Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut, USA.
Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
CNS Spectr. 2020 Feb;25(1):16-23. doi: 10.1017/S1092852918001633.
Essential tremor (ET) is associated with psychological difficulties, including anxiety and depression. Demoralization (feelings of helplessness, hopelessness, inability to cope), another manifestation of psychological distress, has yet to be investigated in ET. Our objectives are to (1) estimate the prevalence of demoralization in ET, (2) assess its clinical correlates, and (3) determine whether demoralization correlates with tremor severity.
We administered the Kissane Demoralization Scale (KDS-II) and several psychosocial evaluations (ie, scales assessing subjective incompetence, resilience, and depression [eg, Geriatric Depression Scale]) to 60 ET subjects. Tremor was assessed with a disability score and total tremor score. KDS-II >8 indicated demoralization.
Among 60 ET subjects (mean age = 70.2 ± 6.8 years), the prevalence of demoralization was 13.3%, 95% confidence interval = 6.9-24.2%. Although there was overlap between demoralization and depression (10% of the sample meeting criteria for both), 54% of depressed subjects were not demoralized, and 25% of demoralized subjects were not depressed. Demoralization correlated with psychological factors, but demoralized subjects did not have significantly higher total tremor scores, tremor disability scores, or years with tremor.
Demoralization has a prevalence of 13.3% in ET, similar to that in other chronic or terminal illnesses (eg, cancer 13-18%, Parkinson's disease 18.1%, coronary heart disease 20%). Demoralization was not a function of increased tremor severity, suggesting that it is a separable construct, which could dictate how a patient copes with his/her disease. These data further our understanding of the psychological and psychosocial correlates of ET.
特发性震颤（ET）与心理困难有关，包括焦虑和抑郁。沮丧（无助、绝望、无法应对的感觉）是心理困扰的另一种表现形式，尚未在 ET 中进行研究。我们的目标是：（1）估计 ET 中沮丧的患病率；（2）评估其临床相关性；（3）确定沮丧是否与震颤严重程度相关。
我们向 60 名 ET 患者发放了基斯恩沮丧量表（KDS-II）和几项心理社会评估量表（例如，评估主观无能、适应力和抑郁的量表[如老年抑郁量表]）。震颤采用残疾评分和总震颤评分进行评估。KDS-II>8 表示沮丧。
在 60 名 ET 患者（平均年龄=70.2±6.8 岁）中，沮丧的患病率为 13.3%，95%置信区间为 6.9-24.2%。虽然沮丧和抑郁之间存在重叠（10%的样本符合两者的标准），但 54%的抑郁患者没有沮丧，25%的沮丧患者没有抑郁。沮丧与心理因素相关，但沮丧患者的总震颤评分、震颤残疾评分或震颤年限均无显著升高。
ET 中沮丧的患病率为 13.3%，与其他慢性或终末期疾病（如癌症 13-18%、帕金森病 18.1%、冠心病 20%）相似。沮丧不是震颤严重程度增加的结果，这表明它是一个可分离的结构，可以决定患者如何应对疾病。这些数据进一步了解了 ET 的心理和心理社会相关性。
