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Résumé: Une analyse phénoménologique interprétative longitudinale des difficultés et des besoins non satisfaits rencontrés par les aidants de patients atteints de maladies neuro-dégénératives a été effectuée sur un groupe de 14 conjoints avant (T1) et après (T2) avoir participé à un groupe de psychoéducation de 6 mois. Lors du premier temps (T1), les aidants décrivent principalement une perte des échanges avec le patient, la solitude et la détresse qu'elle entraîne. Ils verbalisent également les difficultés de gérer la relation d'aide, en particulier leurs besoins non satisfaits de temps libre. Lors du second temps (T2) et sous les effets de la progression de la pathologie, ce sont nouvelles difficultés qui apparaissent, avec l'augmentation de la difficulté à gérer les pertes fonctionnelles et les troubles psychocomportementaux. Nos résultats suggèrent que la psychoéducation a aidé les soignants à faire face aux difficultés liées au fardeau objectif (besoin de temps personnel). Les interventions psychoéducatives devraient à l'avenir aborder davantage la relation dyadique et le besoin de soutien affectif de l'aidant, car il s'agit d'un besoin fort, non satisfait, des aidants. Des interventions de psychoéducation systématiques et répétées peuvent ainsi permettre de mieux identifier les difficultés et les besoins des aidants et de leur fournir une aide adaptée, tout particulièrement en ce qui concerne la relation de couple et l'état émotionnel des aidants. Psycho-education provides information, tools and support to caregivers, and a strong consensus favors the importance of tailoring psycho-education interventions to caregiver needs. Most studies assess needs cross-sectionally, neglecting the evolving nature of needs and challenges inherent to dementia and caregiving, failing to report on how psycho-educative interventions address or incorporate caregiver needs. The purpose of this study was to provide a qualitative and longitudinal assessment of the difficulties and unmet needs of spousal caregivers before and after participating in a psycho-education group. To investigate the difficulties and needs related to caregiving, before and after psycho-education participation, we used a longitudinal Interpretative Phenomenological Analysis (LIPA). LIPA is a prospective person-centered method that explores the lived experience of phenomena without formulating a priori hypotheses. The psycho-educational program was available to any informal caregiver of a person living with dementia (PLWD) in the Brussels region. The multimodal program contains: educational and practical information on dementia sessions with a neuropsychologist specialized in dementia, group sharing and support; home visits by a nurse for personalized assistance to caregivers, art therapy group: available for PLWD that could not be left unsupervised in conjunction with psycho-education sessions. Our study yielded three key findings: (1) caregivers described a loss of relational reciprocity with the person living with dementia at T1 and T2, and reported feeling distressed; (2) at T1, caregivers verbalised difficulties related to their role, the majority of them only identified the lack of personal time as an unmet need; (3) at T2, most caregivers had actively addressed their unmet need for personal time and used respite services to obtain personal time. Our findings would suggest that psycho-education helped caregivers to address difficulties related to objective burden (need for personal time). Psycho-education interventions should systematically and repeatedly assess caregiver difficulties and assist them in identifying their needs in order to provide adequate and tailored strategies and support. [ABSTRACT FROM AUTHOR]

Résumé: La principale proposition thérapeutique face à une insomnie chronique associée à la maladie de Parkinson (MP) est la prescription de benzodiazépines ou apparentés. Comme en population générale, ces molécules sont peu efficaces dans la MP. Elles y sont également associées à des effets indésirables comme la dépendance, la somnolence et les chutes. Le principal objectif de cette revue consiste à sensibiliser les professionnels qui évoluent auprès de patients atteints de MP à une alternative thérapeutique non-médicamenteuse dans le traitement de l'insomnie chronique associée à la MP. Il s'agit de la thérapie cognitive et comportementale. Notons que cette thérapie est définie par la Haute autorité de santé et les instances internationales comme le traitement de première intention pour la prise en charge de l'insomnie chronique associée ou non à une comorbidité. Très récemment, nous avons mis en évidence que l'insomnie chronique associée à la MP était entretenue par les mêmes facteurs psychologiques (émotionnels, comportementaux et cognitifs) identifiés en l'absence de comorbidité neurologique. Nous avons également montré que la thérapie cognitive et comportementale de l'insomnie était un traitement acceptable pour les patients atteints de la MP et efficace sur les symptômes nocturnes et diurnes de l'insomnie associée à cette affection. Insomnia disorder is four times more frequent in Parkinson's disease (PD) than in the general population. In PD, insomnia is associated with a very significant decrease in quality of life and deleterious consequences on both patients and caregivers' health. The main therapeutic option in response to insomnia comorbid to PD is the prescription of benzodiazepines or related drugs. As in the general population, these sedative-hypnotic molecules have very low efficacy in PD and are associated with adverse effects. They are highly addictive and are also associated with drowsiness, risk of falling and decreased life expectancy. These side effects may in themselves be symptoms associated with PD in the absence of insomnia. In this clinical context, we can easily conceive that sedative-hypnotics are likely to potentiate these clinical symptoms in PD. We have recently documented that insomnia disorder comorbid to PD is associated with the classical psychological factors perpetuating insomnia in neurological disease-free individuals with insomnia. These results have allowed us to emphasize that target-oriented interventions for instance cognitive-behavioral therapy for chronic insomnia (CBT-i) should be considered as a treatment approach for insomnia disorder comorbid to PD. As a reminder, for decades, CBT-i is considered the most effective first-line treatment for the management of chronic insomnia associated or not with comorbidity. In this context, we demonstrated the acceptability of CBT-i in the treatment of insomnia comorbid to PD and its effectiveness for the management of night and daytime symptoms of insomnia associated with this neurological condition. The objective of this synthesis is to raise awareness among health professionals of the relevance of psychological therapies (mostly CBT) for insomnia in PD. Unlike drug treatments, these therapies are safety for patients who are already weakened by the PD itself. [ABSTRACT FROM AUTHOR]

