A longitudinal study of the effects of seizure symptoms on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) clinical interpretation

Personality changes in patients suffering from drug-resistant epilepsy after surgical treatment: a 1-year follow-up study

OBJECTIVE

To determine changes in dimensions of personality in a sample of patients suffering from drug-resistant epilepsy at the 1-year follow-up following surgery, compared to non-surgically treated controls.

METHODS

We conducted a prospective comparative controlled study, including drug-resistant epilepsy surgery candidates. Demographic, psychiatric, neurological, and psychological data were recorded. Presurgical and 12-months follow-up evaluations were performed. Personality dimensions were measured by the NEO Five-Factor Inventory, Revised version (NEO-FFI-R), anxiety and depression symptoms were assessed by the Hospital Anxiety and Depression Scale (HADS: HADA-Anxiety and HADD-Depression), psychiatric evaluations were performed using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Axis-I disorders classification. Statistical analysis consisted of comparative tests, correlation analysis, and the stepwise multiple regression test (ANOVA).

RESULTS

A 1-year follow-up was completed by 70 out of 80 patients. Through the study, the surgical group decreased in neuroticism and increased in agreeableness. The controls increased in consciousness, and these changes were predicted by the earlier age of epilepsy onset and lesser score in HADD at the baseline. No personality changes were associated with seizure frequency. The presurgical evaluation concluded that both groups had no differences in demographic, psychiatric, or neurological variables with the only exception being for the number of seizures per month, which was higher in the surgical group. Psychiatric comorbidity in patients was associated with their higher degree of neuroticism and agreeableness at the baseline. Comparing control and surgical groups at the one-year follow-up, the agreeableness personality variable was higher in the surgical group, and as expected, HADS scores were higher in the control group, and seizure frequency was also higher in the control group.

SIGNIFICANCE

Higher agreeableness was the most relevant difference in personality dimensions in patients who underwent surgical treatment compared with the non-surgical treatment group. After surgery patients decreased in neuroticism and increased in agreeableness scores.

Personality changes in patients with refractory epilepsy after surgical treatment: A systematic review

PURPOSE

We aimed to conduct a systematic review to evaluate the personality changes in adult patients with drug-resistant epilepsy following surgical treatment.

METHODS

A systematic review was conducted using the Preferred Reporting Items of Systematic Reviews and MetaAnalyses (PRISMA) statement. We searched PubMed, Medline databases, and the Cochrane Controlled Trials Register, with search terms 'personality', 'epilepsy', and 'surgery'.

RESULTS

Eleven studies were selected. In 7 out of 11 studies, personality changes were more adaptive, with patients experiencing decreased neuroticism, impulsivity, hypochondriasis, psychasthenia. One study showed increased emotional lability. The remainder of the studies showed no changes in personality dimensions. Changes in personality differed according to the localization of the epileptogenic area, depended on seizure status after treatment and duration of follow-up. Seizure freedom as an outcome of surgical treatment influenced the existence of personality changes, and their severity. Adaptive personality changes could be seen from early follow-up assessments even in patients who were not seizure-free, though further follow-ups showed that improvements after 1-2 years were specific to seizure-free patients.

LIMITATIONS

The main limitation of our research is the heterogeneity of approaches used to evaluate personality in the included studies. Furthermore, the included studies also had different sample sizes and comparison groups, different designs, and different follow-up durations. We only included studies that were written in English.

CONCLUSIONS

The majority of studies reported changes in personality dimensions in patients suffering from refractory epilepsy.

A longitudinal study of psychological features in patients before and two years after epilepsy surgery

This study aimed at investigating psychological features before and two years after epilepsy surgery. Fifty patients, 39 with temporal lobe epilepsy (TLE) and 11 with frontal lobe epilepsy (FLE), were assessed at baseline and two years postoperatively with the Karolinska Scales of Personality (KSP). Baseline group level outcome was normal while individual level analyses delineated some mild to moderate degrees of psychological problems exceeding the normal range in subsets of patients. Features of hostility characterized half of the FLE and one-fourth of the TLE patients. Above 1/3 in each group had dependency features. About 1/3 of the TLE patients suffered from psychasthenia. In conclusion, even though group levels were normal, several patients had psychological problems. The main longitudinal result was that the personality features were stable and did not change after epilepsy surgery.

