Spirituality and religion in epilepsy

A neural network for religious fundamentalism derived from patients with brain lesions

Religious fundamentalism, characterized by rigid adherence to a set of beliefs putatively revealing inerrant truths, is ubiquitous across cultures and has a global impact on society. Understanding the psychological and neurobiological processes producing religious fundamentalism may inform a variety of scientific, sociological, and cultural questions. Research indicates that brain damage can alter religious fundamentalism. However, the precise brain regions involved with these changes remain unknown. Here, we analyzed brain lesions associated with varying levels of religious fundamentalism in two large datasets from independent laboratories. Lesions associated with greater fundamentalism were connected to a specific brain network with nodes in the right orbitofrontal, dorsolateral prefrontal, and inferior parietal lobe. This fundamentalism network was strongly right hemisphere lateralized and highly reproducible across the independent datasets (r = 0.82) with cross-validations between datasets. To explore the relationship of this network to lesions previously studied by our group, we tested for similarities to twenty-one lesion-associated conditions. Lesions associated with confabulation and criminal behavior showed a similar connectivity pattern as lesions associated with greater fundamentalism. Moreover, lesions associated with poststroke pain showed a similar connectivity pattern as lesions associated with lower fundamentalism. These findings are consistent with the current understanding of hemispheric specializations for reasoning and lend insight into previously observed epidemiological associations with fundamentalism, such as cognitive rigidity and outgroup hostility.

Giftedness and atypical sexual differentiation: enhanced perceptual functioning through estrogen deficiency instead of androgen excess

Syndromic autism spectrum conditions (ASC), such as Klinefelter syndrome, also manifest hypogonadism. Compared to the popular Extreme Male Brain theory, the Enhanced Perceptual Functioning model explains the connection between ASC, savant traits, and giftedness more seamlessly, and their co-emergence with atypical sexual differentiation. Overexcitability of primary sensory inputs generates a relative enhancement of local to global processing of stimuli, hindering the abstraction of communication signals, in contrast to the extraordinary local information processing skills in some individuals. Weaker inhibitory function through gamma-aminobutyric acid type A (GABAA) receptors and the atypicality of synapse formation lead to this difference, and the formation of unique neural circuits that process external information. Additionally, deficiency in monitoring inner sensory information leads to alexithymia (inability to distinguish one's own emotions), which can be caused by hypoactivity of estrogen and oxytocin in the interoceptive neural circuits, comprising the anterior insular and cingulate gyri. These areas are also part of the Salience Network, which switches between the Central Executive Network for external tasks and the Default Mode Network for self-referential mind wandering. Exploring the possibility that estrogen deficiency since early development interrupts GABA shift, causing sensory processing atypicality, it helps to evaluate the co-occurrence of ASC with attention deficit hyperactivity disorder, dyslexia, and schizophrenia based on phenotypic and physiological bases. It also provides clues for understanding the common underpinnings of these neurodevelopmental disorders and gifted populations.

An online survey on differences in knowledge and stigma about epilepsy among the Tokyo metropolitan area and non-urban areas in Japan, a post-hoc study

PURPOSE

Extant research elucidating the domains of knowledge and bias on epilepsy has consistently underscored a deficiency in cognizance and an inclination toward bias within non-urban areas. Investigations into geographical disparities concerning epilepsy awareness and prejudice within the Japanese context remain conspicuously absent. To address this lacuna in the literature, we undertook a post-hoc analysis to elucidate the discernible regional differentials in epilepsy awareness and the associated stigma.

METHODS

From July to August 2021, we conducted an internet questionnaire survey for 310 people with epilepsy (PWE) and 213 ordinary people without epilepsy who registered on the database of the Japanese Research Company. We inquired PWE to answer the Epilepsy Self-Stigma Scale (ESSS), the Rosenberg Self-Esteem Scale (RSES), and the Epilepsy Knowledge Scale (EKS). We inquired to answer ordinary people without epilepsy EKS. We analyzed residential addresses separately for Greater Tokyo and non-urban areas by comparing the degree of knowledge of people with epilepsy and people without epilepsy.

RESULTS

The average knowledge of people with and without epilepsy in the Greater Tokyo area was 39.60 and 28.43 points, although in non-urban areas (nine regions from all over Japan except for the Greater Tokyo, Tokai region, and Kinki region), the knowledge averages were 38.44 and 28.66 points of 100. In addition, self-stigma was highest in the Greater Tokyo area: 22.99 and in non-urban areas: 22.77. An two-way ANOVA with knowledge as the dependent variable and epilepsy diagnosis status and region (Greater Tokyo area/non-urban areas) as the independent variables revealed no interaction between diagnosis and region (F(1,346) = 1.48, η2 = 0.003). Knowledge was significantly higher in PWE than in people without epilepsy, but we could not identify any significant difference between ESSS (t = 0.24, d = 0.03) and RSES (t = 1.16, d = 0.16) in the Greater Tokyo/non-urban areas.

CONCLUSIONS

We obtained specific information about regional differences in the level of knowledge and stigma about epilepsy in Japan. Because Japan underwent educational reforms after World War II and more than 90% of the population received equally advanced education, the results found no regional differences in knowledge and stigma about epilepsy. We believe collecting information about the respondents' birth and upbringing environment and conducting a thorough investigation is necessary in the future.

Risk of suicide and religious or spiritual beliefs in Brazilian adult patients with epilepsy

In epilepsy, suicidal behavior is higher compared with the general population.

OBJECTIVE

To assess the relationship between suicide risk, religiosity or spirituality, and clinical variables in adult patients with epilepsy (PWE).

METHODOLOGY

The data from the suicide module of the Mini International Neuropsychiatric Interview (MINI) were related to scores on the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS-P) and the Hospital Anxiety and Depression Scale (HADS), as well as clinical variables in 96 adults PWE, with a significance level of p < 0.05.

RESULTS

The study included 49 patients with temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) and 47 cases of other epilepsies. The presence of suicide risk in the MINI was observed in 43 (44.7%) cases. Suicide risk was associated with an earlier age of epilepsy onset, higher seizure frequency, neurological abnormalities, and higher scores on the HADS-A and HADS-D scales. Suicide risk was low in 33 (76.7%) cases and moderate or high in 10 (23.2%) cases. Higher suicide risk was associated with higher education levels, focal structural epilepsy, use of ≥2 antiseizure medications, neurological abnormalities, anxiety, and dimensions such as daily spiritual experiences, religious or spiritual coping, organizational religiousness, and total score in the BMMRS-P.

DISCUSSION

A high number of patients with epilepsy exhibited suicide risk, with epilepsy-related variables, the presence of anxiety, and perceived lower belongingness and social support from religiosity or spirituality anxiety being associated with a higher risk. The social support provided by religiosity/spirituality may be a non-clinical factor associated with suicidal behavior. Suicide in epilepsy is associated with a complex interaction of multidimensional factors.

The effects of strength of religious faith on post-traumatic growth in patients with epilepsy

AIM

This study was conducted to examine the effects of strength of religious faith on post-traumatic growth in patients with epilepsy.