Résumé: Plus de trois-quarts des patients atteints de la maladie de Parkinson (MP) se plaignent d'insomnie et la rémission spontanée de cette plainte est généralement rare. Le diagnostic formel d'insomnie chronique est porté chez plus de la moitié des patients. L'insomnie est ainsi définie comme le trouble du sommeil le plus répandu dans la MP. À l'heure actuelle, les échelles recommandées pour l'évaluation du sommeil dans la MP n'apprécient pas spécifiquement l'insomnie. Devant cette limite, nous avons très récemment montré l'utilité clinique dans la MP du Sleep condition indicator pour le dépistage de l'insomnie selon les critères du DSM-5. Tout comme en population générale, le sexe féminin, les symptômes de dépression et d'anxiété, la fatigue, la somnolence diurne et la consommation d'hypnotiques-sédatifs ont été associés à la sévérité de la plainte d'insomnie dans la MP. L'insomnie réduit également la qualité de vie des patients ainsi que celle de leurs aidants. En revanche, de manière assez intéressante, la contribution des caractéristiques cliniques de la MP à l'insomnie reste très discutée. Ces caractéristiques sont : la durée de la maladie, la sévérité des troubles moteurs, les traitements dopaminergiques et les signes de dysautonomie. Cette observation implique de ne pas considérer systématiquement l'insomnie comme une manifestation symptomatique secondaire à la MP, mais comme une entité clinique à part entière nécessitant un traitement spécifique. L'objectif de cette synthèse est de sensibiliser les professionnels de santé quant à l'importance du dépistage précoce de l'insomnie dans la MP afin de limiter les conséquences associées et sa chronicité. Insomnia is a common complaint in Parkinson's disease (PD) affecting more than three-quarters of patients. Longitudinal studies show that insomnia complaint is a persistent condition in PD, especially in patients with more severe insomnia at baseline. When international and standardized criteria are used, it is estimated that more than half of the patients meet the criteria for insomnia disorder. These data define insomnia as the most prevalent sleep disorder in PD. Given that background, it is surprising that none of the scales recommended by the International Parkinson and movement disorder society to assess sleep disturbances in PD is specifically dedicated to the assessment of insomnia disorder. In this insufficient methodological context, we have recently established the discriminant validity of the Sleep condition indicator for insomnia disorder in PD, as diagnosed with a clinical interview according to the DSM-5 criteria. As in the general population, female sex, symptoms of depression, anxiety, fatigue and daytime sleepiness have been associated with insomnia complaint severity in PD. Insomnia also reduces the quality of life of patients affected by PD and that of their caregivers. In contrast, clinical features of the disease were very slightly related to insomnia with small effect sizes. These features include motor fluctuations, autonomic problems, cardiovascular and thermoregulatory dysfunctions and doses of dopaminergic medications. This observation implies not systematically considering insomnia as a symptomatic manifestation secondary to PD but as a clinical entity requiring specific treatment. The objective of this synthesis is to raise awareness among health professionals of the importance of early detection of insomnia in PD in order to limit the consequences associated with its chronicity. Identifying and assessing insomnia in PD is therefore a major health issue. [ABSTRACT FROM AUTHOR]

This study investigated the relationship between bedtime counterfactual thoughts, depressive symptoms, nocturnal counterproductive thought‐control strategies and insomnia disorder. Six hundred and fifty adults from the general population were recruited and provided data on their counterfactual thoughts' frequency at bedtime, depressive symptoms and use of nocturnal maladaptive strategies of thought control. In addition, all participants followed a face‐to‐face clinical interview for the diagnosis of insomnia disorder. A model positing moderated mediation was tested using conditional process modelling. Overall, 19% of participants met diagnostic criteria for a chronic insomnia diagnosis. Bootstrapped mediation analyses indicated that the association of bedtime counterfactual processing and insomnia diagnosis is mediated by depressive symptoms (B = 0.035, SE = 0.007, bootstrapped 95% CI = 0.023, 0.051). Furthermore, the effects of such a mediation model were significantly larger among individuals with high levels of aggressive suppression than those with low levels of aggressive suppression (B = 0.002, SE = 0.001, bootstrapped 95% CI = 0.001, 0.004). A second model in which a worry strategy moderates the relationship between bedtime counterfactual processing and depressive symptoms was not statistically significant (B = 0.0036, SE = 0.013, p =.78). The present study adds to the literature on the importance of self‐attacking thoughts and negative affects at bedtime. We recommend the evaluation of the impact of adding self‐attacks management strategies to cognitive behavior therapy for individuals with an insomnia disorder. [ABSTRACT FROM AUTHOR]

