Health locus of control in patients with epilepsy and its relationship to anxiety, depression, and seizure control

How do children with focal epilepsies perceive the moment they realize that they are about to have a seizure? A pilot study

PROBLEM

A seizure is a challenging situation for children with epilepsy. Little is known regarding the experience of children who perceive in advance that they are about to have a seizure.

METHODS

From September 2020 to February 2021, we invited children with focal epilepsies aged 6-18 years to participate in a semi-structured interview.

RESULTS

Of 52 children with focal epilepsies, 22 (42 %) said they perceive in advance that they are about to experience a seizure [11 with self-limited epilepsy with centro-temporal spikes (SELECTs), 11 with other focal epilepsies]. All 22/22 (100 %) children described physical symptoms such as headache or a numb feeling in one half of the body. Of those children, 17/22 (77 %) stated they try to do something about the seizure. Those strategies were perceived as helpful by 0/11 (0 %) children with SELECTs and 9/11 (86 %) children with other focal epilepsies (p < 0.001). Of the children with SELECTs 5/11 (45 %), and of those with other focal epilepsies 9/11 (86 %) stated they would like to know in the morning if they are to experience a seizure that day (n.s.).

CONCLUSION

Children who perceive in advance that they are about to have a seizure are well able to describe their experience. Most children take measures to manage their seizures. Those measures were regarded as helpful by most children with other focal epilepsies, but by no child with SELECTs. Larger studies are necessary to determine the factors contributing to the child's perception as well as the nature of the support that they require.

Illness intrusiveness, health locus of control, and anxiety symptoms among veterans with congestive heart failure

Disease severity, illness intrusiveness, and health locus of control (HLC) each contribute to psychosocial wellbeing in patients with congestive heart failure (CHF). To better understand the relationships between these variables regarding anxiety symptoms, we analyzed data from 116 adult male veterans with comorbid CHF and anxiety. Results suggested that illness intrusiveness significantly mediated the relation of CHF severity to anxiety symptom severity, and that the illness intrusiveness domains of physical well-being/diet, work/finances, and other aspects of life (religious/spirituality, community/civic, self-improvement/expression) were also significant mediators of that relationship. The relation of illness intrusiveness to anxiety was not moderated by internal HLC. Findings highlight the importance of assessing and treating various aspects of illness intrusiveness to manage anxiety symptoms in CHF patients.

Can Nutritional Status in Adults Be Influenced by Health Locus of Control?

The external health locus of control (HLC) is based on an assumption that obtained health results depend on the influences of external factors. As for the internal HLC-that is the effect of our own actions and capabilities. Little is known regarding how the HLC can influence body weight or the occurrence of visceral obesity. The study aimed to assess the relationship between the health locus of control and nutritional status in adults. The study included 744 adults (452 women, 292 men; 2.8% underweight, 43.8% normal weight, 29.7% overweight, and 23.7% obese). In addition to anthropometric measurement and socio-demographic data, the health locus of control, using the Multidimensional Health Locus of Control Scale (MHLC) by Wallston K, Wallston B, and DeVellis R, was assessed. The percentage of subjects with an internal HLC did not differ significantly between obese, overweight, and normal-weight groups. However, the percentage of subjects with an external HLC-dependent on the impact of others-was significantly higher in both men and women with obesity than in corresponding overweight and normal-weight groups (p < 0.01). Yet, the percentage of subjects with an external HLC subject to the impact of chance was significantly higher among overweight and obese women than in those of normal weight (p < 0.05) only. Women with overweight or obesity, with external health locus of control, experienced both the impact of others and of chance more often than women with normal weight. However, men with overweight and with obesity more often had external health locus of control influenced only by others.

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.

Multiple sclerosis: relationship between locus of control and quality of life in persons with low versus high disability

Background: Health Locus of Control (HLOC) is the degree to which individuals believe that their health outcomes are controlled by ‘external’ factors – environmental forces, chance, fate, other people, or some higher power – or by ‘internal’ factors – their own behavior or action. Most of the literature on HLOC associates an Internal Health Locus of Control (IHLOC) to pro-health behaviors and better health outcomes. However, a few studies also suggest that in chronic illnesses, an External Health Locus of Control (EHLOC) could be beneficial with respect to pro-health behaviors and perceptions of Quality of Life (QoL), challenging assumptions about what leads to the most effective psychological coping in the face of difficult circumstances. Multiple sclerosis (MS) is a chronic immune condition of the central nervous system and the most frequent cause of non-traumatic disability in young adults, often despite treatment. Method: The primary goal of this non-experimental, cross-sectional, quantitative study of 89 individuals with MS was to explore the HLOC of individuals with MS, and to identify whether holding an EHLOC positively impacts the MS patients’ perceived QoL while taking into consideration their level of disability. Results: This research found that individuals with higher disability scores tended to hold more EHLOC beliefs, and that there was a significant correlation between QoL and holding EHLOC beliefs. Conclusion: This study was able to capture the importance of control beliefs in the QoL of individuals with MS with higher disability. The clinical implications of the findingare explored and areas for further research are suggested.

Seizure triggers identified postictally using a smart watch reporting system

Persons with epilepsy (PWE) often report that seizure triggers can influence the occurrence and timing of seizures. Some previous studies of seizure triggers have relied on retrospective daily seizure diaries or surveys pertaining to all past seizures, recent and/or remote, in respondents. To assess the characteristics of seizure triggers at the granularity of individual seizures, we used a seizure-tracking app, called EpiWatch, on a smart watch system (Apple Watch and iPhone) in a national study of PWE. Participants tracked seizures during a 16-month study period using the EpiWatch app. Seizure tracking was initiated during a pre-ictal state or as the seizure was occurring and included collection of biosensor data, responsiveness testing, and completion of an immediate post-seizure survey. The survey evaluated seizure types, auras or warning symptoms, loss of awareness, use of rescue medication, and seizure triggers for each tracked seizure. Two hundred and thirty four participants tracked 2493 seizures. Ninety six participants reported triggers in 650 seizures: stress (65.8%), lack of sleep (30.5%), menstrual cycle (19.7%), and overexertion (18%) were the most common. Participants often reported having multiple combined triggers, frequent stress with lack of sleep, overexertion, or menses. Participants who reported triggers were more likely to be taking 3 or more anti-seizure medications compared to participants who did not report triggers. Participants were able to interact with the app and use mobile technology in this national study to record seizures and report common seizure triggers. These findings demonstrate the promise of longitudinal, self-reported data to improve our understanding of epilepsy and its related comorbidities.

How does "locus of control" affect persons with epilepsy?