METHOD

This cross-sectional and correlational study was conducted with 112 participants who were admitted to the neurology outpatient clinic of a university hospital in eastern Turkey, who met the research criteria and agreed to participate in the study. The data were collected by using "Descriptive Information Form", "Santa Clara Strength of Religious Faith Questionnaire (SCSRFQ)", and "Post-traumatic Growth Inventory (PTGI)". Santa Clara Strength of Religious Faith Questionnaire SCRFSQ has a maximum strength of faith score of 40 points and the PGTI has a maximum growth after a traumatic event score of 105 points.

RESULTS

Mean SCSRFQ total score of the participants was found to be 31.04 ± 5.17. Mean PTGI total score was found to be 60.54 ± 16.50. As a result of the regression analysis, it was found that the independent variable affected the dependent variable PTGI total score significantly (F(1,110) = 13.999, p = 0.000). It was also found that the independent variable affected the PTGI total score positively (β = 0.336) and explained 11% of the PTGI total score (p < 0.001).

CONCLUSION

It was found that the participants had high strength of religious faith score and moderate post-traumatic growth score. It was found that post-traumatic growth increased as strength of religious faith increased.

SEEG-RF for revealing and treating Geschwind syndrome's epileptic network: A case study

Stereotypic neural networks are repeatedly activated in drug-refractory epilepsies (DRE), reinforcing the expression of certain psycho-affective traits. Geschwind syndrome (GS) can serve as a model for such phenomena among patients with temporal lobe DRE. We describe stereo-electroencephalogram (SEEG) exploration in a 34-year-old male with DRE and GS, and his treatment by SEEG-radiofrequency (SEEG-RF) ablation. We hypothesized that this approach could reveal the underlying epileptic network and map eloquent faculties adjacent to SEEG-RF targets, which can be further used to disintegrate the epileptic network. The patient underwent a multi-modal pre-surgical evaluation consisting of video EEG (VEEG), EEG source localization, 18-fluorodexyglucose-PET/MRI, neuropsychological and psychiatric assessments. Pre-surgical multi-modal analyses suggested a T4-centered seizure onset zone. SEEG further localized the SOZ within the right amygdalo-hippocampal region and temporal neocortex, with the right parieto-temporal region as the propagation zone. SEEG-RF ablation under awake conditions and continuous EEG monitoring confirmed the abolishment of epileptic activity. Follow-up at 20 months showed seizure suppression (Engel 1A/ILEA 1) and a significantly improved and stable psycho-affective state. To the best of our knowledge this is the first description of the intracranial biomarkers of GS and its further treatment through SEEG-RF ablation within the scope of DRE.

Psychological and social aspects of people with epilepsy expressed through drawing: Pilot study

INTRODUCTION

Frequently, the psychological and social aspects of PWE go unnoticed in medical consultations. Even in spite of having seizure control, some people can experience a poor quality of life. The objective of the study was to determine if drawing facilitates the expression of the psychological and social difficulties of PWE.

METHODS

Hermeneutic, qualitative, situated knowledge study located in the city of Medellín, Colombia. The participants were asked to make one or several drawings under the question "what it is like to live with epilepsy". The drawings were analyzed with criteria of Gestalt psychology, semiotics, image-word relationship and context.

RESULTS

Sixteen drawings of ten participants were obtained. The drawings revealed the construction of an identity of otherness and negative emotionality due to epilepsy. The social concepts of restriction, prohibition, dependency, and exclusion appear in the drawings. The authors expose the ways to face adversity.

CONCLUSION

Drawing can expose and facilitate the expression of the psychological and social difficulties of PWE, which often go unnoticed in the medical office. Free drawing is an easy-to-use global tool that has been underused in the medical field.

Dissociation in patients with epilepsy and functional seizures: A narrative review of the literature

Dissociation is a "disruption of the usually integrated functions of consciousness, memory, identity or perception of the environment" according to DSM-5.  It is commonly seen in psychiatric disorders including primary dissociative disorders, post-traumatic stress disorder, depression, and panic disorder. Dissociative phenomena are also described in the context of substance intoxication, sleep deprivation and medical illnesses including traumatic brain injury, migraines, and epilepsy. Patients with epilepsy have higher rates of dissociative experiences as measured on the Dissociative Experiences Scale compared to healthy controls. Ictal symptoms, especially in focal epilepsy of temporal lobe origin, may include dissociative-like experiences such as déjà vu/jamais vu, depersonalization, derealization and what has been described as a "dreamy state".  These descriptions are common in the setting of seizures that originate from mesial temporal lobe epilepsy and may involve the amygdala and hippocampus. Other ictal dissociative phenomena include autoscopy and out of body experiences, which are thought to be due to disruptions in networks responsible for the integration of one's own body and extra-personal space and involve the temporoparietal junction and posterior insula. In this narrative review, we will summarize the updated literature on dissociative experiences in epilepsy, as well as dissociative experiences in functional seizures. Using a case example, we will review the differential diagnosis of dissociative symptoms. We will also review neurobiological underpinnings of dissociative symptoms across different diagnostic entities and discuss how ictal symptoms may shed light on the neurobiology of complex mental processes including the subjective nature of consciousness and self-identity.

What caused Joan of Arc's neuropsychiatric symptoms? Medical hypotheses from 1882 to 2016

Between 1882 and 2016, the medical literature offered a variety of etiologic hypotheses to explain Joan of Arc's voices, visions, and unwavering belief that she was the instrument of God. Although Joan lived from 1412 to 1431, there is extensive primary documentation of her life, including transcripts of her testimony during the Trial of Condemnation. Once this source material was compiled and made available, physician-authors began to theorize about Joan's neuropsychiatric symptoms in the context of her remarkable achievements. This article summarizes all papers written by physician-authors about Joan of Arc. The historical flow of diagnostic speculation in the medical literature reflects the cultural context in which it was produced as well as the emergence of novel ideas and new technologies in psychiatry, neurology, and neuropsychiatry. The early literature offered psychological theories and addressed the question of whether Joan was sane. The later literature focused on the possibility that Joan might have had epilepsy, with discussions of seizure etiology and possible cerebral focus, and also reflections on the purview of science as well as spirituality and the brain. This article offers the first comprehensive review of the medical literature about Joan of Arc, making this scholarship more accessible.

Religious Experience and Clinical-EEG Aspects in Adult People with Epilepsy

Spirituality and religiosity are complex cognitive phenomena; however, the relationship between spiritual experiences and epilepsy continues to be debated. Methods. Data from the daily spiritual experience scale (DSES) were related to EEG data and clinical variables of 100 adult people with epilepsy (PWEs). DSES scores were compared to 51 normal individuals (control group [CG]), with a significance level of P < .05. Results. The total score in the DSES was 36.1 ± 14 and 37.6 ± 13.2, respectively, in the PWEs and in the CG. In the PWEs, there was a correlation between DSES and age (Pearson's correlation; -0.22; P = .027) and educational level (0.207; P = .039). PWEs with ≥one seizure/month have a lower frequency of daily spiritual experiences than those with better controlled seizures (T-test; 39.2 ± 16.2 vs 31.7 ± 7.6; P = .038). EEG epileptiform activity (EA) in the right hemisphere was associated with a higher frequency of spiritual experiences than those with left-hemisphere EA (29.8 ± 9.0 vs 38.5 ± 17.5; P = .010). Conclusion. Demographic aspects, EA in the right hemisphere, and lower seizure frequency are associated with daily spiritual experiences in epilepsy, suggesting an association between aspects of spirituality, epilepsy, and neurobiological correlates.