Objective: To test the efficacy of cognitive behavioral therapy for insomnia (CBT‐i) in Parkinson's Disease (PD) and to evaluate its impact on indices of daytime and psychological functioning. Method: Fifteen patients with insomnia disorder (ID) comorbid to PD were enrolled in a single‐case design with multiple baselines. Total wake time, sleep efficiency, and daytime sleepiness were recorded on a sleep diary. Self‐reported measures of insomnia, anxiety and depressive symptoms, health‐related quality of life, and psychological variables perpetuating ID were completed. All patients also underwent a clinical interview for ID diagnosis. Results: CBT‐i was associated with significant changes in sleep variables and ID criteria. Significant positive treatment‐related effects were also noted for all indices of daytime and psychological functioning, and for variables perpetuating ID. All of these improvements were well maintained at 3‐month follow‐up. Conclusion: CBT‐i is a promising therapeutic avenue for patients with PD. [ABSTRACT FROM AUTHOR]

Objective/Background: Safety behaviors play a prominent role in the development and maintenance of insomnia. The Sleep-Related Behaviors Questionnaire (SRBQ) is a self-report questionnaire designed to assess safety behaviors employed to cope with fatigue or to improve sleep. Despite its frequent use in insomnia, no systematic psychometric validation of the SRBQ has been conducted; its factor structure has never been explored. Furthermore, there is no French version of this scale. The goal of this study was to empirically validate a French version of the SRBQ. Participants/Methods: A total of 539 French-speaking community-dwelling participants from the general population completed a face-to-face clinical interview to determine insomnia disorder against DSM-5 criteria and several questionnaires including the French SRBQ. Results: SRBQ items with poor psychometric properties were removed, thus leading to a 20-item version (SRBQ-20). Exploratory factor analysis and parallel analysis revealed three distinct factors with good internal consistency. The results supported the internal temporal stability of the SRBQ-20. The construct validity of that instrument was underpinned by correlations obtained with various measures of insomnia and related constructs. Adequate discriminative validity was established by comparing individuals with insomnia and individuals without insomnia. Conclusions: This study demonstrated that the French version of the SRBQ-20 has good psychometric properties. [ABSTRACT FROM AUTHOR]

Résumé: La prévalence de la douleur chez les résidents avec maladie d'Alzheimer en Ehpad est élevée, mais, malgré les recommandations des experts, cette douleur reste sous-évaluée et mal prise en charge. Dans les Ehpad, les aides-soignantes (AS) sont en première ligne pour détecter et évaluer la douleur. Pourtant, à ce jour, aucune étude n'a caractérisé leur savoir-faire en la matière. L'impact de leurs caractéristiques personnelles sur leurs évaluations reste mal connu. Dans cette étude, nous avons demandé à des AS en Ehpad de réaliser des toilettes en binôme à des résidents avec des troubles cognitifs importants. Elles ont ensuite évalué, de manière indépendante, la présence et l'intensité de la douleur ressentie par ces personnes. Sur les 42 toilettes réalisées, 28,9 % des binômes d'aides-soignantes n'étaient pas en accord quant à la présence de douleur chez le résident évalué. De plus, le statut professionnel et le fait d'avoir déjà utilisé des échelles d'hétéro-évaluation de la douleur semblaient avoir un impact sur la concordance inter-juges. En conclusion, il est urgent de proposer des procédures d'évaluation et de prise en charge de la douleur des résidents avec maladie d'Alzheimer, adaptées aux compétences et conditions de travail des AS en Ehpad. In French care facilities for dependent aged people (NHDAP), prevalence of pain among residents with dementia is high, and source of behavior disturbances and quality of life impairment. However, in spite of many international expert statements, pain remains under-assessed and under-managed in these patients. Certified nursing assistants (CNA) are on the front-line in NHDAP to detect the presence of pain in residents with communication difficulties, while they received little training for pain management and directives for specific care. Moreover, no studies were presently devoted to the impact of demographic and socio-professional determinants of CNA on pain assessment. In our study, we assessed the presence and intensity of pain in cognitively impaired residents in NHDAP, by CNA performing as a pair for the morning care. 42 pairs were recruited and independently completed a standardized behavioral assessment for pain (Doloplus scale) as well as a numeric rating scale. CNA personal characteristics were investigated to analyse the determinants of potential assessment discrepancies between each of the pairs. Presence of pain was detected in 51.1 to 91.1% of the patients depending on the tool and analysis criteria. In 28.9% important discrepancies were observed in the pain assessment between the CNA pairs, which could be related to professional status and prior use of the observational assessment. These inter-rater discrepancies should be reduced providing clear pain assessment guidelines for CNA in NHDAP, and further studies should be completed to figure out the role of CNA personal determinants in the patients' pain assessment. [ABSTRACT FROM AUTHOR]