PURPOSE

Locus of control (LOC) is the degree to which people believe that they have control over the outcome of events in their lives. A person's locus can be internal, external, or chance. A person with internal locus of control believes that one can control one's own life. A person with external locus of control believes that his life is controlled by external factors or people over which he has no influence. A person with chance locus of control believes that fate, chance, or luck controls his own life. The aim of the current study was to determine the health locus of control, anxiety, and depression levels in persons with epilepsy (PWE) and to assess whether locus of control has relation to anxiety, depression, and seizure control.

METHODS

Patients aged 18 years or older with a history of epilepsy for at least 1 year were recruited from the outpatient epilepsy clinic or from the inpatient epilepsy monitoring unit at SCTIMST, Trivandrum from January 2019 to May 2020. Patients filled the questionnaire form consisting of demographic data, age of onset of seizures, present seizure control, and the current antiepileptic drugs. The Hospital Anxiety and Depression (HAD) scale was used to estimate the level of anxiety and depression in these patients. The Form-C of the Multidimensional Health Locus of Control (MHLC) scale was used to evaluate the health locus of control. Healthy controls aged 18 years or older and free of any chronic disease or psychiatric illness were also recruited. They were asked to fill the questionnaire forms with basic demographic data. HAD scale was used to estimate the level of anxiety and depression and form-C of MHLC was used to evaluate the health locus of control in the healthy controls. The mean scores of anxiety, depression, and locus of control were compared between the two groups.

RESULTS

A total of 170 participants were recruited which consisted of 100 PWE and 70 healthy controls. The mean anxiety and depression scores were 8.13(SD = 4.23) and 5.85(SD = 3.66) in the PWE group and 6.75(SD = 3.39) and 4.14(SD = 2.96) in the control group, respectively. The mean internal, external, and chance LOC scores were 24.95(SD = 10.92), 26.94(SD = 4.96), and 24.41(SD = 6.46) in the PWE group; and 29.44(SD = 5.62), 26.53(SD = 5.79), and 19.9(SD = 7.13) in the control group, respectively. Persons with epilepsy had higher chance LOC scores and lower internal LOC scores compared to controls (p = 0.00003, p < 0.00001 respectively). There were no differences in the external LOC scores between the two groups (p = 0.620). Persons with epilepsy with some level of anxiety had lower internal LOC scores compared to patients with no anxiety (p = 0.04). PWE with poor seizure control had higher external LOC score and lower internal LOC scores which however did not reach statistical significance. Persons with epilepsy with poor seizure control had higher anxiety and depression scores.

CONCLUSIONS

Persons with epilepsy had low perceptions of internal and strong perceptions of chance health locus of control. This means that PWE feel that luck plays an important role in their disease control. This information is important in the counseling of persons with epilepsy.

Preferred ways of giving birth in non-pregnant and pregnant nulliparous women: the role of control beliefs

PURPOSE

To explore the association between delivery-specific, health-related control beliefs and preferred ways of delivery in nulliparous Hungarian women. Moreover, since data about the delivery-specific control beliefs and delivery-related preferences of non-pregnant nulliparous women are lacking, the present study also seeks to provide descriptive information in this regard.

METHODS

A total of 984 Hungarian nulliparous women (26.45 ± 5.42 years; 660/77.2% non-pregnant and 224/22.8% pregnant) were included in the present study. The online assessment included measures of delivery-specific (internal-, healthcare professional-, and chance-related) health control beliefs, fears of childbirth, self-esteem, as well as preferences regarding delivery setting (i.e. spontaneous vaginal birth in hospital, planned cesarean birth and home birth).

RESULTS

Healthcare professional-related control beliefs were associated with a stronger preference for spontaneous vaginal birth in hospital (OR = 1.87, 95% CI: 1.56-2.23) and planned cesarean birth (OR = 1.96, 95% CI: 1.60-2.40), alongside a weaker preference for home birth (OR = 0.31, 95% CI: 0.25-0.39). In contrast, internal delivery-specific control beliefs predicted a weaker preference for planned cesarean (OR = 0.66, 95% CI: 0.55-0.78) and a stronger preference for home birth (OR = 1.63, 95% CI: 1.33-2.00). A general preference index for medicalized ways of delivery was negatively associated with internal - and positively with healthcare professional - and chance-related control beliefs (βs = -.173, .074 and .445, respectively).

CONCLUSIONS

Delivery-related control beliefs are important psychological characteristics in the prediction of preferences for ways of delivery. Understanding delivery-specific control beliefs may be an important component of supporting women to give birth in a mentally and physically healthy way.

Fatigue and cognitive functions in epilepsy: A review of the literature

Epilepsy is a common neurological disorder affecting people of all ages and inducing cognitive impairments. While research has advanced in terms of neuropsychological enquiries of the various epileptic syndromes, the understanding of more complex and ill-defined phenomena such as fatigue is still unclear for epilepsy. It is suggested that fatigue is not just physical, but there can also be a cognitive element to it. Although studies in other conditions have been able to identify a relationship between fatigue and particular cognitive components, similar evidence is sparse in patients with epilepsy. This review is an attempt to gather, analyze, integrate, and critically discuss available information on fatigue and its rapport with various aspects of epilepsy, particularly focusing on cognition. Future directions are discussed urging researchers to target cognitive components of fatigue.

Would people living with epilepsy benefit from palliative care?

Palliative care (PC) is an approach to the care of persons living with serious illness and their families that focuses on improving quality of life and reducing suffering by addressing complex medical symptoms, psychosocial needs, spiritual well-being, and advance care planning. While PC has traditionally been associated with hospice care for persons with cancer, there is now recognition that PC is relevant to many noncancer diagnoses, including neurologic illness, and at multiple points along the illness journey, not just end of life. Despite the recent growth of the field of neuropalliative care there has been scant attention paid to the relevance of PC principles in epilepsy or the potential for PC approaches to improve outcomes for persons living with epilepsy and their families. We believe this has been a significant oversight and that PC may provide a useful framework for addressing the many sources of suffering facing persons living with epilepsy, for engaging patients and families in challenging conversations, and to focus efforts to improve models of care for this population. In this manuscript we review areas of significant unmet needs where a PC approach may improve patient and family-centered outcomes, including complex symptom management, goals of care, advance care planning, psychosocial support for patient and family and spiritual well-being. When relevant we highlight areas where epilepsy patients may have unique PC needs compared to other patient populations and conclude with suggestions for future research, clinical, and educational efforts.

Effect of seizure viewing on psychological outcome in persons with epilepsy

PURPOSE

Psychiatric disease is the most common co-morbidity seen in persons with epilepsy (PWE), often secondary to psychosocial disturbances due to poor adaptation to the disease. Optimizing epilepsy treatment by targeting both seizure control and addressing psychological issues go a long way in improving psychological outcome among PWE. This study aims to assess the psychological status among PWE using validated questionnaires and to assess the effect of viewing their own seizures on their psychological milieu post-viewing.