Ictal religious speech in non-dominant temporal lobe epilepsy: three cases

Ictal religious speech and gestures, rare ictal semiological findings, sign the epileptic focus at the non-dominant temporal lobe in the literature. Therefore, we aim to present non-dominant temporal lobe semiological findings, including ictal praying and religious gestures in three cases.

Localization of ictal Islamic rituals: Study of epilepsy center in Makkah

BACKGROUND

Ictal semiology is important to aid the diagnosis of seizure type. Patients frequently require admission to an epilepsy monitoring unit (EMU) to reach a correct diagnosis of epilepsy type. Some patients may exhibit unusual ictal phenomena that can lead to the diagnosis of psychogenic seizures. Unusual ictal phenomena include ictal kissing, praying, and drinking. Ictal religious speech and praying are other examples of unusual ictal phenomena. This study aims to assess the localization value of ictal Islamic rituals.

METHODS

We retrospectively reviewed all patients admitted to the EMU at King Abdullah Medical City in Makkah between 2017 and 2021. Patients with ictal Islamic rituals were included in the study.

RESULTS

Nine out of the 279 cases admitted to the EMU have different ictal Islamic rituals. Some patients exhibited multiple Islamic rituals during their seizures. Six patients performed Islamic religious speech, including asking Allah to help, asking for forgiveness, and making basmala (in the name of Allah). Three patients exhibited self-immunization patterns (tahseen). Three patients repeatedly raised their right index fingers (shahada movements). All nine patients had seizures originating from the right temporal lobe.

CONCLUSIONS

Islamic rituals are rare ictal phenomena localized to the right temporal lobe.

A framework for health equity in people living with epilepsy

Epilepsy is a disease where disparities and inequities in risk and outcomes are complex and multifactorial. While most epilepsy research to date has identified several key areas of disparities, we set out to provide a multilevel life course model of epilepsy development, diagnosis, treatment, and outcomes to highlight how these disparities represent true inequities. Our piece also presents three hypothetical cases that highlight how the solutions to address inequities may vary across the lifespan. We then identify four key domains (structural, socio-cultural, health care, and physiological) that contribute to the persistence of inequities in epilepsy risk and outcomes in the United States. Each of these domains, and their core components in the context of epilepsy, are reviewed and discussed. Further, we highlight the connection between domains and key areas of intervention to strive towards health equity. The goal of this work is to highlight these domains while also providing epilepsy researchers and clinicians with broader context of how their work fits into health equity.

Parental religiosity is associated with changes in youth functional network organization and cognitive performance in early adolescence

Parental religious beliefs and practices (religiosity) may have profound effects on youth, especially in neurodevelopmentally complex periods such as adolescence. In n = 5566 children (median age = 120.0 months; 52.1% females; 71.2% with religious affiliation) from the Adolescent Brain Cognitive Development study, relationships between parental religiosity and non-religious beliefs on family values (data on youth beliefs were not available), topological properties of youth resting-state brain networks, and executive function, inhibitory control, and cognitive flexibility were investigated. Lower caregiver education and family income were associated with stronger parental beliefs (p < 0.01). Strength of both belief types was correlated with lower efficiency, community structure, and robustness of frontoparietal control, temporoparietal, and dorsal attention networks (p < 0.05), and lower Matrix Reasoning scores. Stronger religious beliefs were negatively associated (directly and indirectly) with multiscale properties of salience and default-mode networks, and lower Flanker and Dimensional Card Sort scores, but positively associated with properties of the precuneus. Overall, these effects were small (Cohen's d ~ 0.2 to ~ 0.4). Overlapping neuromodulatory and cognitive effects of parental beliefs suggest that early adolescents may perceive religious beliefs partly as context-independent rules on expected behavior. However, religious beliefs may also differentially affect cognitive flexibility, attention, and inhibitory control and their neural substrates.

Saints, demons, and faith - A review of the historical interaction between Christianity and epilepsy

The view that epilepsy is caused by demonic possession prevailed throughout the Middle Ages and re-emerges in rare cases of misguided exorcisms even in modern Western societies. This review reflects on the biblical sources of the demonic understanding of seizures and the subsequent marginalization of people with epilepsy. While the development of science led to a decline in beliefs of supernatural causes of seizures, the link between Christianity and epileptology is sustained through recurrent considerations of epileptic phenomena among religious figures. The influence of epilepsy on the legacy of historical persons of Christianity should be regarded with caution because of limited clinical evidence in historical documents. However, it should be acknowledged that religious experiences, as well as general religiosity, can be important in modern-day epilepsy care as they are shown to have psychological, societal, and even clinical implications. Further studies should expand our knowledge on the contemporary importance of the Christian tradition for people with epilepsy.

Spiritual care for the management of Parkinson's disease: Where we are and how far can we go

An increasing number of studies have investigated the neural networks and brain regions activated by different aspects of religious faith or spiritual practice. The extent to which religiousness and spirituality are dependent on the integrity of neural circuits is a question unique to neurological illnesses. Several studies have reported that neural networks and brain areas represent the various components of religious faith or spiritual activity in recent decades. In addition to research in healthy people, another strategy is to observe if neurological abnormalities caused by stroke, tumour, brain damage, or degenerative sickness are accompanied by an alteration in religiosity or spirituality. Similarly, Parkinson's disease (PD), an ailment characterized by dopaminergic neuron malfunction, has been utilized to explore the role of dopaminergic networks in the practice, experience, and maintenance of religious or spiritual beliefs. Case-control and priming studies have demonstrated a decline in spirituality and religion in people with PD due to dopaminergic degeneration. These studies could not adequately control for confounding variables and lacked methodological rigour. Using qualitative and quantitative assessments, a mixed-method approach might shed additional light on putative religious beliefs alterations in PD. In the current review paper, we discussed the recent research on the impact of PD on spiritual beliefs and spirituality.

Seizure semiology: ILAE glossary of terms and their significance

This educational topical review and Task Force report aims to address learning objectives of the International League Against Epilepsy (ILAE) curriculum. We sought to extract detailed features involving semiology from video recordings and interpret semiological signs and symptoms that reflect the likely localization for focal seizures in patients with epilepsy. This glossary was developed by a working group of the ILAE Commission on Diagnostic Methods incorporating the EEG Task Force. This paper identifies commonly used terms to describe seizure semiology, provides definitions, signs and symptoms, and summarizes their clinical value in localizing and lateralizing focal seizures based on consensus in the published literature. Video-EEG examples are included to illustrate important features of semiology in patients with epilepsy.

