title: Tackling psychosocial maladjustment in Parkinson's disease patients following subthalamic deep-brain stimulation: A randomised clinical trial.
abstract: BACKGROUND
  Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for the motor and non-motor signs of Parkinson's disease (PD), however, psychological disorders and social maladjustment have been reported in about one third of patients after STN-DBS. We propose here a perioperative psychoeducation programme to limit such social and familial disruption.
  
  
  METHODS
  Nineteen PD patients and carers were included in a randomised single blind study. Social adjustment scale (SAS) scores from patients and carers that received the psychoeducation programme (n = 9) were compared, both 1 and 2 years after surgery, with patients and carers with usual care (n = 10). Depression, anxiety, cognitive status, apathy, coping, parkinsonian disability, quality-of-life, carers' anxiety and burden were also analysed.
  
  
  RESULTS
  Seventeen patients completed the study, 2 were excluded from the final analysis because of adverse events. At 1 year, 2/7 patients with psychoeducation and 8/10 with usual care had an aggravation in at least one domain of the SAS (p = .058). At 2 years, only 1 patient with psychoeducation suffered persistent aggravated social adjustment as compared to 8 patients with usual care (p = .015). At 1 year, anxiety, depression and instrumental coping ratings improved more in the psychoeducation than in the usual care group (p = .038, p = .050 and p = .050, respectively). No significant differences were found between groups for quality of life, cognitive status, apathy or motor disability.
  
  
  CONCLUSIONS
  Our results suggest that a perioperative psychoeducation programme prevents social maladjustment in PD patients following STN-DBS and improves anxiety and depression compared to usual care. These preliminary data need to be confirmed in larger studies.
authors.affiliation: Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.|AP-HP, Personalised Neurology & Psychiatry University Department, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Université Paris Est Créteil, Créteil, France.|Department of Mental Health and Psychiatry, Geneva University Hospital, University of Geneva, Geneva, Switzerland.
authors.forename: Joao
authors.initials: J
authors.lastname: Flores Alves Dos Santos
authors.affiliation: AP-HP, Groupe Hospitalier Pitie-Salpêtrière, Biostatistics Unit and Clinical Research Unit, Paris, France.|Sorbonne Universités, UPMC Univ Paris 06 UMR_S1136, and INSERM UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Tezenas du Montcel
authors.affiliation: AP-HP, Hôpital de la Salpêtrière, Genetic Department, Paris, France.
authors.forename: Marcella
authors.initials: M
authors.lastname: Gargiulo
authors.affiliation: AP-HP, Hôpital de la Salpêtrière, Neurology Department, Paris, France.|AP-HP, Hôpital de la Salpêtrière, Centre d'Investigation Clinique, Paris, France.
authors.forename: Cecile
authors.initials: C
authors.lastname: Behar
authors.affiliation: AP-HP, Hôpital de la Salpêtrière, Neurology Department, Paris, France.|AP-HP, Hôpital de la Salpêtrière, Centre d'Investigation Clinique, Paris, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Montel
authors.affiliation: AP-HP, Hôpital de la Salpêtrière, Neurology Department, Paris, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Hergueta
authors.affiliation: AP-HP, Hôpital de la Salpêtrière, Neurosurgery Department, Paris, France.
authors.forename: Soledad
authors.initials: S
authors.lastname: Navarro
authors.affiliation: Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.|AP-HP, Hôpital de la Salpêtrière, Neurosurgery Department, Paris, France.
authors.forename: Hayat
authors.initials: H
authors.lastname: Belaid
authors.affiliation: AP-HP, Groupe Hospitalier Pitie-Salpêtrière, Biostatistics Unit and Clinical Research Unit, Paris, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Cloitre
authors.affiliation: Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.|AP-HP, Hôpital de la Salpêtrière, Centre d'Investigation Clinique, Paris, France.|AP-HP, Hôpital de la Salpêtrière, Neurosurgery Department, Paris, France.
authors.forename: Carine
authors.initials: C
authors.lastname: Karachi
authors.affiliation: Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.|AP-HP, Personalised Neurology & Psychiatry University Department, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Université Paris Est Créteil, Créteil, France.|Department of Mental Health and Psychiatry, Geneva University Hospital, University of Geneva, Geneva, Switzerland.|AP-HP, Hôpital de la Salpêtrière, Centre d'Investigation Clinique, Paris, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Mallet
authors.affiliation: Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.|AP-HP, Hôpital de la Salpêtrière, Neurology Department, Paris, France.|AP-HP, Hôpital de la Salpêtrière, Centre d'Investigation Clinique, Paris, France.
authors.forename: Marie-Laure
authors.identifier: http://orcid.org/0000-0003-1423-5620
authors.initials: ML
authors.lastname: Welter
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D057565:Apathy; D017028:Caregivers / Q000523:psychology; D003071:Cognition; D046690:Deep Brain Stimulation / Q000009:adverse effects; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D010353:Patient Education as Topic; D059035:Perioperative Period; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods; D011788:Quality of Life; D016037:Single-Blind Method; D012917:Social Adjustment; D020531:Subthalamic Nucleus / Q000000981:diagnostic imaging / Q000503:physiopathology; D016896:Treatment Outcome