METHODS

A prospective interventional study was conducted enrolling 52 PWE. Their baseline psychological scores were assessed using Hospital Anxiety Depression Scale (HADS), Self Esteem Inventory (SEI), Locus of Control (LOC) and Quality of Life in Epilepsy (QOLIE-31). The scores were reassessed 3 months post seizure viewing and compared with the baseline scores.

RESULTS

Among the 52 patients analyzed, anxiety was present in 20 (38.4%) and depression in 8 (15.3%). The mean HADS-A (anxiety) scores for study population was 9.56 ± 4.12. Gender, income status, risk factors antedating index seizure, type of seizure, temporal semiology, seizure frequency, MRI or EEG characteristics did not have any significant association with baseline psychological scores. There was statistically significant reduction in HADS-A scores from 9.56 ± 4.12 to 8.35 ± 3.85 in the study population after seizure viewing (p = 0.049). We identified patient characteristics that benefit seizure viewing with respect to each of the psychological batteries mentioned earlier.

CONCLUSION

This study emphasizes that viewing one's own seizures improves the psychological milieu of PWE and improves their quality of life by helping them cope up with their illness more judiciously.

Does Epilepsy Have an Impact on Locus of Control?

Many chronic diseases impair patients' quality of life and may also affect their control perceptions. This could particularly happen for patients with epilepsy whose seizures often imply loss of control as a deeply disturbing experience. In 1980, a study on learned helplessness in epilepsy found a highly significant reduction of internal general locus of control (GLOC) and an increase of chance and powerful others health-related LOC (HLOC). In consequence, LOC became a frequent target of investigations relating to depression and anxiety, quality of life, coping, compliance, and other psychosocial aspects of epilepsy. Both GLOC and HLOC were investigated, and special groups like children, elderly, mentally handicapped persons, and those with psychogenic non-epileptic seizures were addressed. Most studies attempted to relate in-group differences of LOC to other parameters. Seizure-free patients were found to have a more internal HLOC, and patients with severe epilepsies have a more external HLOC. Patients with a high external HLOC seem to have more difficulties with coping and to be more anxious. Whereas external GLOC was correlated with learned helplessness, internal GLOC was associated with high self-efficacy and better life quality. An association of external LOC with depression seemed not to be a stable co-relation as clinical improvement following epilepsy surgery dissociated the two. A hypothesis was confirmed that the ability of some patients to counteract seizures at their onset, thus preserving control, was correlated with a higher internal HLOC. Some other theoretically well-founded hypotheses were not supported. Absolute figures as reported in several papers are of limited use because the only normative data for comparison come from a local sample of 1976 from Tennessee, whereas LOC scores may differ largely dependent on cultural and societal conditions. Very few controlled studies exist, and the early finding of a generally externalized LOC in epilepsy was confirmed only in one study performed in a South Indian community known for strong stigma against epilepsy. A recent transcultural investigation conducted in Brazil and Lithuania found no differences from healthy controls and between countries. It seems worthwhile to further investigate relations of LOC with epilepsy stigma.

Depression in People with Epilepsy. What is the Connection?

INTRODUCTION

Depression is the most common psychiatric comorbidity in people with epilepsy. It worsens the prognosis and quality of life of these patients. Despite this, depression is poorly diagnosed and when the treatment is given, it is frequently suboptimal.

OBJECTIVE

To perform a narrative review of the medical literature, seeking to collect useful information regarding the relationship between epilepsy and depression.

RESULTS

Narrative reviews, systematic reviews, meta-analyses, clinical trials, and follow-up studies were identified in English and Spanish with no time limit, including epidemiological, clinical, associated factors, etiological explanations, diagnostic and therapeutic approaches to comorbid depression in epilepsy.

CONCLUSION

The relationship between epilepsy and depression is complex. The available scientific evidence suggests the possibility of a bidirectional relationship that could be explained from common aetiopathogenic mechanisms. Despite the high prevalence of depression in epileptic patients, this mental disorder continues to be poorly identified by clinicians. To improve this, we have easy-to-apply instruments that routinely screen this patient population and contribute substantially to making the problem more visible and seek to improve the quality of life for this population.

Patient perspectives on the acceptability of mHealth technology for remote measurement and management of epilepsy: A qualitative analysis

BACKGROUND

Innovative uses of mobile health (mHealth) technology for real-time measurement and management of epilepsy may improve the care provided to patients. For instance, seizure detection and quantifying related problems will have an impact on quality of life and improve clinical management for people experiencing frequent and uncontrolled seizures. Engaging patients with mHealth technology is essential, but little is known about patient perspectives on their acceptability. The aim of this study was to conduct an in-depth qualitative analysis of what people with uncontrolled epilepsy think could be the potential uses of mHealth technology and to identify early potential barriers and facilitators to engagement in three European countries.

METHOD

Twenty people currently experiencing epileptic seizures took part in five focus groups held across the UK, Italy, and Spain. Participants all completed written consent and a demographic questionnaire prior to the focus group commencing, and each group discussion lasted 60-120 min. A coding frame, developed from a systematic review of the previous literature, was used to structure a thematic analysis. We extracted themes and subthemes from the discussions, focusing first on possible uses of mHealth and then the barriers and facilitators to engagement.

RESULTS

Participants were interested in mHealth technology as a clinical detection tool, e.g., to aid communication about seizure occurrence with their doctors. Other suggested uses included being able to predict or prevent seizures, and to improve self-management. Key facilitators to engagement were the ability to raise awareness, plan activities better, and improve safety. Key barriers were the potential for increased stigma and anxiety. Using familiar and customizable products could be important moderators of engagement.

CONCLUSION

People with uncontrolled epilepsy think that there is a scope for mHealth technology to be useful in healthcare as a detection or prediction tool. The costs will be compared with the benefits when it comes to engagement, and ongoing work with patients and other stakeholders is needed to design practical resources.

The Relationship Between Epilepsy and Anxiety Disorders

PURPOSE OF REVIEW

The current review aims at providing an overview of relevant aspects of anxiety symptoms and anxiety disorders (AD) in adults patients with epilepsy (PWE).