The Heavenly Passage Known in the West as Reissner’s Fiber

This article explores the hypothesis that Reissner’s fiber, an enigmatic, anomalous, thread-like structure that runs from the center of the brain to the end of the spinal cord, is the neural substrate of suprasensory perceptions of the divine. Justification for this hypothesis derives from a comparative study of descriptions of the “subtle body” from ancient esoteric traditions, testable speculations about altered states of consciousness correlated with the subtle dynamics of the fiber, and the fiber’s evolutionary trajectory in humans from its perinatal involution to its potential regeneration. While adequate testing of the hypothesis will require new technologies, preliminary investigations are underway. The goal of this research is to promote research about Reissner’s fiber with the hope that it could lead to the discovery of a universal religious experience underlying the transcendent unity of religions.

A Neural Circuit for Spirituality and Religiosity Derived From Patients With Brain Lesions

BACKGROUND

Over 80% of the global population consider themselves religious, with even more identifying as spiritual, but the neural substrates of spirituality and religiosity remain unresolved.

METHODS

In two independent brain lesion datasets (N₁ = 88; N₂ = 105), we applied lesion network mapping to test whether lesion locations associated with spiritual and religious belief map to a specific human brain circuit.

RESULTS

We found that brain lesions associated with self-reported spirituality map to a brain circuit centered on the periaqueductal gray. Intersection of lesion locations with this same circuit aligned with self-reported religiosity in an independent dataset and previous reports of lesions associated with hyper-religiosity. Lesion locations causing delusions and alien limb syndrome also intersected this circuit.

CONCLUSIONS

These findings suggest that spirituality and religiosity map to a common brain circuit centered on the periaqueductal gray, a brainstem region previously implicated in fear conditioning, pain modulation, and altruistic behavior.

Postictal psychosis, a cause of secondary affective psychosis: A clinical description study of 77 patients

OBJECTIVE

Postictal psychosis (PIP) is a severe complication occurring at least in 2% of patients with epilepsy. Since the 19th century, psychiatrists have reported the specificity of PIP presentation, but descriptions did not clearly distinguish PIP from after-seizure delirium. This study aimed to provide a precise description of psychiatric signs occurring during PIP, and improve recognition of PIP.

METHODS

We performed a review of clinical descriptions available in literature (48 patients), that we gathered with a retrospective multicentric case series of patients from three French epilepsy units (29 patients). For each patient, we collected retrospectively the psychiatric signs, and epilepsy features.

RESULTS

We found a high prevalence of persecutory (67.5%) and religious (55.8%) delusions, with almost systematic hallucinations (83.1%) and frequent mood disturbances (76.6%), especially euphoria. Severe consequences were not negligible (other-directed assault in 20.8%, self-directed in 13.0%). The type of delusion was associated with mood symptoms (p = 0.017). Episode onset was mainly sudden/rapid (90.9%), its duration was mostly between one and 14 days (64.9%) and the response to antipsychotic medication was good. Disorder was recurrent in more than a half of the sample (57.1% of patients with at least 2 episodes).

CONCLUSION

Considering our findings, PIP resembles more an affective psychosis, than a purely psychotic disorder. The presence of affective signs differentiates PIP from other psychotic comorbidities in epilepsy. Additionally, resemblance between PIP and psychotic manic episode might help to discuss links between epilepsy and bipolar disorder.

Religious conversion in an older male with longstanding epilepsy

Religious experiences in epilepsy patients have provoked much interest with suggestions that hyperreligiosity is associated with temporal lobe seizures. Extreme varieties of religious behavior may be more frequent in epilepsy patients during ictal activity or during post-ictal psychotic episodes. We report a 75 year-old man with epilepsy who developed a progressive decline in cognition and behavior following a religious conversion 15 years earlier. He subsequently developed religious delusions of increasing severity and symptoms of Capgras syndrome. Brain imaging revealed bilateral posterior cortical atrophy, chronic right parieto-occipital encephalomalacia, and right mesial temporal sclerosis. Electroencephalograms and neuropsychological testing revealed initial right temporal lobe abnormalities followed by progressive frontal and bilateral dysfunction. The case highlights how a history of seizures, superimposed on sensory deprivation and a progressive impairment of right posterior and bilateral anterior brain function, may have contributed to religious conversion, which was followed by dementia and delusions involving religious content.

Epilepsy, violence, and crime. A historical analysis

In the 19th and early 20th century, epilepsy was one of the most investigated disorders in forensic psychiatry and psychology. The possible subsidiary symptoms of epilepsy (such as temporal confusion, alterations of consciousness, or increased aggression) played pivotal roles in early forensic and criminal psychological theories that aimed to underscore the problematic medical, social and legal status of epileptic criminals. These criminals were considered extremely violent and capable of committing sudden, brutal acts. Although the theory of "epileptic criminality" was refuted due to 20th-century developments in medicine, forensic psychiatry, and criminal psychology, some suppositions related to the concept of epileptic personality have lingered. This paper explores the lasting influence of the theory of epileptic personality by examining the evolution of the theories of epileptic criminality both in the international and the Hungarian context. Specifically, it calls attention to the twentieth-century revival of the theory of epileptic personality in the works of Leopold Szondi, István Benedek and Norman Geschwind. The paper shows that the issue of epileptic personality still lingers in neuropsychology. In doing so, biological reductionist trends in medical-psychological thinking are traced, and attention is drawn to questions that arise due to changing cultural and medical representations.

Spontaneous Spiritual Awakenings: Phenomenology, Altered States, Individual Differences, and Well-Being

Spontaneous Spiritual Awakenings (SSAs) are subjective experiences characterised by a sudden sense of direct contact, union, or complete nondual merging (experience of oneness) with a perceived ultimate reality, the universe, "God," or the divine. These profound transformative experiences have scarcely been researched, despite extensive anecdotal evidence suggesting their potential to catalyse drastic, long-term, and often positive shifts in perception, world-view, and well-being. The aims of this study were to investigate the phenomenological variances of these experiences, including the potential differences between SSAs and Spontaneous Kundalini Awakenings (SKAs), a subset of awakening experiences that the authors postulate may produce a higher likelihood of both physical and negative effects; to explore how these experiences compare to other altered states of consciousness (ASCs), including those mediated by certain psychedelic substances; and understand their impact on well-being. Personality trait absorption and temporal lobe lability (TLL) were assessed as predictors of Spontaneous Spiritual and Kundalini Awakenings (SSA/SKAs). A mixed within and between-participants self-report survey design was adopted. A total of 152 participants reporting their most powerful SSA/SKAs completed questionnaires measuring nondual, kundalini, and mystical experience, as well as depth of ASC, and trait absorption and TLL. Spontaneous Kundalini Awakenings were found to be significantly more physical, but not significantly more negative than SSAs, and overall, both sets of experiences were perceived to be overwhelmingly more positive than negative, even in cases where the experience was initially challenging. The phenomenological distribution of SSA/SKAs was similar to other measured ASCs although greater in magnitude, and appeared most similar in distribution and in magnitude to drug-induced ASCs, particularly classic psychedelics DMT and psilocybin. Temporal lobe lability and trait absorption were found to predict the SSA/SKA experience. The limitations and implications of these findings are discussed.

