Montel Sébastien Robert, Bungener Catherine
Laboratory of Clinical Psychopathology and Neuropsychology, University Paris Descartes, France.
Surg Neurol. 2009 Aug;72(2):105-10; discussion 110-1. doi: 10.1016/j.surneu.2008.05.026. Epub 2008 Sep 10.
Although the positive effect of DBS of the STN on motor signs and mobility in PD is indisputable, the effect on mental health (depression and anxiety) as well as on QoL is subject to more debate. Some works have already shown that coping strategies have an impact on QoL, depression, and anxiety. To date, no studies have examined the coping strategies used by patients with PD who undergo STN stimulation. We decided to investigate the coping strategies of patients with PD who have undergone an STN DBS and their relationship with QoL while taking depression and anxiety into account.
A total of 40 patients stimulated for 12 months and 40 patients under dopatherapy were compared. The 2 groups were matched according to age, sex, age at disease onset, severity of disease, motor scores, daily treatment dosage, and professional status. Semistructured interviews were carried out, after which, their mental and cognitive states were assessed using different scales (MINI, MADRS, EHD, HAMA, FAB). Finally, all subjects completed 3 self-report questionnaires: 2 assessing coping strategies (WCC, CHIP), and 1, QoL the Parkinson Disease Questionnaire (PDQ-39).
Depression and anxiety were not significantly influenced by the type of treatment. Concerning coping strategies, we found a significant effect of the stimulation on instrumental strategies with higher scores for patients under dopatherapy. As for QoL, the only difference concerned communication with a poorer QoL for stimulated patients. We noted no significant correlations between any coping strategies and all of the dimensions of QoL in the stimulated group, whereas we found the opposite result for the dopatherapy group.
These results encourage us to prepare patient candidates for such stimulation by developing interventions focused first on their expectations and second, on their coping strategies.
尽管STN脑深部电刺激术（DBS）对帕金森病（PD）的运动症状和活动能力有积极作用这一点无可争议，但对心理健康（抑郁和焦虑）以及生活质量（QoL）的影响仍存在更多争议。一些研究已经表明应对策略会对生活质量、抑郁和焦虑产生影响。迄今为止，尚无研究考察接受STN刺激的PD患者所采用的应对策略。我们决定调查接受STN-DBS治疗的PD患者的应对策略及其与生活质量的关系，并同时考虑抑郁和焦虑因素。
对40例接受刺激12个月的患者和40例接受药物治疗的患者进行比较。两组在年龄、性别、发病年龄、疾病严重程度、运动评分、每日治疗剂量和职业状况方面进行匹配。进行半结构化访谈，之后使用不同量表（MINI、MADRS、EHD、HAMA、FAB）评估他们的心理和认知状态。最后，所有受试者完成3份自我报告问卷：2份评估应对策略（WCC、CHIP），1份评估生活质量——帕金森病问卷（PDQ-39）。
治疗类型对抑郁和焦虑没有显著影响。关于应对策略，我们发现刺激对工具性策略有显著影响，接受药物治疗的患者得分更高。至于生活质量，唯一的差异在于沟通方面——接受刺激的患者生活质量较差。我们注意到，在接受刺激的组中，任何应对策略与生活质量的所有维度之间均无显著相关性，而在药物治疗组中我们得到了相反的结果。
这些结果促使我们通过首先制定针对患者期望、其次针对其应对策略的干预措施，为接受此类刺激的候选患者做好准备。