RECENT FINDINGS

Firstly, the appropriate diagnosis of type of anxiety symptoms and AD in PWE will be presented. Anxiety symptoms are often peri-ictal and classified in relation to their temporal occurrence to seizures. Anxiety symptoms are of three types: preictal (preceding a seizure), ictal (presenting as part of the seizure symptoms and signs), and postictal (occurring within 72 h of a seizure). AD are diagnosed in the interictal period and occur independently of seizures. Four specific AD in PWE can be objectified: anticipatory anxiety of epileptic seizures (AAS), seizure phobia, epileptic social phobia, and epileptic panic disorder. Secondly, the bidirectional pathophysiological relationship between anxiety and epilepsy will be described. Anxiety is a trigger for seizures in some patients, and the notion of stress and arousal is essential to understand the relationship between anxiety and seizure. Moreover, seizures arising from the limbic network especially involving amygdala, which may express fear-related semiology, provide insight into the pathophysiology of AD comorbidities. Thirdly, the methods of screening for AD and anxiety symptoms will be detailed. Fourthly, the pharmacological and psychobehavioral management of anxiety symptoms and AD in PWE will be presented. Arousal-based approaches for preictal and ictal symptoms and anxiety-based approaches for postictal and interictal symptoms will be presented. Despite lack of evidence-based approaches, it is recognized that management of epilepsy is not only about controlling seizures, but also depends heavily on detecting, correctly diagnosing, and appropriately managing anxiety symptoms and AD comorbidities, in order to maximize quality of life. Improving self-control and self-efficacy is of fundamental importance in the management of PWE. Further rigorously designed studies focusing on anxiety symptoms and AD are essential to improve the overall care of PWE.

A sociological approach to resilience in health and illness

Work on resilience in health and illness has been approached from a number of perspectives. These are the biological and psychosocial with a focus on the individual's responses to cope and adapt to changing circumstances wrought by changing physical health states. This we argue has a place but is far too narrow emphasizing the neoliberal view that the sick or imperfect individual is ultimately responsible for their own health outcomes. In this perspective, the individual's failure to cope or adapt may be seen as a personal failure to interact with the health system on offer. A broader sociological approach focuses on the overarching sociopolitical system within which health and illness occur and looks at the role of concepts such as growing social and economic inequity and the process by which neoliberalism establishes the framework of unequal opportunity and life chances. At this broader level, resilience relates to interplay between the sociopolitical and health systems and the individual. It is the role of the health system to provide opportunities, and supports and to reduce inequities to promote healthy lifestyle and beneficial coping approaches. We aim to understand and describe the mechanisms and opportunities afforded to individuals by their place in the social structure and to argue for health reform that makes a health system that assists all individuals be resilient. Longitudinal data from the Australian Epilepsy Longitudinal Survey are used to understand how income, inequity, and social isolation affect resilience over time.

Cognitive and Perceptual Factors, Not Disease Severity, Are Linked with Anxiety in COPD: Results from a Cross-Sectional Study

PURPOSE

Guided by the Transactional Model of Stress and Coping, the purpose of this cross-sectional study was to examine clinical factors-demographics, chronic obstructive pulmonary disease (COPD) severity, cognitive/perceptual variables (appraisal and coping)-and their relationship to clinically elevated symptoms of anxiety in a sample of veterans with COPD.

METHOD

Participants included a sample of veterans with COPD, with or without comorbid congestive heart failure, and clinically significant symptoms of anxiety (n = 172, mean age = 65.3, SD = 8.1), who previously presented to an outpatient VA setting. Participants completed questionnaires examining COPD severity (respiratory impairment and dyspnea- and fatigue-related quality of life); perceptions of a stressor (COPD illness intrusiveness); perceptions of control (locus of health control, mastery over COPD, self-efficacy); coping strategies (adaptive and maladaptive); and anxiety and depressive symptoms.

RESULTS

Multivariable linear regressions revealed that anxiety was positively associated with more maladaptive coping and locus of control (attributed to other people), above and beyond disease severity, demographics, and depressive symptoms.

CONCLUSION

These findings suggest that cognitive and perceptual factors are concurrent with anxiety; however, longitudinal investigations are needed to fully understand this relationship. Future research should also focus on identifying optimal assessment and treatment procedures when evaluating and treating patients with COPD and symptoms of anxiety.

TRIAL REGISTRATION

NCT01149772.

Control perceptions in epilepsy: A transcultural case-control study with focus on auras

OBJECTIVE

General Locus of Control (GLoC) is used to measure the extent to which people perceive life events as results of their own actions or external factors. This study analyzes the relationship between GLoC and people with epilepsy's (PWE) clinical characteristics, levels of anxiety, depression, religiosity/spirituality, and quality of life, with particular attention to possible influences of auras.

METHODS

A case-control study was carried out with 186 consecutive patients with a definite diagnosis of epilepsy in Brazil and Lithuania. Besides clinical and demographic data, all patients answered to internationally validated scales: Rotter's GLoC, Hospital Anxiety and Depression Scale (HADS), Quality of Life in Epilepsy (QOLIE-31), and Index of Core Spiritual Experiences-Revised (INSPIRIT-R).

RESULTS

Patient's mean age was 36.15 ± 13.75 years, 61.3% were female, mean age at onset of epilepsy was 17.27 ± 13.59 years, and monthly seizure frequency was 8.22 ± 20.00. People with epilepsy were more depressed than controls, (p = 0.03). Within the group with epilepsy, patients reporting auras and reacting to them had higher levels of depression (p = 0.002) and anxiety (p = 0.004) and lower QOLIE-31 (p = 0.01) score but did not differ in GLoC (p = 0.73) or INSPIRIT-R (p = 0.71). Patients with perceived ability to prevent seizures in response to auras had no increased levels of depression and anxiety.

CONCLUSIONS

General Locus of Control externalization in PWE was not confirmed. To perceive and be able to react to auras is associated with increased anxiety and depressive symptoms in PWE but not if it results in preventing seizures. No transcultural differences in these parameters were found.

Disclosure of Diagnosis in Early Recognition of Psychosis

There is a debate concerning risks and benefits of early intervention in psychosis, especially concerning diagnosis disclosure. The present study reports preliminary findings on self-reported locus of control and psychological distress after the disclosure of diagnosis in an early recognition center. We compared the ratings of the locus of control and psychological distress before and after communication of diagnosis. The study included individuals with an at-risk mental state (ARMS) (n = 10), schizophrenia (n = 9), and other psychiatric disorders (n = 11). Results indicate greater endorsement of the internal locus of control in individuals with ARMS after communication of diagnosis in contrast to the other groups. Our results suggest that disclosure of diagnosis in an early recognition center leads to a reduction of psychological distress and increased feelings of control over one's health. Persons with ARMS seem to particularly benefit from disclosure of diagnosis as part of early intervention.