Religion, spirituality, and epilepsy

This review provides responses to four questions on epilepsy, religion, and spirituality. Firstly, have early religious beliefs and writings stigmatized and discriminated against epilepsy and if so, what has been done to correct this? We provide textual evidence suggesting an affirmative response. Secondly, which religious luminaries, gods, saints, and religious symbols have connections with epilepsy? We argue that the evidence to suggest that St Paul, Joan of Arc, the Prophet Mohammed, and others had epilepsy is weak and emphasizes the limitations of imposing contemporary neurological frameworks upon them. Furthermore, we discuss how different faith traditions identify Divine figures, as associated with epilepsy, and the use of religious symbols in healing. Thirdly, why is religiosity associated with having epilepsy? We review empirical studies focusing upon the epileptic personality, religiosity, mysticism, and religious conversion and find that, while some studies suggest that religious experience may be associated with epilepsy, this cannot be taken as proven. Fourthly, in what ways has religion been a force for good for those with epilepsy? We discuss the role of Christian social reform in caring for individuals with epilepsy and that of religion in coping with the condition. We conclude by arguing that the relationship between religion and epilepsy has been overstated in the academic literature.

Psychotic Disorders in Epilepsy: Do They Differ from Primary Psychosis?

Any attempt to compare the definitions of symptoms listed for "primary psychoses" with those adopted in studies of psychoses in patients with epilepsy (PWE) will encounter problems of heterogeneity within both conditions. In this manuscript, five psychotic illnesses listed in Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5), that is, brief psychotic illness, schizophreniform disorder, schizophrenia, delusional disorder, and schizoaffective disorder are compared with postictal (or periictal) and interictal psychotic disorders in PWE. After examining definitions of primary psychoses, definitions of psychoses adopted in the papers dealing with postictal and interictal psychoses are summarized. Further, diagnostic criteria of five types of psychotic disorders in PWE proposed in 2007 by Krishnamoorthy et al. are also discussed, which include postictal psychosis, comorbid schizophrenia, iatrogenic psychosis caused by antiepileptic drugs (AEDs) (AED-induced psychotic disorder: AIPD), and forced normalization. Evidently, a comparison between postictal psychosis and schizophrenia is pointless. Likewise, schizophrenia may not be an appropriate counterpart of forced normalization and AIPD, given their acute or subacute course.Based on these preliminary examinations, three questions are selected to compare primary psychoses and psychoses in PWE: Is postictal psychosis different from a brief psychotic disorder? Does epilepsy facilitate or prevent the development of psychosis or vice versa? Is interictal psychosis of epilepsy different from process schizophrenia? In conclusion, antagonism between psychosis and epileptic seizures in a later stage of active epilepsy seems not to be realized without reorganization of the nervous system promoted during an earlier stage. Both genetic predisposition and the summated effects of epileptic activity must be taken into consideration as part of a trial to explain interictal psychosis. Interictal psychosis is an aggregate of miscellaneous disorders, that is, co-morbid schizophrenia, AED-induced psychotic disorders, forced normalization, and "epileptic" interictal psychosis. Data are lacking to conclude whether differences exist between process schizophrenia and "epileptic" interictal psychosis in terms of negative symptoms, specific personal traits, and the "bizarre-ness" of delusory-hallucinatory contents. These discussions may shed light on the essence of process schizophrenia, thus allowing it stand out and receive increased focus.

Pediatric epilepsy and psychoeducational interventions: A review of the literature

For many individuals, living with epilepsy is truly a family affair throughout the life span. When it comes to childhood epilepsy, the unpredictability of seizure patterns, comorbid conditions, the risk of sudden unexpected death in epilepsy (SUDEP), and societal stigma can be emotionally taxing on children and their primary caregivers. To this end, this article proposes to review psychoeducational interventions provided to primary caregivers of children with an epilepsy diagnosis and the impact of such interventions on general parental coping skills. There were three main themes identified (1) caregivers' knowledge and self-efficacy about seizure management; (2) parental epilepsy-related fears, anxiety, and stress; (3) parental sleep quality and SUDEP psychoeducation. Overall, considering research limitations, providing epilepsy-related psychoeducational interventions to primary caregivers of children with epilepsy seems to have promising evidence in the literature. After receiving such interventions, the studies show that caregivers' psychosocial outcomes improved; they become more empowered to manage their children's seizures and advocate for their children's psychosocial needs.

Determination of health fatalism and the factors affecting health fatalism in patients with epilepsy in the North of Turkey

OBJECTIVE

In individuals with epilepsy, health fatalism can affect their perceptions of health and their responses to solutions offered, both positively and negatively. This study aimed to investigate health fatalism in people with epilepsy in Turkey and the factors that influence their health fatalism.

METHOD

This descriptive and cross-sectional study was conducted between December 2019 and April 2020 with 100 epilepsy patients who were referred to a neurology outpatient clinic in the North of Turkey. The data for the study were collected using a descriptive information form and the Health Fatalism Scale (HES).

RESULTS

The total mean score on the Health Fatalism Scale for the study participants was found to be 56,16 ± 15,71. Significant association was found between health fatalism and educational status (p < 0,05), polytherapy (p < 0,05), and frequency of seizures (p < 0,001).

CONCLUSION

In this study, individuals with epilepsy expressed high levels of fatalism in their health beliefs. It was found that illiterate individuals with epilepsy held more fatalistic beliefs. In addition, it was found that participants who used polytherapy and those who had frequent seizures also had higher levels of fatalistic health beliefs.

Epilepsy characteristics and cognitive, social, and mood functions in relation to intrinsic religiosity

PURPOSE

The purpose of the study was to relate the Intrinsic Religiosity Inventory (IRI) with clinical epilepsy variables, the occurrence of depressive symptoms, and the quality of life (QoL) of 169 adult people with epilepsy (PWEs). Data were compared with those of a similar control group (CG) without psychiatric disorders, with p < 0.05.

RESULTS

A higher intrinsic religiosity (IR) was observed in PWEs when compared with the CG. Impairment in multiple cognitive domains was found in 41 (24.2%) cases, and a score >15 in the Neurological Disorders Depression Inventory for Epilepsy was observed in 44 (26%) cases. In PWE, a greater IR was associated with the use of more than one antiepileptic drug (AED), epileptiform activity (EA) in the left hemisphere, temporal lobe epilepsy with hippocampal sclerosis (TLE-HS), and the absence of depressive disorders. An early age of onset and the social functioning dimension of the Quality of Life in Epilepsy Inventory (QOLIE-31) were the predictive factors for a higher IR in the linear multivariate regression analysis.

