Format

Send to

Choose Destination
CNS Spectr. 2019 Apr 3:1-8. doi: 10.1017/S1092852918001633. [Epub ahead of print]

Demoralization in essential tremor: prevalence, clinical correlates, and dissociation from tremor severity.

Author information

1
Division of Movement Disorders, Department of Neurology, Yale School of Medicine,Yale University,New Haven, Connecticut,USA.
2
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.
3
Center for Neuroepidemiology and Clinical Neurological Research & Division of Movement Disorders, Department of Neurology, Yale School of Medicine,Yale University,New Haven, Connecticut,USA.
4
Department of Psychiatry, Yale School of Medicine,Yale University,New Haven, Connecticut,USA.
5
Center for Neuroepidemiology and Clinical Neurological Research & Division of Movement Disorders, Department of Neurology, Yale School of Medicine & Department of Chronic Disease Epidemiology, Yale School of Public Health,Yale University,New Haven, Connecticut,USA.

Abstract

OBJECTIVE:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

Demoralization; depression; essential tremor; movement disorders; resilience; tremor severity

PMID:
30940264
DOI:
10.1017/S1092852918001633

Supplemental Content

Full text links

Icon for Cambridge University Press
Loading ...
Support Center