The pain, depression, disability pathway in those with low back pain: a moderation analysis of health locus of control

Low back pain (LBP) is common, impacts on the individual and society, and is a major health concern. Psychological consequences of LBP, such as depression, are significant barriers to recovery, but mechanisms for the development of depression are less well understood. One potential mechanism is the individual’s health locus of control (HLoC), that is, perception of the level of control an individual has over their health. The objective of this study is to investigate the moderation effect of HLoC on the pain–depression–disability pathway in those with LBP. The design is a nested cross-sectional analysis of two existing cohorts of patients (n=637) who had previously consulted their primary care physician about LBP. Measures were taken of HLoC, pain intensity and interference, depression, disability, and bothersomeness. Structural Equation Modeling analysis was applied to two path models that examined the pain to depression to disability pathway moderated by the HLoC constructs of Internality and Externality, respectively. Critical ratio (CR) difference tests were applied to the coefficients using pairwise comparisons. The results show that both models had an acceptable model fit and pathways were significant. CR tests indicated a significant moderation effect, with stronger pathway coefficients for depression for those who report low Internality (β 0.48), compared to those with high Internality (β 0.28). No moderation effects were found within the Externality model. HLoC Internality significantly moderates the pain–depression pathway in those with LBP, meaning that those who have a low perception of control report greater levels of depression. HLoC may signify depression among people with LBP, and could potentially be a target for intervention.

Stress regulation in drug-resistant epilepsy

The prevalence of psychological distress, especially depressive and anxiety disorders, is higher in epilepsy than in other chronic health conditions. These comorbid conditions contribute even more than epileptic seizures themselves to impaired quality of life in patients with epilepsy (PWE). The link between these comorbidities and epilepsy appears to have a neurobiological basis, which is at least partly mediated by stress through psychological and pathophysiological pathways. The impact of stress in PWE is also particularly important because it is the most frequently reported seizure trigger. It is therefore crucial for clinicians to take stress-related conditions and psychiatric comorbidities into account when managing PWE and to propose clinical support to enhance self-control of stress. Screening tools have been specially designed and validated in PWE for depressive disorders and anxiety disorders (e.g. NDDI-E, GAD-7). Other instruments are useful for measuring stress-related variables (e.g. SRRS, PSS, SCS, MHLCS, DSR-15, ERP-R, QOLIE-31) in order to help characterize the individual "stress profile" and thus orientate patients towards the most appropriate treatment. Management includes both pharmacological treatment and nonpharmacological methods for enhancing self-management of stress (e.g. mindfulness-based therapies, yoga, cognitive-behavioral therapies, biofeedback), which may not only protect against psychiatric comorbidities but also reduce seizure frequency.

Disruptions in cortico-subcortical covariance networks associated with anxiety in new-onset childhood epilepsy

Anxiety disorders represent a prevalent psychiatric comorbidity in both adults and children with epilepsy for which the etiology remains controversial. Neurobiological contributions have been suggested, but only limited evidence suggests abnormal brain volumes particularly in children with epilepsy and anxiety. Since the brain develops in an organized fashion, covariance analyses between different brain regions can be investigated as a network and analyzed using graph theory methods. We examined 46 healthy children (HC) and youth with recent onset idiopathic epilepsies with (n = 24) and without (n = 62) anxiety disorders. Graph theory (GT) analyses based on the covariance between the volumes of 85 cortical/subcortical regions were investigated. Both groups with epilepsy demonstrated less inter-modular relationships in the synchronization of cortical/subcortical volumes compared to controls, with the epilepsy and anxiety group presenting the strongest modular organization. Frontal and occipital regions in non-anxious epilepsy, and areas throughout the brain in children with epilepsy and anxiety, showed the highest centrality compared to controls. Furthermore, most of the nodes correlating to amygdala volumes were subcortical structures, with the exception of the left insula and the right frontal pole, which presented high betweenness centrality (BC); therefore, their influence in the network is not necessarily local but potentially influencing other more distant regions. In conclusion, children with recent onset epilepsy and anxiety demonstrate large scale disruptions in cortical and subcortical brain regions. Network science may not only provide insight into the possible neurobiological correlates of important comorbidities of epilepsy, but also the ways that cortical and subcortical disruption occurs.

Attitudes towards epilepsy among a sample of Turkish patients with epilepsy

OBJECTIVE

The attitude of patients with epilepsy towards their disease is an important factor in disease management and quality of life. The aim of this study was to define the attitudes of patients with epilepsy towards their disease and the factors that affect their attitudes.

PATIENTS AND METHOD

This descriptive study was performed on patients admitted to an epilepsy outpatient clinic of a university hospital between May and September 2015. The sample consisted of 70 patients over 18years of age with a diagnosis of epilepsy and no health problem other than epilepsy. Patients with no seizure in the last two years were excluded. The Epilepsy Attitude Scale was used to evaluate attitudes of the patients towards epilepsy; the Epilepsy Knowledge Scale, Rotter's Locus of Control Scale, Hospital Anxiety and Depression Scale (HADS), and the Quality of Life in Epilepsy-10 (QOLIE-10) were used to investigate the attitude-related factors.

RESULTS

Among the 70 participants, 43 were female, and the mean age was 31.4years. The educational level of the patients was lower (primary school) in 38.6% of the sample, and 18.6% were unemployed. Time since diagnosis was 15.1years, 75.7% of the participants had generalized type of seizures, and more than half had seizures more frequently than once a month. The mean score of the attitude scale was 59.7±6.62 (range: 14-70). The attitudes of the patients towards epilepsy were found to be related to their educational status, living alone, and the attitudes of their families. The attitude scores were also related to the level of knowledge on epilepsy, stigma, and depression. Furthermore, the attitude was found to be correlated with quality of life.

CONCLUSION

Patients with epilepsy had moderate-to-good attitude towards their disease. It was observed that the attitude was related to the knowledge, stigma, and depression rather than to demographic factors and the seizures, and furthermore, the attitude was found to be correlated with quality of life.

[The strategies for psychological self-control of seizures in patients with focal epilepsy]

AIM

To investigate self-control strategies for epileptic seizures and their relationship to the individual coping-style in patients with focal epilepsy.

MATERIAL AND METHODS

Twenty one adult patients with focal epilepsy were examined. Strategies for seizure control and coping-style were estimated with the CBES-SC and the Brief COPE scale, respectively. The control group consisted of 20 healthy individuals.

RESULTS

86% of patients tried to control their seizures. Most of the patients (33%) preferred to use behavioral self-management strategies, which reduced the consequences of seizure. Patients with the high self-control activity more often had adaptive problem-focused coping-style in comparison to the patients with the low self-control (p<0.01).

CONCLUSION

The psychological coping-style modifying support can motivate patient to the wider use of strategies for seizure control and improve a psychosocial adjustment of the patient.