CONCLUSION

The IR was significantly higher in PWE. A higher IR was related to TLE-HS, EA in the left hemisphere, later onset of epilepsy, a better performance in the semantic verbal fluency (SVF) test, and the absence of depressive disorders, suggesting a complex neurophysiological relationship involving multiple factors.

The Neural Basis of Religious Cognition

Religion’s neural underpinnings have long been a topic of speculation and debate, but an emerging neuroscience of religion is beginning to clarify which regions of the brain integrate moral, ritual, and supernatural religious beliefs with functionally adaptive responses. Here, we review evidence indicating that religious cognition involves a complex interplay among the brain regions underpinning cognitive control, social reasoning, social motivations, and ideological beliefs.

Did Prophet Mohammad (PBUH) have epilepsy? A neurological analysis

INTRODUCTION

The Prophet of Islam is one of the several famous religious figures who allegedly suffered from epilepsy. Early Greek chronicler Theophanes was one of the first to mention that the revelations of The Prophet were episodes of epilepsy, sparking a debate that has continued to date. This argument, for the most part, was confined to historic literary writings only until it was quoted by some eminent neurologists of recent times. They suggested probable diagnosis of temporal lobe epilepsy, adding credibility to the historical claims.

MATERIAL AND METHOD

Review of works of some prominent historians, orientalists, literati from previous twelve centuries, and recent neurologists who believed The Prophet to be epileptic was done. The resource material that influenced them to believe this was likewise examined. Other archived literature including Hadith, the primary resource material that provides detailed information about the day-to-day happenings in The Prophet's life with books on the life of The Prophet by orientalists and Muslim historians describing such features during revelations and other events, was scrutinized. Documentations of these events from all resources were compared and analyzed from a neurological perspective.

RESULTS

The author on analysis found literature indicating faulty translations of the original Arabic text into Latin as one of the reason for misleading conclusions. Verbatim translations of Arabic phrases used symbolically have taken away the exact construal giving it a wrong perspective. Similarly, The Prophet's peri-revelation episodes as they appear in Hadith when evaluated from a neurological perspective suggest that The Prophet did not have epilepsy.

CONCLUSION

A judicious analysis of the features on which the historians and literati based their suspicion to label The Prophet epileptic, provides little supportive evidence when analyzed from a neurological perspective. Without judicious analysis of clinical data chances of misdiagnosis tend to be fairly high.

The relationship between individual differences in gray matter volume and religiosity and mystical experiences: A preregistered voxel-based morphometry study

The neural substrates of religious belief and experience are an intriguing though contentious topic. Here, we had the unique opportunity to establish the relation between validated measures of religiosity and gray matter volume in a large sample of participants (N = 211). In this registered report, we conducted a confirmatory voxel-based morphometry analysis to test three central hypotheses regarding the relationship between religiosity and mystical experiences and gray matter volume. The preregisterered hypotheses, analysis plan, preprocessing and analysis code and statistical brain maps are all available from online repositories. By using a region-of-interest analysis, we found no evidence that religiosity is associated with a reduced volume of the orbito-frontal cortex and changes in the structure of the bilateral inferior parietal lobes. Neither did we find support for the notion that mystical experiences are associated with a reduced volume of the hippocampus, the right middle temporal gyrus or with the inferior parietal lobes. A whole-brain analysis furthermore indicated that no structural brain differences were found in association with religiosity and mystical experiences. We believe that the search for the neural correlates of religious beliefs and experiences should therefore shift focus from studying structural brain differences to a functional and multivariate approach.

Belief in the miracles of Lourdes: A voxel-based morphometry study

BACKGROUND

It has been shown that particular religious beliefs and practices are associated with brain function and structure. The present voxel-based morphometry study investigated the correlation between the belief in the miracles of Lourdes (a major Catholic pilgrimage site) and gray matter volume in specific brain regions associated with theory of mind (ToM).

METHOD

Structural brain data from 84 women (mean age: 25 years; no current somatic illness; 80% Roman-Catholic) were correlated with self-report measures on belief in miracles, religious-spiritual well-being, and psychological problems. Selected brain regions of the ToM network included the temporoparietal junction (TPJ), hippocampus, amygdala, and medial prefrontal cortex (MPFC).

RESULTS

The belief in the miracles of Lourdes was positively correlated with general religiousness and with feelings of connectedness; there was no association with psychological problems. Belief in miracles of Lourdes correlated positively with TPJ volume and negatively with MPFC volume.

CONCLUSION

Belief in the miracles was associated with brain volume in regions involved in mentalizing and self-control.

Epilepsy stigma in Saudi Arabia: The roles of mind-body dualism, supernatural beliefs, and religiosity

INTRODUCTION

The stigma of epilepsy continues to negatively impact people with epilepsy (PWE) in many Arab Middle Eastern countries, including Saudi Arabia. Socioreligious, cultural, and philosophical ideas prevalent in the region may contribute to the underpinnings of stigma toward PWE, but this has not been sufficiently studied.

MATERIALS AND METHODS

This study recruited a convenience sample of people without epilepsy from clinic waiting rooms and through social media. Participants completed a questionnaire with questions about demographics, mind-body dualism (MBD), supernatural beliefs (SB), attitudes toward epilepsy (ATE), and religiosity.

RESULTS

A total of 210 participants were recruited. Analysis of variance (ANOVA) showed a significant difference in the mean total ATE scores, indicating better ATE with higher education (p < 0.001). Despite the relatively high level of education and a high proportion of participants with medical training, only slightly more than half rejected the possibility that demonic possession may be a cause of epilepsy. Attitudes toward epilepsy were correlated with MDB and SB but not with religiosity. Mind-body dualism and religiosity correlated significantly with negative attitudes toward PWE (p < 0.05). A linear regression model using ATE as the dependent variable and MDB, SB, and educational level as independent variables significantly predicted ATE (F = 15.6, p < 0.001, R2 = 0.24), although SB dropped out as a predictor of ATE in that model. Another regression used SB as the dependent variable, and MBD, religiosity, and educational level as independent variables were also significant with all three variables predicting SB (F = 64.0, p < 0.001).

CONCLUSIONS

Mind-body dualism was related to the cognitive process leading to supernatural misconceptions about epilepsy and negative attitudes toward PWE in Saudi Arabia. Although misconceptions that supernatural possession was the cause of epilepsy (justifying treatment by religious healing) and was likely derived from prevalent religious beliefs of the region, religiosity was not associated with negative attitudes toward PWE. The merits and efficacy of an intervention focused on reducing the negative effects of MBD and SB on ATE warrants further investigation.

Religiosity and spirituality in patients with epilepsy

OBJECTIVE

Religiosity and spirituality (R/S) are widely regarded as important allies against illness and suffering in general. Findings in temporal lobe epilepsy (TLE) suggest the temporal lobe as the anatomical-functional basis of religious experiences. Both R/S are relevant in patients with epilepsy (PWE) since epilepsy can lead to psychosocial issues for a significant portion of patients and their families. To investigate R/S in PWE, as well as the impact of different epileptic syndromes on patients' R/S.

