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Forty patients with Parkinson's disease and 24 patients with dystonia took part in a study aiming to assess the value of access to and contact with a nurse practitioner over a 6 month period. Patients in each group were randomly allocated to “intervention” or “control” groups, which were matched on important variables. All patients completed a set of questionnaires relating to psychosocial function at two time points separated by 6 months. In the intervening period, those allocated to the “intervention” group received two home visits and five telephone calls from the nurse practitioner. This contact was not provided to the “control” group. The nurse practitioner had a major impact on the provision of information and the facilitation of referral to other health-care agencies. The results of an independent assessment indicated that the patients in the “intervention” programme had found access to and contact with a nurse practitioner of great value. In contrast, the results of the questionnaire assessment did not reveal any statistically significant change in psychosocial functioning from the first to the second assessment for either the “intervention” or “control” groups. The lack of change in the questionnaire measures is discussed in terms of possible sampling bias and the duration of intervention and follow-up. Recommendations are made for future studies, and for the possible provision of clinical services.

This study has characterized the long-term neurobehavioural changes in a woman who, following the intake of an unidentified substance, sustained subtotal bilateral lesions of the globus pallidus and small lesions at selective sites adjacent to it. Associated with these lesions was a significantly reduced blood flow in multiple frontal cortical regions, most prominently in area 10, the anterior cingulate and the supplementary motor cortex. Her cognitive deficits were generally consistent with those found in patients with frontal lobe dysfunction but some deficits, i.e. in visual memory and learning, were more compatible with temporal lobe dysfunction. Incapacitating personality or obsessive compulsive changes as reported by others with similar lesions were absent and she could live independently. The cognitive changes are consistent with the view that the globus pallidus has important functions in mediating how internal representations of stimulus input are converted into various forms of action, for example, in planning solutions to problems and in working memory.

Eighty-five patients with idiopathic spasmodic torticollis were compared with an equally chronic group of 49 cervical spondylosis sufferers in terms of body concept, depression, and disability. The torticollis patients were significantly more depressed and disabled and had a more negative body concept. Depression had different determinants in the two groups. Extent of disfigurement was a major predictor of depression in torticollis. Neuroticism accounted for the greatest proportion of the variance of depression in cervical spondylosis.

Changes in depression, disability, body concept, and severity of head deviation were examined in a sample of 67 patients with idiopathic torticollis, who were reassessed 2 years after taking part in an initial study (before the use of botulinum toxin injections). Over the follow-up period, torticollis was unchanged in 41·8%, had improved in 26·9% and deteriorated in 31·3% of cases. The overall levels of depression, disability, and body concept across the two occasions did not change. Changes in the clinical severity of torticollis over the follow-up period had a significant effect on psychological adjustment. Those whose torticollis improved were less depressed and disabled and a had a more positive body concept compared to the patients whose torticollis had worsened. Measures of illness severity had stronger associations with measures of psychological adjustment at follow-up than at the time of initial study. Longer duration of torticollis was associated with larger increases in depression and disability during the 2 years of follow-up. The results suggest that the experience of depression, disability, and negative body concept in a proportion of torticollis sufferers is a reaction to the neurological illness. A minority of the patients who remain chronically depressed are primary candidates for therapeutic intervention aiming at improving their adjustment to the illness.

The assumption that spasmodic torticollis represents a conversion reaction was examined by evaluating profiles of 61 patients on the hypochondriasis, depression, and hysteria scales of the Minnesota Multiphasic Personality Inventory. Thirty-six per cent of the sample had normal profiles. A conversion “V” profile with scores above 70 was found in a minority (9%) of the patients. The profile of the majority of the group was characterized by the presence of mild depression. It was concluded that a personality profile suggestive of conversion reaction is not typical of patients with spasmodic torticollis.