Anxiety disorders in people with epilepsy

Anxiety disorders are frequent, though probably underdiagnosed, comorbidities in epilepsy. Epilepsy and anxiety may share common neurobiological correlates as shown in animal models and suggested by studies demonstrating anxiety disorders before the manifestation of epilepsy. Comorbid anxiety disorders have a major impact on the affected patients' quality of life and may increase the risk for suicidality. Successful treatment of the epilepsy may alleviate anxiety symptoms. Treatment of anxiety is based on selective serotonin reuptake inhibitors, benzodiazepines (although only as second-line choices), and psychotherapy. Specific AEDs (especially pregabalin) have been shown to have anxiolytic properties. This paper is aimed at reviewing anxiety disorders in patients with epilepsy discussing current scientific evidence about pathophysiology, clinical aspects, and treatment strategies.

The social space of empowerment within epilepsy services: The map is not the terrain

Empowerment is now seen as an integral component of holistic practice and service design in healthcare, particularly as it relates to the improvement of quality of life for people with epilepsy. However, the literature suggests that empowerment is a neglected and poorly understood concept by service users and providers alike within epilepsy services. Conceptual ambiguity is a further impediment to its understanding and implementation. Bearing this in mind, a clear definition of empowerment is needed in order to realistically recognize, encourage, and prioritize empowerment as a service design philosophy. Therefore, this paper undertakes a concept analysis of empowerment with reference to epilepsy services. Results indicate that empowerment demands a transformation of consciousness and a readiness to act on this transformation in order to allow people to gain personal power and autonomy over their own life, including the self-management of their condition. With this in mind, a critical reflection on the 'micro' and 'macro' levels of power that exist within epilepsy services is warranted with reference to theoretical principles. In this context although the map is not the terrain, we argue that an educational intervention guided by critical social theory principles has the potential to encourage an understanding of empowerment and 'holds the key' to future advances for its implementation within epilepsy services.

Self-control of epileptic seizures by nonpharmacological strategies

Despite the unpredictability of epileptic seizures, many patients report that they can anticipate seizure occurrence. Using certain alert symptoms (i.e., auras, prodromes, precipitant factors), patients can adopt behaviors to avoid injury during and after the seizure or may implement spontaneous cognitive and emotional strategies to try to control the seizure itself. From the patient's view point, potential means of enhancing seizure prediction and developing seizure control supports are seen as very important issues, especially when the epilepsy is drug-resistant. In this review, we first describe how some patients anticipate their seizures and whether this is effective in terms of seizure prediction. Secondly, we examine how these anticipatory elements might help patients to prevent or control their seizures and how the patient's neuropsychological profile, specifically parameters of perceived self-control (PSC) and locus of control (LOC), might impact these strategies and quality of life (QOL). Thirdly, we review the external supports that can help patients to better predict seizures. Finally, we look at nonpharmacological means of increasing perceived self-control and achieving potential reduction of seizure frequency (i.e., stress-based and arousal-based strategies). In the past few years, various approaches for detection and control of seizures have gained greater interest, but more research is needed to confirm a positive effect on seizure frequency as well as on QOL.

Epileptic aura and perception of self-control

OBJECTIVE

The health locus of control is the subjective perception of control over one's health. It has been studied for years as one of several factors that determine patient health-related behaviors. The aim of this study was to investigate how the epileptic aura is associated with the health locus of control, anxiety, and depression.

METHODS

Patients were included retrospectively, based on patient records from the epilepsy monitoring unit of the Rigshospitalet University Hospital. Participants were asked about the presence and nature of auras in a semistructured interview. The Multidimensional Health Locus of Control Scale, Form C was used to evaluate the health locus of control. Three domains were evaluated: internal, where health is controlled by personal action; chance, where health is controlled by fate or luck; and powerful others, where health is controlled by the actions of others (e.g., doctors and parents). The Hospital Anxiety and Depression Scale was used to evaluate levels of anxiety and depression.

RESULTS

Forty-nine patients, with mean age of 38years, participated in the study. Of these, 67% reported experiencing one or more auras; i.e., subjective warning signs prior to a generalized or focal seizure with an impairment in consciousness. Patients that could react to their aura prior to a seizure scored higher on the internal subscale of the Multidimensional Health Locus of Control questionnaire compared to participants that could not react to their aura.

CONCLUSIONS

The ability to react to an aura prior to a seizure correlated positively with the internal subscale of the health locus of control. However, it did not significantly correlate with the external subscales of chance and powerful others in the health locus of control. Moreover, there was no significant relation between the ability to react to an aura prior to a seizure and the levels of anxiety or depression.

The societal integration of individuals with epilepsy: perspectives for the 21st century

Epilepsy is a common neurologic disorder seen throughout the world. Advances in therapy have made it possible for persons with epilepsy (PWEs) to have improved seizure control and a better quality of life. However, it is not entirely clear whether this has resulted in their successful integration into society. This review examines the societal integration of PWEs, identifying both the progress made and the challenges that continue to hamper further advances. In general, PWEs are more integrated in western-oriented cultures. However, there continue to be ongoing difficulties due to poor education and intellectual functioning, poor social and family support, the undertreatment of coexisting psychiatric conditions, transportation and mobility limitations, and problems obtaining employment. This review also discusses the effects of low socioeconomic status on integration and the persisting prejudices that affect certain racial groups. Most importantly, this review underscores the fact that societal stigma towards PWEs is still very much alive. At the beginning of the 21st century, PWEs still encounter difficulties in their quest for full societal integration. Along with medical advances being made to improve seizure control, much still has to be done to bring about the reforms necessary to help PWEs live more meaningful and productive lives.

The social context of anxiety and depression: exploring the role of anxiety and depression in the lives of Australian adults with epilepsy

AIM

To examine key determinants of anxiety and depression in a community sample of people with epilepsy.

METHOD

Data were analyzed from the 2010 Australian Epilepsy Longitudinal Survey, examining living with epilepsy in Australia. The HADS was analyzed, and Pearson correlations and block recursive regression were undertaken to identify key associations between anxiety, depression, and a range of variables and to identify key determinants of anxiety and depression.

RESULTS

Key factors to influence anxiety were social aspects of stigma, effectiveness of seizure control, whether in employment, and the number of different epilepsy drugs. Determinants for depression were social aspects of stigma, whether in employment, and the effectiveness of seizure control. Stigma was also found to be an important mediating variable for employment, control, and the number of drugs.

CONCLUSION

Understanding the mechanisms involved in anxiety and depression in a community sample of people with epilepsy requires the inclusion of opportunities for paid employment and the effects of psychosocial factors such as stigma. Without this fuller social context, there are limitations on understanding factors that influence anxiety and depression and how to deal with the outcomes.