METHODS

One hundred PWE and 50 healthy volunteers matched for age, sex and educational level were submitted to an interview, as well as three previously validated questionnaires: Index of Core Spiritual Experience (INSPIRIT-R), Hospital Anxiety and Depression Scale (HADS), and the Quality of Life in Epilepsy Inventory (QOLIE-31).

RESULTS

PWE's and control's mean ages were 35.9 ± 12.4 vs. 36.3 ± 18.1 years, mean schooling was 8.9 ± 3.7 vs. 10.1 ± 4.2 years. The mean age of epilepsy onset was 14.5 ± 12.1 and monthly frequency of seizures was 5.9 ± 12.6. INSPIRIT-R's scores were not statistically significantly different between patients and controls (3.0 ± 0.8 vs. 3.0 ± 0.8); however, INSPIRIT-R's scores were significantly higher in TLE patients when compared with other epilepsy syndromes (3.2 ± 0.7 vs. 2.8 ± 0.9; p = 0.04).

CONCLUSION

Temporal lobe epilepsy patients have higher levels of R/S.

Spirituality and quality of life in epilepsy and other chronic neurological disorders

PURPOSE

The patients with neurological disorders often report a different quality of life (QoL), which is in part explained by clinical-pathological or psychosocial variables. This study evaluated spirituality in patients with chronic brain pathologies, aiming to clarify its specificity and position to a multidimensional model of QoL.

METHODS

A hundred and ninety-nine adult patients with epilepsy (E) (n = 88), mild cognitive impairment (MCI) (n = 32), ischemic vascular disorders (n = 29), tumors (n = 28), or multiple sclerosis (MS) (n = 22), and 66 healthy subjects were assessed using the World Health Organization Quality of Life (WHOQoL) 100, Spiritual, Religious and Personal Beliefs (SRPB), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI) for the QoL, spirituality, depression, and anxiety. The Multiple Ability Self-Report Questionnaire (MASQ) and neuropsychological tests evaluated the cognitive functions.

RESULTS

Factor analysis of the SRPB, STAI, and BDI scores yielded four factors: Personal Meaning, Inner Freedom, Awe and Openness, and Mood. Quality of life and spirituality were very similar between the patient groups. In comparison with the controls, all of the patients showed worse QoL, spirituality, mood, and lexical-memory abilities, and the patients with MCI and brain vascular disorders (BVD) also revealed worse cognitive impairments. Trait anxiety, self-rated health, age, and the SRPB Inner independence and Hope and optimism facets predicted the patients' WHOQoL 100 total score; the spiritual, affective, and socioeconomic variables predicted many QoL domains, but diagnosis only affected the Physical domain. Anxiety, self-rated health, Hope and optimism, and Personal beliefs predicted the controls' WHOQoL 100 total score.

CONCLUSIONS

Spirituality, as marked by the meaning of self, inner independence, and transcendence, is distinct from mood. It cooperates, together with the affective states, to determine the QoL of the patients with chronic brain pathologies whereas diagnosis has a limited impact. These findings support a multidimensional cross-disease model for the QoL in neurological disorders.

A diffusion tensor imaging study of brain microstructural changes related to religion and spirituality in families at high risk for depression

INTRODUCTION

Previously in a three-generation study of families at high risk for depression, we found that belief in the importance of religion/spirituality (R/S) was associated with thicker cortex in bilateral parietal and occipital regions. In the same sample using functional magnetic resonance imaging and electroencephalograph (EEG), we found that offspring at high familial risk had thinner cortices, increased default mode network connectivity, and reduced EEG power. These group differences were significantly diminished in offspring at high risk who reported high importance of R/S beliefs, suggesting a protective effect.

METHODS

This study extends previous work examining brain microstructural differences associated with risk for major depressive disorder (MDD) and tests whether these are normalized in at-risk offspring who report high importance of R/S beliefs. Diffusion tensor imaging (DTI) data were selected from 99 2nd and 3rd generation offspring of 1st generation depressed (high-risk, HR) or nondepressed (low-risk, LR) parents. Whole-brain and region-of-interest analyses were performed, using ellipsoidal area ratio (EAR, an alternative diffusion anisotropy index comparable to fractional anisotropy). We examined microstructural differences associated with familial risk for depression within the groups of high and low importance of R/S beliefs (HI, LI).

RESULTS

In the LI group, HR individuals showed significantly decreased EAR in white matter regions neighboring the precuneus, superior parietal lobe, superior and middle frontal gyrus, and bilateral insula, supplementary motor area, and postcentral gyrus. In the HI group, HR individuals showed reduced EAR in white matter surrounding the left superior, and middle frontal gyrus, left superior parietal lobule, and right supplementary motor area. Microstructural differences associated with familial risk for depression in precuneus, frontal lobe, and temporal lobe were nonsignificant or less significant in the HI group.

CONCLUSION

R/S beliefs may affect microstructure in brain regions associated with R/S, potentially conferring resilience to depression among HR individuals.

Gastaut-Geschwind Syndrome, Faciobrachial Dystonic Seizure, and Autoimmune Limbic Encephalitis

Here we report a case of a 55-year-old male who had presented with recent falls and behavioral changes, including a heightened religious preoccupation, hypergraphia, and paranoid ideations. He was initially treated for psychosis but soon exhibited absence-like seizures, which were consistent with faciobrachial dystonic seizures. Workup for underlying infectious, immunodeficiency, and autoimmune causes revealed antibodies towards the leucine-rich glioma inactivated subunit of the voltage-gated potassium complex. The patient was treated with steroids and intravenous immune globulin with symptomatic relief. In retrospect, the patient met criteria for Gastaut-Geschwind (GG) syndrome, with notable features of hypergraphia and hyperreligiosity. This case illustrates how the GG syndromal pattern contributes to the suspicion of autoimmune limbic encephalitis and may expedite diagnosis and prevent the accumulation of disability.

Psychotic-Like Symptoms and the Temporal Lobe in Trauma-Related Disorders: Diagnosis, Treatment, and Assessment of Potential Malingering

Objective

To overview the phenomenology, etiology, assessment, and treatment of psychotic-like symptoms in trauma-related disorders focusing on the proposed role of temporal lobe dysfunction.

Method

We describe the literature pertaining to (i) psychotic-like symptoms and temporal lobe dysfunction in trauma-related disorders and (ii) psychological testing profiles in trauma-related disorders. We define trauma-related disorders as borderline personality disorder, post-traumatic stress disorder, and the dissociative disorders. Our search terms were dissociative disorders, temporal lobe, trauma, post-traumatic stress disorder, borderline personality disorder, psychosis, and malingering.

Results

Trauma-related psychotic-like symptoms are common and can differ in phenomenology from primary psychotic symptoms. Hallucinations consist of auditory and nonauditory content that may or may not relate to traumatic content. Child voices are highly suggestive of complex dissociative disorders. Critically, not only do these symptoms resemble those seen in temporal lobe epilepsy, but the temporal lobe is implicated in trauma-related disorders, thus providing a plausible neurobiological explanation. Despite such evidence, these symptoms are frequently considered atypical and misdiagnosed. Indeed, common structured psychological assessment tools categorize these symptoms as possible indicators of invalid testing profiles.

