Emotional Distress Associated with Surgical Treatment and its Relationship with Coping Profiles Among Chronically ill Older Patients

The study determines the patterns of coping styles among older patients with hip osteoarthritis and assesses the derived profiles in terms of perceived stress and anxiety before and after arthroplasty. Sixty-one hospital patients (mean age 70.3 years) were analysed one day before arthroplasty and three months after. The participants were assessed with the Brief-COPE (coping style), PSS-10 (perceived stress) and STAI (anxiety) psychometric tests. Four coping patterns were yielded using data clustering: rational, enterprising (resourceful), potentially maladaptive and flexible. Repeated measures ANOVA indicated a main effect within subjects but did not indicate that decreases of stress and anxiety varied differently between groups. Cluster 1 (a coping profile characterised by high helplessness, low active coping, high avoidance) reported significantly greater stress and anxiety than all other groups before and after hip replacement, while clusters 2 (flexible), 3 (resourceful) and 4 (rational) were characterised by similar levels of anxiety and stress. Older patients with osteoarthritis might differ in terms of emotional response to surgical treatment. Screening for coping styles at admission to hospital may indicate more vulnerable individuals.     

Cognitive-behavioral Strategies for Parkinson’s Disease: A Report of Three Cases

Three patients diagnosed with idiopathic Parkinson’s disease (PD) were treated with cognitive-behavioral therapy (CBT): a 43-year-old woman suffering from depression and social anxiety, a 45-year-old man with sexual problems and maladaptive coping strategies, and a 78-year-old man with freezing of gait. On the basis of functional analyses, interventions were selected, including cognitive methods, social skills training, paradoxical instructions and strategies to improve management of freezing. The interventions were related to improved adaptation to motor impairments and better ability to cope with the disease. These case presentations suggest that CBT can improve quality of life in PD by modifying maladaptive cognitive, emotional and behavioral reactions to the disease and its symptoms.     

Dissociation of reward and effort sensitivity in methcathinone‐induced Parkinsonism

Methcathinone‐induced Parkinsonism is a recently described extrapyramidal syndrome characterized by globus pallidus and substantia nigra lesions, which provides a unique model of basal ganglia dysfunction. We assessed motivated behaviour in this condition using a novel cost‐benefit decision‐making task, in which participants decided whether it was worth investing effort for reward. Patients showed a dissociation between reward and effort sensitivity, such that pallidonigral complex dysfunction caused them to become less sensitive to rewards, while normal sensitivity to effort costs was maintained.