The psychosocial correlates of depressive disorders and suicide risk in people with epilepsy

OBJECTIVE

Despite considerable effort to identify correlates of psychopathology in people with epilepsy (PWE), research has yet to identify consistent predictors. We tested the association between factors predicted by a model of adjustment to illness and psychopathology in PWE.

METHODS

In 123 PWE recruited from a tertiary referral centre, we examined the cross-sectional relationship between psychosocial factors (illness representations, coping, self-illness enmeshment and self-efficacy) with depression and suicide risk, while controlling for condition-related and demographic factors.

RESULTS

Multivariate analyses confirmed previous findings showing that condition-related and demographic variables did not consistently account for unique variance in depression although employment status was found to be a significant predictor of suicide risk. In multivariate analyses escape-avoidance coping and the illness consequences subscale of the illness representation questionnaire predicted unique variance in both depression and suicide risk.

CONCLUSION

The results provided partial support for a model of adjustment to illness. Specifically, those who believed epilepsy was serious and coped through avoidance were more likely to be depressed and report a current level of suicide risk. These results suggest that interventions that target coping strategies and illness representations may be warranted for PWE with psychopathology.

Depression in epilepsy: a systematic review and meta-analysis

OBJECTIVE

To estimate the prevalence of depression in persons with epilepsy (PWE) and the strength of association between these 2 conditions.

METHODS

The MEDLINE (1948-2012), EMBASE (1980-2012), and PsycINFO (1806-2012) databases, reference lists of retrieved articles, and conference abstracts were searched. Content experts were also consulted. Two independent reviewers screened abstracts and extracted data. For inclusion, studies were population-based, original research, and reported on epilepsy and depression. Estimates of depression prevalence among PWE and of the association between epilepsy and depression (estimated with reported odds ratios [ORs]) are provided.

RESULTS

Of 7,106 abstracts screened, 23 articles reported on 14 unique data sources. Nine studies reported on 29,891 PWE who had an overall prevalence of active (current or past-year) depression of 23.1% (95% confidence interval [CI] 20.6%-28.31%). Five of the 14 studies reported on 1,217,024 participants with an overall OR of active depression of 2.77 (95% CI 2.09-3.67) in PWE. For lifetime depression, 4 studies reported on 5,454 PWE, with an overall prevalence of 13.0% (95% CI 5.1-33.1), and 3 studies reported on 4,195 participants with an overall OR of 2.20 (95% CI 1.07-4.51) for PWE.

CONCLUSIONS

Epilepsy was significantly associated with depression and depression was observed to be highly prevalent in PWE. These findings highlight the importance of proper identification and management of depression in PWE.

Psychosocial predictors of depression and anxiety in patients with epilepsy: a systematic review

BACKGROUND

People with epilepsy (PWE) have a high chance of experiencing depression and anxiety disorders over their lifetime. However, those most at risk are unknown. Psychosocial variables have been suggested as potentially important risk factors. A systematic review was conducted in order to critically assess available evidence regarding the psychosocial predictors of depression and anxiety in adults with epilepsy.

METHODS

Electronic databases searched were MEDLINE, PsycINFO and Web of Science. Studies were included if they assessed depressive or anxiety symptoms using a validated questionnaire, and controlled for the role of potentially important epilepsy factors. Eleven studies were identified and assessed for research standards using the Quality Index Scale (QIS).

RESULTS

Ten of the eleven studies found at least one significant predictor of depression and all six studies that assessed anxiety found one or more significant predictors.

LIMITATIONS

Overall QIS score was only 7.5 out of 15, indicating significant design limitations of many included studies. There was also large variability between studies in measures used to assess psychosocial variables.

CONCLUSION

Studies did not support the importance of attributional theory and stigma in the development of depression in epilepsy. There was inconsistent support for the role of illness representations but likely support for the role of stress and self-efficacy. Consistent support was found for the role of coping strategies and perceived social support. Given that psychosocial factors are potentially modifiable, a better understanding of their role in the development of depression in people with epilepsy is urgently needed to guide effective treatments.

Aura interruption: the Andrews/Reiter behavioral intervention may reduce seizures and improve quality of life - a pilot trial

Patients with epilepsy frequently experience depression and emotional stress and these may function as seizure triggers in epileptogenic frontotemporal cortex, which serves in emotional processing. Eight patients enrolled in a pilot trial of a 6-month epilepsy-specific behavioral approach comprising counseling and relaxation to recognize and eliminate emotional seizure triggers. Potential participants with psychogenic seizures were excluded by long-term EEG and/or the MMPI profile. One participant became seizure free, another had an approximately 90% reduction in seizures, and two additional participants achieved a greater than 50% reduction in seizure frequency (total responder rate=50%), stable during 6 months of observation after the intervention. All completers showed marked and stable improvement of quality of life (Quality of Life in Epilepsy-89 inventory) and temporary improvement in the Profile of Mood States. An adequately powered randomized controlled trial is needed to confirm our findings, which suggest that behavioral approaches may hold promise for motivated patients with epilepsy.

Motivation, psychopathology, locus of control, and quality of life in women with epileptic and nonepileptic seizures

To examine factors that may potentially aid in the differential diagnosis and subsequent tailoring of treatment for patients with epileptic (ES) and psychogenic nonepileptic (PNES) seizures, thirty female patients with PNES and 51 female patients with temporal lobe epilepsy were assessed in the areas of motivation, psychopathology, health-related locus of control (HRLOC), and health-related quality of life (HRQOL). The two groups demonstrated equivalent levels of motivation, clinically elevated yet comparable mood symptoms, and no general differences in HRLOC. Despite similar mood disturbances in both groups, the participants with PNES had a later age of seizure onset, exhibited greater personality disturbances, attributed more control over their condition to nonphysicians, and endorsed a greater negative impact of their seizures on physical and emotional aspects of HRQOL. Preliminary analyses suggest that chronic anxiety and overall HRQOL may be core discriminators between these seizure groups. Addressing such issues may prove useful in tailoring more specific treatments for these etiologically disparate conditions.

Behavioral risk factors among Arizonans with epilepsy: Behavioral Risk Factor Surveillance System 2005/2006

Modifiable risk factors to help improve health outcomes for people with epilepsy in Arizona were identified using the 2005-2006 Arizona Behavioral Risk Factor Surveillance System (BRFSS). Of 9524 adults who participated in this survey, 125 reported ever being diagnosed with epilepsy (lifetime prevalence=1.3%, 95% CI=1.1-1.6%). Individuals with active epilepsy (those who had seizures in the prior 3 months and/or were taking anticonvulsants) had an overall lower quality of life. This likely resulted from a large number of medical comorbidities and poor mental and physical health days. Regression models suggested that for individuals with active epilepsy, physical activity was associated with fewer activity-limited days, whereas for individuals with inactive epilepsy, medical comorbidity was positively associated with activity-limited days. Further research is needed to increase the reliability of the findings.