Conclusion

Psychotic-like symptoms are common in trauma-related disorders, may be related to temporal lobe dysfunction, and are frequently misinterpreted. This may lead to ineffective treatment and inappropriate determinations of malingering in the forensic system.

Consciousness as an Inhibited Manifestation and Quantum Physics

The term soul is used in the traditional literature as a synonym for one's true Self and is associated with the subjective essence of one's living. Since, we don't have any means to quantify it, the science has ruled out this idea from its investigations. But, in a recent study, Ceylan et al. (2017) has reintroduced the word soul to scientific literature and examined the possibility of the study of the soul through scientific modalities. The primary focus of their study is to find and understand the scientific analog of the soul as quoted and discussed in the traditional literature. In the present paper, we examine the idea of a soul that uses a novel approach; integrating neuroscience and quantum physics, as proposed in Ceylan et al. (2017). For this purpose, we make use of findings from neuroscientific studies on meditation to understand the concepts of soul and consciousness in terms of inhibition mechanisms. In this context, this paper serves as an attempt to call for more studies to discuss and expand the hypothesis about the soul as uninhibited mental activity.

The mind of suicide terrorists

After reviewing the available literature about the main hypotheses on suicide terrorism and the psychological characteristics of terrorists that have been proposed throughout the years, the present authors have put forward some personal considerations on what the distinctive traits of today's suicide bombers might be. In spite of the heterogeneity and paucity of "real" data, it is evident that there is no peculiar familial, educational, or socioeconomic factors that may account for religious radicalization leading to suicide terrorism. On the contrary, some common psychological features can be highlighted: such as isolation, feelings of emptiness, cold rationality, a lack of empathy, and a lust for martyrdom and death. To die to kill: this is the core feature, a sort of organizer that can twist higher cognitive and emotional processes, resulting in the supreme and highly rewarding suicidal and killing behaviors.

Effects of religiosity and religious coping on medication adherence and quality of life among people with epilepsy

The epidemiologic information demonstrates the importance of caring people with epilepsy (PWE). Indeed, the impaired quality of life (QoL) and medication nonadherence rate among PWE have been reported. However, religiosity and religious coping could be potential factors for clinicians to foster appropriate intervention on epileptic care. This study investigated two models to further understand the relationships between religiosity, religious coping (including positive and negative coping), medication adherence, and QoL in an Iranian sample with epilepsy. Eligible PWE (n=760) completed the religiosity scale (Duke University Religion Index; DUREL) at baseline; the religious coping scale (Brief Religious Coping Scale; Brief RCOPE) one month later; the medication adherence scale (Medication Adherence Report Scale; MARS-5) two months later; and the QoL scale (Quality of Life in Epilepsy; QOLIE-31) twelve months later. Their antiepileptic drug serum level was measured during the period they completed the MARS. Through structural equation modeling (SEM), we found that religiosity directly correlated with negative religious coping and medication adherence, and indirectly correlated with medication adherence through negative religious coping. Both positive and negative religious coping directly correlated with medication adherence and QoL. Therefore, religiosity and religious coping may be determinants of medication adherence and QoL in PWE; health professionals may consider asking PWE if religion is important to them and how they use it to cope with their epilepsy.

High spirituality may be associated with right hemispheric lateralization in Korean adults living with epilepsy

PURPOSE

Although it is known that epilepsy and spirituality are related, spirituality in epilepsy has received relatively little clinical and scientific attention. Therefore, we investigated which epilepsy-related factors are associated with high spirituality in Korean adults living with epilepsy.

METHODS

This cross-sectional study was conducted in two university hospitals in Korea. Spirituality was assessed using the 6-item Spirituality Self-Rating Scale (SSRS). The participants were categorized into high and low spirituality groups according to the median SSRS score. The presumptive seizure onset zone was determined based on the clinical semiology, electroencephalography, and magnetic resonance imaging findings.

RESULTS

Of the 180 participants, 61.7% declared that they had a religious affiliation. The median SSRS score was 15 (interquartile range: 7, 22). The high spirituality subgroup consisted of 92 (51.1%) participants. In the univariate analyses, the high spirituality group was significantly associated with female sex (p<0.05), older age (p<0.01), longer epilepsy duration (p<0.05), polytherapy (p<0.05), complex partial seizure (p<0.05), levetiracetam or topiramate usage (p<0.05), and a right-lateralized seizure onset zone. The multiple logistic regression analysis identified right hemispheric lateralization as the only independent factor associated with high spirituality (odds ratio: 2.410, 95% confidence interval: 1.051-5.528, p<0.05).

CONCLUSIONS

High spirituality may be associated with right hemispheric lateralization but not with the temporal localization of the seizure onset zone in Korean adults with epilepsy.

„Gesunde“ und leidvolle Religiosität. Versuch einer psychiatrisch-psycho(patho)logischen Abgrenzung

Der vorliegende Artikel charakterisiert „gesunde“ Religiosität und, von klassisch psychiatrischem Standpunkt aus, psychopathologisch relevante Formen und stellt sie einander gegenüber. Auch die jeweiligen Auswirkungen auf das psychische Befinden werden berücksichtigt. Auf den Begriff „Spiritualität“ wird kurz eingegangen. Bei der vorliegenden Problematik sind Verständnis und Empathie besonders wichtig, um den kommunikativen und ggf. therapeutischen Zugang zu Menschen mit devianter Religiosität zu gewinnen.

Neuroanatomical correlates of familial risk-for-depression and religiosity/spirituality

OBJECTIVE

To examine potential neural substrates that underlie the interplay between religiosity/spirituality and risk-for-depression. A new wave of data from a longitudinal, three generation study of individuals at high risk for depression is presented. In addition to providing new longitudinal data, we extend previous findings by employing additional (surface-based) methods for examining cortical volume.

MEASURES PARTICIPANTS AND METHODS

Magnetic resonance imaging (MRI) scans were collected on 106 second and third generation family members at high or low risk for major depression defined by the presence or absence of depression in the first generation. Religiosity/spirituality measures were collected at the same time as the MRI scans and comprised self-report ratings of personal religious/spiritual (R/S) importance and frequency of religious attendance. Analyses were carried out with Freesurfer. Interactive effects of religiosity/spirituality and risk-for-depression were examined on measures of cortical thickness and cortical surface area.

RESULTS

A high degree of belief in the importance of religion/spirituality was associated with both a thicker cortex and a larger pial surface area in persons at high risk for familial depression. No significant association was found between cortical regions and religious attendance in either risk group.

CONCLUSIONS AND RELEVANCE

The results support previous findings of an association between R/S importance and cortical thickness in individuals at high risk for depression, and extend the findings to include an association between R/S importance and greater pial surface area. Moreover, the findings suggest these cortical changes may confer protective benefits to religious/spiritual individuals at high risk for depression.