Personality traits and social behaviors predict the psychological adjustment of Chinese people with epilepsy

The mediating role of health literacy between the presence of chronic disease and psychological distress among older persons in Xi'an city of China

BACKGROUND

The increased number of older persons in China, and the prevalence of most chronic diseases raised with age significantly increased the total disease burden. When a person ages, psychological distress happens when they are faced with stressors that they cannot cope with. Psychological distress refers to non-specific symptoms of depression, anxiety, and stress. Health literacy influences several health outcomes, such as emotional functioning among the population. The primary purpose of this study is to examine the mediator role of health literacy between the presence of chronic disease and psychological distress among older persons living in Xi'an city. Thus, this study used the Cognitive Behavior Theory (CBT) as a combination of the basic behavioral and cognitive psychology principles to explain the cognitive processes associated with psychological distress.

METHODS

This study employs a quantitative research design using a cross-sectional survey of 300 older persons over 60 years living in the six urban districts of Xi'an city. Data were collected using the Health Literacy Questionnaire (HLQ) and the Depression Anxiety Stress Scale (DASS-21). This study employed descriptive statistics and inferential methods to analyze the data. The inferential methods applied structural equation modeling (SEM) to test the hypothesis of the mediator role of health literacy between the presence of chronic disease and psychological distress.

RESULTS

In this study, chronic disease had an effect on health literacy among older persons living in Xi'an city (β=-0.047, p < 0.01); chronic disease impact on psychological distress among older persons living in Xi'an city (β = 0.047, p < 0.01); health literacy was identified effect on psychological distress among older persons in Xi'an city (β=-0.738, p < 0.001); health literacy as a partial mediator between chronic disease and psychological distress (β = 0.07, p < 0.01).

CONCLUSION

Psychological distress among older persons is affected by chronic disease and health literacy. Health literacy had a partial mediating effect on the presence of chronic disease and psychological distress. Improved health literacy measures should be considered when treating older persons with psychological distress.

Impact of metacognition on attitudes toward epilepsy in medical students

PURPOSE

This study evaluated medical students' knowledge and attitudes toward epilepsy and the influence of metacognition thereon.

METHOD

Valid questionnaires were administered to medical students including undergraduate, professional postgraduate, and standardized residency training students (N = 503). The questionnaire had 4 parts: demographic information, knowledge of epilepsy, attitudes toward epilepsy, and metacognitive assessment. The Chinese Public Attitudes Toward Epilepsy scale and 30-Item Metacognition Questionnaire were used to assess attitudes and metacognition, respectively.

RESULTS

Almost all participants had heard of epilepsy; 38.8% had witnessed a seizure and 25% were acquainted with a person with epilepsy. The proportion of correct answers to epilepsy-related knowledge ranged from 40.6% (Putting an object into the mouth of a person experiencing an epileptic seizure) to 97% (Convulsion is a symptom of epilepsy). However, knowledge of epilepsy was not able to affect attitudes toward epilepsy. Age, years of clinical experience, having witnessed a seizure, positive belief of worry, and need to control thinking were correlated with the different domains of attitude toward epilepsy. When participants were divided into 2 groups-i.e., those with high and low knowledge of epilepsy, participants in the former group who had a positive belief of worry or had not witnessed any seizures were more likely to have negative attitudes toward epilepsy.

CONCLUSION

Medical students showed good awareness of the etiology and symptoms of epilepsy. Overall, attitudes toward epilepsy were negative. A positive belief of worry was associated with a more negative attitude toward epilepsy among respondents with greater knowledge of epilepsy.

Assessment of Anxiety in Patients With Epilepsy: A Literature Review

Objective

Approximately 20% of people with epilepsy (PWE) suffer from anxiety. These fears are quite diverse and may manifest periictally or interictally, be part of the seizure's semiology, or an expression of reactive psychological distress from seizures themselves. Our review addresses the question of what screening tools are used in clinical care and epileptological research to capture the complexity of epilepsy-specific anxieties.

Method

On 2021/11/11, we entered a search string in PubMed that covered our research interest as completely as possible. We also screened the bibliographies of our findings and followed PubMed's recommendations. From the assessments we found in the included studies, we extracted domains that represent the range of manifestations of anxiety, in order to compare the tools and to discuss to what extent they are suitable for assessing epilepsy-specific anxieties.

Results

We screened 1,621 abstracts. In total, we identified 24 different anxiety assessments. In addition to the psychiatric assessments in use, we found 7 tools that were designed to assess epilepsy-specific anxieties. The latter focus on different aspects of epilepsy-specific anxieties. In some cases, the conceptual frameworks are not sufficiently transparent or divergent.

