and the association of sleep
disturbance with demographic, psychological, and disease variables was assessed.
DESIGN: The sleep ratings from three groups, PD patients, their spouses, and
healthy controls, were compared using analyses of variance. Stepwise
regressions were used to predict sleep disturbance for each group and gender.
SETTING: Participants completed questionnaires as part of a nationwide survey
in Germany. PARTICIPANTS: Participants included 153 PD-spouse pairs and a group
of 103 healthy controls. MEASUREMENTS: Zung Self-Rating Depression Scale and
self-ratings of sleep disturbance, stress level, and disease symptoms (for PD
patients). RESULTS: Sleep disturbances were significantly higher in women than
in men in all groups. For PD patients, sleep disturbance occurred frequently in
25% of male and 41% of female participants and was best predicted by the
patient's depression rating. For spouses, frequent sleep disturbance was
reported by 27% of male and 48% of females and was likewise predicted by the
spouse's own rating of depression. A second, relatively less common type of
sleep disturbance was also reported by spouses.
This disturbance was
associated with waking during the night to help the patient and was best
predicted by patient factors. CONCLUSION: Improvement of sleep quality of
caregivers may be an important component of treatment to reduce distress caused
by PD.
PMID: 9033518 [PubMed -
indexed for MEDLINE]
20: Arch Neurol. 1996 Sep;53(9):881-4.
Comment in:
Arch Neurol. 1996 Sep;53(9):848.
A randomized study of the
efficacy of the PROPATH Program for patients with Parkinson disease.
Mercer BS.
Department of Neurology,
Harvard Community Health Plan, Boston, MA 02115, USA.
OBJECTIVES: To assess (1)
the effects of the PROPATH Program, a health management program designed for patients
with Parkinson disease, on perceived general health and psychological
well-being and satisfaction with medical care,
(2) utilization of health
care resources by patients with Parkinson disease, and
(3) physician impressions of
the PROPATH Program. DESIGN: Patients were randomized to receive either the
PROPATH Program in addition to usual care or usual medical care only. All
patients and their physicians completed periodic questionnaires designed to
assess the study variables. SETTING: Staff model health maintenance
organization from June 1992 through June 1993. PATIENTS:
Forty-six English-speaking
patients diagnosed with Parkinson disease of Hoehn-Yahr stages I through IV.
RESULTS: Enrollment in the PROPATH Program resulted in a statistically significant
improvement in patient perception of general health and psychological
well-being after 1 year. There was no significant difference in patient
satisfaction with medical care or utilization of health care resources. The
large majority of physicians did not find the PROPATH Program to be helpful for
development of a treatment plan, management of the illness, identification of
problems sooner than by usual treatment, or identification of drug side
effects. CONCLUSIONS: The PROPATH Program may play a useful role in assisting
patients to deal with the psychological aspect of Parkinson disease by
improving perception of general health and psychological well-being. The
program had no significant effect on patient satisfaction with medical care or
medical resource utilization.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 8815853 [PubMed -
indexed for MEDLINE]
21: Schweiz Rundsch Med
Prax. 1994 Sep 27;83(39):1076-8.
[Mental suffering IN
patients with parkinsonism]
[Article in French]
Dessibourg CA, Vaney C.
Comprehensive treatment of
patients with parkinson's disease demands that not only motoric dysfunctions
but also psychosocial aspects have to be considered.
The scope of this review is to
cover not only the frequent dementia and depressive states associated with this
disease, but also the drug-induced behavioral abnormalities, insomnia,
conflicts with those providing care and implications for professional
activities. The fundamental pathophysiological and psychopathological
mechanisms are explained and illustrated by examples.
Publication Types:
Case Reports
Review
Review, Tutorial
PMID: 7939073 [PubMed -
indexed for MEDLINE]
22: Psychiatry. 1994 Aug;57(3):275-7.
Comment on:
Psychiatry. 1994 Aug;57(3):269-74.
Neurological trauma and
family functioning: toward a social neuropsychology.
Howe GW.
Department of Psychiatry and
Behavioral Sciences, George Washington University, Washington, DC.
Griffin and Greene ("Social
Interaction and Symptom Sequences," this issue) present evidence linking
patterns of family interaction with the expression of disease symptoms, in this
case orofacial bradykinesia in a patient with Parkinson's disease. They argue
that symptom expression may be influenced by family interaction for many
diseases or chronic conditions and advocate the use of behavioral observation
and microanalytic coding of behavior sequences as a means of studying this
linkage. They note that the success of this approach will depend on the
temporal characteristics of symptom fluctuation and suggest that observational
strategies will be primarily useful for studying symptoms that fluctuate across
seconds or minutes rather than across days. What kinds of conditions might this
include? Griffin and Greene mention three categories:
(1)
mental and emotional
disorders; (2) chronic pain; (3) neurological conditions.