The effects of perceived emotional distress on language performance in intractable epilepsy

We evaluated the potential moderating effect of emotional distress (Minnesota Multiphasic Personality Inventory 2, scales D and Pt) on language functioning (i.e., Boston Naming Test, phonemic paraphasic error production on the Boston Naming Test, Controlled Oral Word Association Task, Animal Naming, Token Test) in patients with left (N=43) and right (N=34) mesial temporal lobe epilepsy (MTLE) and frontal lobe epilepsy (FLE) (N=30). Video/EEG and brain imaging results confirmed localization. Logistic regression models revealed that perceived emotional distress moderated language performance. Performance of patients with left MTLE and that of patients with FLE were equally poor across language measures. Performance of patients with right MTLE was intact. Depression and anxiety differentially moderated performance. Anxiety was associated with better performance in patients with FLE on classically temporal lobe-mediated tasks (Boston Naming Test). Depression was associated with worse language performance on measures for which impaired performance was traditionally intrinsic to the underlying epileptogenic lesion (word fluency in FLE). Emotional distress influences language performance. Adequate treatment of mood should be considered when managing pharmacoresistant epilepsy.

The impact of seizure-related items and comorbid medical conditions on the MMPI-2 profiles of patients with epilepsy and psychogenic nonepileptic seizures

This study examined the impact of seizure-related items and selected comorbid medical conditions on Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2), Scales 1 and 3 and the psychogenic nonepileptic seizure (PNES) profile [Wilkus RJ, Dodrill CB, Thompson PM. Intensive EEG monitoring and psychological studies of patients with pseudoepileptic seizures. Epilepsia 1984;25:100-7] in patients with epileptic seizures (ES) and PNES. Sixty patients with a long-term video/EEG monitoring diagnosis of either ES (N=30) or PNES (N=30) and valid MMPI-2 profiles were included in this study. MMPI-2 seizure-related items [Derry PA, Harnadeck MCS, McLachlan RS, Sontrop J. Influence of seizure content on interpreting psychopathology on the MMPI-2 in patients with epilepsy. J Clin Exp Neuropsychol 1997;19:396-404] were removed to determine if their inclusion overpathologizes and/or misclassifies patients with epilepsy. Removal of seizure-related items did not result in any clinically meaningful changes in MMPI-2 profiles for patients with ES. The presence of comorbid medical conditions was not associated with greater Scale 1 or 3 scores or the likelihood of a PNES profile in either group. Results suggest that clinical elevations on MMPI-2 profiles may not be explained by the presence of seizures or comorbid medical conditions.

Personality profile of patients with juvenile myoclonic epilepsy

In the study described here we attempted to evaluate the personality profiles of 25 patients with juvenile myoclonic epilepsy (JME) at the time of diagnosis, before treatment, and to explore a potential relationship between behavioral aspects and clinical outcome. For this purpose we employed a standardized and objective instrument, the Minnesota Multiphasic Personality Inventory (MMPI), and found that patients with JME have a personality profile similar to that of the control group, which corresponds to the 3,1 code type MMPI profile. We also noted that the characteristics of this personality type include those described in patients with long-duration JME by previous researchers. Consequently, we conclude that personality aberrations are not a feature of this syndrome. Furthermore, we observed that under treatment, EEGs normalized in patients who had exhibited "psychotic tendencies" pretreatment. The credibility of our results is supported by the fact that assessment of the personality profile was not confounded by medication or the longitudinal burden of epileptic seizures.

Mood, Personality, and Health-related Quality of Life in Epileptic and Psychogenic Seizure Disorders

PURPOSE

Patients with psychogenic nonepileptic seizures (PNES) rate their health-related quality of life (HRQOL) more poorly than those with epileptic seizures (ES). This has been explained in part by mood state. We sought to investigate whether HRQOL differences between diagnostic groups (PNES vs. ES) can be explained by additional, perhaps chronic, aspects of mood and personality. An understanding of these relationships may inform treatment designed to improve HRQOL in ES or PNES.

METHODS

One-hundred fourteen individuals (69 ES and 45 PNES) completed the quality of life in Epilepsy-89. The profile of mood states (POMS) and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) were employed to measure current and chronic mood symptoms, respectively. Multiple regression analyses determined the contribution of chronic mood symptoms to HRQOL beyond the variance accounted for by current mood state and seizure diagnosis.

RESULTS

Similar to previous reports, individuals with PNES reported poorer HRQOL than those with ES. Current mood state was strongly related to HRQOL and appeared to moderate the relationship between seizure diagnosis and HRQOL. However, when more chronic psychological symptoms, such as somatization and emotional distress, were included in a model, the moderating role of mood state was not significant.

CONCLUSION

Analyzed independently, mood state is related to HRQOL, but when chronic indicators of psychological symptoms are included in a model mood is related to HRQOL, but, the moderating effect of mood is no longer significant. Treatments designed to improve HRQOL among individuals with intractable seizures should also address chronic psychological distress and symptoms associated with high levels of somatization.

