Screening diagnostics of emotional distress in patients with facial neuropathy

Abstract

Patients with facial nerve neuropathy (NLN) are often emotionally labile, inadequately assess the severity of symptoms and prognosis of the disease, have low compliance and motivation for treatment and rehabilitation.The purpose of the study: to develop a screening method for assessing the attitude of a patient with NLN to the disease in order to determine his need for psychological assistance and identify factors affecting compliance and motivation for treatment and rehabilitation.Material and methods: the study included 80 patients with NLN of various genesis who applied during the first 3 months (group 1, n = 37) and 3 months after the onset of symptoms (group 2, n = 43). All patients underwent a neurological examination, an assessment of the severity of NLN on the House–Brackmann scale and were asked to fill out a questionnaire on screening diagnostics of indicators of emotional well-being.Results. In Group 1, the severity of the disease was due to weakness of facial muscles and lagophthalmos, in Group 2 — mainly complications in the form of muscle hypertonia (88.4% of patients) and synkinesias on the affected side (89.2%), while strength partially recovered from 6 [3; 6] to 3 [3; 4] points according to According to the House– Brackmann scale, and the frequency of lagophthalmos decreased by 2 times (from 78.4% to 32.6%). The severity of paresis was not correlated with the severity of emotional disorders (p = 0.607) and the presence of lagophthalmos — 3 [2; 6] versus 4 [2; 8] (p = 0.412). The total score of negative questionnaire responses was higher in patients with complications: muscle hypertonicity — 5 [3; 7] versus 3 [1; 5] (p = 0.033) and synkinesia — 6 [3.5; 7.5] versus 3 [2: 6] (p = 0.010). Moreover, the severity of emotional disorders was associated with the number of complications (p = 0.006). Patients believed that the disease made them less attractive (72.5%), others pay too much attention to the face (46.3%) and changed their attitude (18.8%). Since the acute period of NLN, the mood has changed in 65% of patients. Every second patient believed that the disease divided his life into “before” and “after”, every third answered: “this is the worst thing that happened to me in my life.” In three cases, statements of suicidal thoughts were noted. Patients who sought help in the chronic period of NLN are more dysfunctional in terms of emotional state — the total score of negative responses was 6 [3.5; 3] versus 3 [1; 5] (p = 0.001). A third of the patients were convinced that the main responsibility for recovery lies with doctors, so they are at risk of refusing treatment.Conclusion: in the debut of NLN, every second patient worries about appearance and notes a decrease in mood. Negative thoughts and feelings in patients in the chronic stage of the disease occur in 90% of cases. The developed screening method of psychological assessment of the patient’s attitude to the disease allows to determine the patient’s need for psychological help, to identify indications for consultation with a psychologist or psychiatrist.