Conclusion

Because a diagnosis of epilepsy can result in, or seizures may appear as, anxiety, it is important to better understand this psychological burden and address it therapeutically, if necessary. There is a need for screening tools that integrate specific points of a variety of assessments, so as to cover the broad range of epilepsy-specific fears. None of the assessments we found meets this integrative perspective. At the same time, the appropriate design of such a required tool presupposes a conceptual framework of what should be considered as epilepsy-specific anxiety.

Epilepsy in China: major progress in the past two decades

China has approximately 10 million people with epilepsy. There is a vast epilepsy treatment gap in China, mainly driven by deficiencies in health-care delivery and social discrimination resulting from cultural beliefs about epilepsy. WHO's Global Campaign Against Epilepsy project in China showed that it was possible to treat epilepsy in primary care settings, which was a notable milestone. The China Association Against Epilepsy has been a necessary force to stimulate interest in epilepsy care and research by the medical and scientific community. Nearly 20 different anti-seizure medications are now available in China. Non-pharmacological options are also available, but there are still unmet needs for epilepsy management. The Chinese epilepsy research portfolio is varied, but the areas in which there are the most concentrated focus and expertise are epidemiology and clinical research. The challenges for further improvement in delivering care for people with epilepsy in China are primarily related to public health and reducing inequalities within this vast country.

Revisiting personality in epilepsy: Differentiation of personality in two epilepsies starting in adolescence

PURPOSE

The purpose of this study was to investigate personality characteristics and clinical parameters in two well-defined epilepsies: mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE/HS) and juvenile myoclonic epilepsy (JME) through NEO Revised Personality Inventory (NEO-PI-R) and Neurobehavior Inventory (NBI) standardized instruments.

METHODS

One hundred patients undergoing corticoamygdalohippocampectomy (CAH), 100 patients with JME, and 100 control subjects answered the personality measures. Clinical parameters such as psychiatric symptoms, seizure frequency, duration of epilepsy, and side of the lesion in MTLE/HS group were investigated. Statistical analysis consisted of the mean and standard deviation (SD) of each variable. Student's t-test or Fisher exact test were used according to the variable studied.

RESULTS

The three groups were within the average range of NEO-PI-R and NBI, although 'tendencies' and differences were demonstrated. The MTLE/HS and control subjects had a similar profile: low scores in Neuroticism and high in Conscientiousness (r = -0.330; p < 0.001/r = -0.567; p < 0.001, respectively) in opposition to what occurred in JME, low in Conscientiousness and high in Neuroticism (r = -0.509; p = 0.005). The NBI 'sense of personal destiny' trait was higher (3.15; p = 0.003) in MTLE/HS than in JME and controls. The JME 'law and order' scores were lower than in other groups (p = 0.024). A tendency towards specific NBI traits differentiates MTLE/HS (Factor 3) from JME (Factor 1) groups. Psychiatric symptoms and seizure frequency were correlated with worse scores in NBI and, especially, in Neuroticism domain of NEO-PI-R.

CONCLUSION

Specific personality features were linked to each epileptic disease. These findings highlight the importance of considering unique features linked to epilepsy conditions in daily clinical observation to develop support programmes.

The effects of temperament and character traits on perceived social support and quality of life in patients with epilepsy

OBJECTIVES

This study aimed to investigate the effect of temperament and character traits on perceived social support and quality of life in patients with epilepsy (PWE).

METHODS

Fifty-two PWE and 54 healthy controls were included in this study. Demographics and clinical data were recorded. Temperament and Character traits were investigated using Temperament and Character Inventory (TCI), Perceived Social Support was evaluated by Multidimensional Scale of Perceived Social Support Scale (MSPSS), and quality of life was assessed using a 36-Item Short-Form Health Survey (SF-36). Participants also completed the Hospital Anxiety Depression Scale (HADS).

RESULTS

TCI and MSPSS scores showed no significant difference between the groups (p>0.05). Mental and physical subscales of SF-36 were significantly lower in PWE than the controls (p=0.012, p=0.020, respectively). Multiple linear regression analysis indicated that Reward Dependence and Cooperativeness were independent predictors for perceived social support, and Persistence score was an independent predictor for the physical subscale of SF-36 even after adjustment for confounding background variables (p<0.05, for all).

CONCLUSION

Temperament and character traits may affect perceived social support and quality of life in PWE. Thus, an evaluation of temperament and character traits may play a significant role in preventing negative effects on perceived social support and quality of life in PWE.

Epilepsy, mental health disorder, or both?

Temporal lobe epilepsy (TLE), a subset of the seizure disorder family, represents a complex neuropsychiatric illness, where the neurological presentation may be complemented by varying severity of affective, behavioral, psychotic, or personality abnormalities, which, in turn, may not only lead to misdiagnosis, but also affect the management. This paper outlines a spectrum of mental health presentations, including psychosis, mood, anxiety, panic, and dissociative states, associated with epilepsy that make the correct diagnosis a challenge.