Obsessionality, obsessive-compulsive disorder, and temporal lobe epilepsy

We evaluated the prevalence of obsessive-compulsive disorder (OCD) in patients with temporal lobe epilepsy (TLE) and we investigated the hypothesis that obsessionality may represent a trait in TLE. Eighty-two consecutive patients with epilepsy, 62 with TLE and 20 with idiopathic generalized epilepsy (IGE), and 82 matched healthy controls were evaluated using the SCID-IP, Y-BOCS, MMPI-2 (specifically the Psychasthenia and Obsessiveness scales), BDI, and STAI Y1 and Y2. Nine of the TLE patients, none of the IGE patients, and one of the controls had a diagnosis of OCD. Psychasthenia and Obsessiveness scores were significantly higher in the TLE than in the IGE and control groups. Patients with TLE and OCD differed significantly with respect to history of depression when compared with patients with TLE without OCD, whereas there were no differences in age at onset and duration of epilepsy, seizure pattern and frequency, MRI features, laterality of the EEG focus, antiepileptic drug therapy and combinations, and BDI scores.

A prospective study of anxiety with respect to seizure outcome after epilepsy surgery

PURPOSE

To evaluate if degree of anxiety proneness is affected by seizure outcome after epilepsy surgery.

METHODS

Five scales related to anxiety, which are part of the Karolinska Scales of Personality (KSP), were administered pre-operatively and 2-8 years post-operatively to 31 female and 26 male patients. High scores indicate a high degree of anxiety. Seizure outcome was either Engel I or Engel II-IV.

RESULTS

Mean age of the patients was 39 years (S.D. 10). Forty-seven patients had temporal surgery and 10 patients had extra-temporal surgery. The outcome in 34 patients was classified as Engel I and in 23 patients as Engel II-IV. There were statistically significant decreases (paired t test) in t scores for the Somatic Anxiety scale (expected mean 50, from 55.4 to 50.2, P = 0.001) and the Psychic Anxiety scale (expected mean 50, from 56.2 to 51.6, P = 0.006) in patients in Engel I. No other significant differences were observed. After taking baseline imbalances into account (ANCOVA), there were no statistically significant differences in the change in degree of anxiety proneness between patients in the two outcome groups.

CONCLUSION

Patients undergoing successful epilepsy surgery experienced small decreases in somatic anxiety and psychic anxiety. Since there were important pre-operative imbalances between the two outcome groups, these differences could not be attributed to the effect of seizure freedom after epilepsy surgery.

Personality testing and epilepsy: comparison of two MMPI-2 correction procedures

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is widely used for assessing psychopathology. However, its reliability in people with neurologic disease has been questioned. This concern is especially true for epilepsy, a disease with symptoms, i.e., seizures, that frequently include experiences likely to suggest psychopathology. Correction procedures, in which select items are removed and the test is rescored, may improve MMPI-2 specificity. The MMPI-2 was administered to 27 subjects with epilepsy, and the results were compared before and after application of three correction procedures: rational, statistical, and combined. The statistical correction resulted in clinically significant T-score changes (> or = 5 points) in two MMPI-2 clinical scales, while a combined correction procedure produced clinically significant changes in three scales. In the subgroup of patients with intractable epilepsy, two noncorrected scale T-scores > or = 65 fell to the normal range with both the statistical and combined procedures. These results suggest cautious interpretation of standard MMPI-2 scores in patients with epilepsy.

Severity of depressive symptoms, hippocampal sclerosis, auditory memory, and side of seizure focus in temporal lobe epilepsy

The relationship between severity of depressive symptoms and performance on three Wechsler Memory Scale-III auditory memory and learning subtests was examined in 84 inpatients diagnosed with medically intractable seizures of left (n=46, LTLE) or right (n=38, RTLE) temporal lobe origin. Depressive symptom severity was associated with auditory recall test performance in individuals with LTLE, but not RTLE. Multiple regression analyses indicated that severity of depressive symptoms, hippocampal sclerosis, and naming ability were significant predictors of auditory memory test performance in LTLE; however, hippocampal sclerosis was the only significant predictor of auditory memory in RTLE. Results demonstrate the importance of hippocampal sclerosis, greater self-report of depressive symptoms, and poor naming ability as independent predictors of poor auditory memory and learning abilities. Results suggest that a complex relationship exists among multiple risk factors that combine to influence performance on auditory memory tests as a function of side of seizure focus.