Prevalence of anxiety disorders in patients with refractory focal epilepsy--a prospective clinic based survey

Comorbid anxiety disorders severely affect daily living and quality of life in patients with epilepsy. We evaluated 97 consecutive outpatients (41.2% male, mean age=42.3+/-13.2 years, mean epilepsy duration=26.9+/-14.2 years) with refractory focal epilepsy using the German version of the anxiety section of the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Nineteen patients (19.6%) were diagnosed with an anxiety disorder (social phobia, 7.2%; specific phobia, 6.2%; panic disorder, 5.1%; generalized anxiety disorder, 3.1%; anxiety disorder not further specified, 2.1%; obsessive-compulsive disorder, 1.0%; posttraumatic stress disorder, 1.0%). Four-week prevalence rates reported elsewhere for the general population in Germany are 1.24% for social phobia, 4.8% for specific phobia, 1.1% for panic disorder, 1.2% for generalized anxiety disorder, 1.3% for anxiety disorder not further specified, and 0.4% for obsessive-compulsive disorder. A trend for people with shorter epilepsy duration (P=0.084) and younger age (P=0.078) being more likely to have a diagnosis of anxiety disorder was revealed. No gender differences were found; however, this may be due to the small sample size. In conclusion, anxiety disorders are frequent in patients with refractory focal epilepsy, and clinicians should carefully examine their patients with this important comorbidity in mind.

Predicting seizures: a behavioral approach

This article reviews the epilepsy cycle, distinguishing the interictal, preictal, ictal, and postictal phases. Evidence suggesting that the preictal phase can sometimes be identified based on neurophysiologic signals, premonitory features, the presence of trigger factors, or self-report is also reviewed. Diary studies have shown that seizures are not randomly distributed in time and that a subgroup of persons with epilepsy can predict an impending seizure. Paper diary data and preliminary analysis of electronic diary data suggest that seizure prediction is feasible. Whereas all of this evidence sets the stage for seizure prediction and preemptive therapy, several questions remain unanswered. First, what proportion of persons with epilepsy can predict their seizures? Second, within and among individuals, how accurate is prediction? Third, can prediction be improved through education about group level or individual predictors? And finally, in a group that can make robust predictions what are the most effective interventions for reducing seizure probability at times of high risk? The answers to these questions could reduce the burden of epilepsy by making seizures predictable and setting the stage for preemptive therapy. This work could improve the understanding of epilepsy by providing a context for studying the transitions from the interictal to preictal and ictal states. More prospective studies are needed; challenges certainly exist, but as the studies discussed here demonstrate, the field is rich with promise for improving the lives of patients with epilepsy.

Psychosocial impairments in children with epilepsy depend on the side of the focus

This article explores the idea that epileptic activity may interfere with psychosocial functions and development in children. In an adult population with epilepsy, left hemispheric seizure focus predicts worse psychosocial functioning. The developmental aspects of these disturbances require further studies. We studied self-report measures of cognitive (locus of control) and emotional (Beck Youth Inventories of Emotional and Social Impairment) functions in 30 children with partial epilepsy (6-15 years) and 60 healthy matched controls. Multivariate statistics revealed significant lateralization effects, with left-sided foci (n=15) leading to more external locus of control. Opposite to adults, the children with right hemispheric foci (n=15) exhibited more emotional impairments (anger, disruptive behavior) than the left hemispheric group. The cognitive and emotional dysfunctions in epilepsy may result from the interaction of focus lateralization and brain development. The cognitive disturbances beginning in childhood may lead to the stronger emotional impairments observed in adults with left hemispheric seizures.

The psychosocial impact of epilepsy in adults

Although defined by the presence of recurrent seizures, epilepsy can be so much more and can include a very wide range of difficulties in cognition, psychiatric status, and social adaptive functioning. These psychosocial complications of epilepsy have a long history, generating calls for action by national commissions, public health agencies, and special action groups which are briefly summarized here. Next, a brief overview of the prevalence of psychosocial complications of epilepsy in population-based and other representative is presented. Finally, with a focus on the onset and development of psychosocial difficulties, the following points are stressed: (1) neurobiological factors likely contribute to psychosocial problems in a major way, but currently this contribution is poorly understood, and (2) although neurobiological factors may prove important, they operate in a social setting, and therefore, a full accounting of the etiology, treatment, and prevention of psychosocial problems in epilepsy will require an integrated biopsychosocial model and life span perspective.

The impact of 'social determinants of health' on epilepsy prevalence and reported medication use

There is a limited understanding of the complex relationship between poverty and epilepsy. To address the complex interaction of environmental and psychosocial factors in epilepsy a 'social determinants of health' model is presented where individual factors are influenced through three pathways (social environment, work and material factors). In the 2005 California Health Interview Survey, 246 of 604 (41%) persons with a history of epilepsy were in poverty, defined as <200% Federal Poverty Level (FPL). Multivariable logistic regression analyses revealed persons in poverty are not more likely to report a history of epilepsy compared to those not in poverty. However, persons with a history of epilepsy in poverty were significantly less likely than those not in poverty to report taking medication for epilepsy (OR 0.5) once material factors (annual income and living situation) and healthcare access were controlled for in the final sequential model. Healthcare practitioners must continue to recognize that connection to social services and the cost of medications are significant barriers to optimal care in persons with epilepsy. Improved connection to patient advocacy organizations and medication assistance programs may help close these gaps.

Culturecology, Women, and African-Centered HIV Prevention

The Healer Women Fighting Disease Integrated Substance Abuse and HIV Prevention Program for African American women is based on a conceptual framework called “culturecology” and an African-Centered Behavioral Change Model (ACBCM). Culturecology poses that an understanding of African American culture is central to both behavior and behavioral transformation. The ACBCM model suggests that behavioral change occurs through a process of resocialization and culturalization. These processes minimize negative social conditions and maximize prosocial and life-affirming conditions. The participants were 149 women—105 in the intervention group and 44 in the comparison group. Findings show significant changes among participants from pretest to posttest in (1) increasing motivation and decreasing depression (cultural realignment ), (2) increasing HIV/AIDS knowledge and self-worth (cognitive restructuring ), and (3) adopting less risky sexual practices (character development ). The African-centered approach demonstrates promise as a critical component in reducing and/or eliminating health disparities in the African American community.