Publication Types:
Comment
PMID: 7800775 [PubMed -
indexed for MEDLINE]
23: Psychiatry. 1994 Aug;57(3):269-74.
Comment in:
Psychiatry. 1994 Aug;57(3):275-7.
Social interaction and
symptom sequences: a case study of orofacial bradykinesia exacerbation in
Parkinson's disease during negative marital interaction.
Griffin WA, Greene SM.
Marital Interaction
Laboratory, Arizona State University, Phoenix 85287.
Evidence is rapidly
accumulating that disease symptoms are influenced by psychological factors, and
most potently, by familial relationships. This case study demonstrated the
detrimental influence of negative marital interaction on orofacial bradykinesia
and speech productivity in a 74 year old male Parkinson's disease patient. An
increase in bradykinesia symptoms followed a series of specific negative
comments by the wife during a conversation; these symptoms showed partial
reversal during a subsequent conversation with a lab assistant.
The analytic method and data
summary strategies used to determine this relationship are discussed relative
to their possible utility for other disorders.
Publication Types:
Case Reports
PMID: 7800774 [PubMed -
indexed for MEDLINE]
24: Neurology. 1993 Dec;43(12 Suppl 6):S41-4.
Psychosocial aspects of
Parkinson's disease.
Ellgring H, Seiler S,
Perleth B, Frings W, Gasser T, Oertel W.
Institute for Psychology,
Julius-Maximilians-University of Wurzburg, Germany.
Although Parkinson's disease
has a definite neurologic basis, patients and relatives experience a multitude
of stresses, only partly related to motor symptoms. Subjective and behavioral
problems may be regarded as secondary disease symptoms. In an integrated
approach, patients and relatives receive psychological counseling and learn new
coping strategies for everyday situations. Results show that even elderly
patients can make use of structured psychological interventions and change
dysfunctional behaviors and cognitions.
Measures specifically
adjusted to Parkinson's disease are aimed at helping patients make better use
of the beneficial effects of medication and counteract the possible negative
effects of social and emotional stressors. Relatives need information about the
disease and training to cope adequately with difficult caring situations.
Future evaluation of medical treatment of Parkinson's disease should consider
the interaction of psychological factors and symptom intensity.
This interaction may result
in momentary changes in the effects of medication because of psychological
conditions. In the early stages of the disease, medication has the most
positive effect, and psychological interventions should also have the most
benefit.
PMID: 8264910 [PubMed -
indexed for MEDLINE]
25: Mov Disord. 1989;4(3):283-5.
Comment on:
Mov Disord. 1988;3(1):30-6.
Trauma as an etiology of
parkinsonism: opinions in the nineteenth century.
Keppel Hesselink JM.
Publication Types:
Comment
Historical Article
Letter
PMID: 2674702 [PubMed -
indexed for MEDLINE]
26: Adv Neurol. 1987;45:349-52.
Assessment of rest tremor in
Parkinson's disease.
Cleeves L, Findley LJ, Gresty
M.
PMID: 3825709 [PubMed -
indexed for MEDLINE]
27: Contemp Neurol Ser. 1974;(11):79-113.
Disorders of the autonomic
nervous system. Chapter 6. Arterial hypotension.
Johnson RH, Spaulding JM.
Publication Types:
Review
PMID: 4615877 [PubMed -
indexed for MEDLINE]
28: Adv Neurol. 1974;5:387-96.
The "on-off" side
effect of L-DOPA.
Markham CH.
PMID: 4440586 [PubMed -
indexed for MEDLINE]
29: Phys Ther. 1973 Aug;53(8):849-55.
Parkinson's disease and physical
therapy management.
Wroe M, Greer M.
PMID: 4719852 [PubMed -
indexed for MEDLINE]
30: Practitioner. 1972 Aug;209(250):240-3.
Discordant identical twins.
II. Parkinsonism.
Pembrey ME.
PMID: 5078238 [PubMed -
indexed for MEDLINE]
31: J Psychosom Res. 1971 Mar;15(1):107-12.
Effect of emotional stress
on spasticity and rigidity.
Boman K.
PMID: 5576337 [PubMed -
indexed for MEDLINE]