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Michaelis R, Schöller H, Popkirov S, Edelhäuser F, Kolenik T, Trinka E, Schiepek G. Psychological precursors of epileptic seizures. Epilepsia 2024; 65:e35-e40. [PMID: 38100099 DOI: 10.1111/epi.17865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 01/14/2024]
Abstract
Psychological stress is the most commonly self-reported precursor of epileptic seizures. However, retrospective and prospective studies remain inconclusive in this regard. Here, we explored whether seizures would be preceded by significant changes in reported stressors or resource utilization. This study is based on high-frequency time series through daily online completion of personalized questionnaires of 9-24 items in epilepsy outpatients and compared responses 1-14 days before seizures with interictal time series. Fourteen patients (79% women, age = 23-64 years) completed daily questionnaires over a period of 87-898 days (median = 277 days = 9.2 months). A total of 4560 fully completed daily questionnaires were analyzed, 685 of which included reported seizure events. Statistically significant changes in preictal compared to interictal dynamics were found in 11 of 14 patients (79%) across 41 items (22% of all 187 items). In seven of 14 patients (50%), seizures were preceded by a significant mean increase of stressors and/or a significant mean decrease of resource utilization. This exploratory analysis of long-term prospective individual patient data on specific stressors and personal coping strategies generates the hypothesis that medium-term changes in psychological well-being may precede the occurrence of epileptic seizures in some patients.
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Affiliation(s)
- Rosa Michaelis
- Witten/Herdecke University, Herdecke, Germany
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Helmut Schöller
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria
- University Hospital of Psychiatry, Psychotherapy, and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Friedrich Edelhäuser
- Witten/Herdecke University, Herdecke, Germany
- Department of Early Rehabilitation, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Tine Kolenik
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria
- University Hospital of Psychiatry, Psychotherapy, and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Neurointensive Care, and Neurorehabilitation, member of the European Reference Network EpiCARE, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience, Salzburg, Austria
| | - Günter Schiepek
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria
- University Hospital of Psychiatry, Psychotherapy, and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
- Faculty of Psychology and Educational Sciences, Ludwig Maximilian University of Munich, Munich, Germany
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Kyte EB, Holth Skogan A, Bjøråsen Baklid Å, Malmgren K, Ozanne A, Alfstad KÅ. Patients' long-term perspectives on gains and losses after temporal lobe resection for epilepsy. Epilepsy Behav 2023; 147:109400. [PMID: 37703614 DOI: 10.1016/j.yebeh.2023.109400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/25/2023] [Accepted: 08/19/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To investigate long-term (>10 years) experiences and overall satisfaction with temporal lobe resections (TLB) for epilepsy. METHODS Eligible participants were identified through the administrative epilepsy surgery registry at Oslo University Hospital. Data were collected through individual, semi-structured interviews with fifty participants. Interview records were analyzed using reflexive thematic analysis. RESULTS Participants' answers were divided into two main themes: "looking back on surgery" and"considering gains and losses from surgery". Most participants expressed satisfaction with having undergone surgery. Nevertheless, postsurgical problems had been encountered, and presurgical hopes had only partly been fulfilled. They described memory and naming problems with a major impact on daily life. Further, they had thoughts about effects on employment, independence, and feelings of loneliness, and expressed a need for more and better preoperative information. CONCLUSIONS Presurgical hopes go beyond seizure freedom and memory and naming problems are experienced lasting many years after surgery in the temporal lobe. Better preoperative information, particularly about unwanted cognitive effects, is of prime importance. By exploring patientś presurgical hopes, a common ground for expectations on surgery may be found along with strategies on how to cope with cognitive difficulties and possible negative life changes.
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Affiliation(s)
- Eli B Kyte
- The National Centre for Epilepsy, Member of the ERN EpiCARE, Oslo University Hospital, Postboks 4950, Nydalen, 0424 Oslo, Norway.
| | - Annette Holth Skogan
- The National Centre for Epilepsy, Member of the ERN EpiCARE, Oslo University Hospital, Postboks 4950, Nydalen, 0424 Oslo, Norway.
| | - Åsne Bjøråsen Baklid
- The National Centre for Epilepsy, Oslo University Hospital, Postboks 4950, Nydalen, 0424 Oslo, Norway
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Blå stråket 7, SE-413 45 Gothenburg, Sweden; Department of Neurology, Member of ERN EpiCare, Sahlgrenska University Hospital, Blå Stråket 7, 413 46 Gothenburg, Sweden.
| | - Anneli Ozanne
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 100, 405 30 Gothenburg, Sweden; Department of Neurology, Member of ERN EpiCare, Sahlgrenska University Hospital, Blå Stråket 7, 413 46 Gothenburg, Sweden.
| | - Kristin Å Alfstad
- The National Centre for Epilepsy, Member of the ERN EpiCARE, Oslo University Hospital, Postboks 4950, Nydalen, 0424 Oslo, Norway.
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Goldberg SB, Anders C, Stuart-Maver SL, Kivlighan DM. Meditation, mindfulness, and acceptance methods in psychotherapy: A systematic review. Psychother Res 2023; 33:873-885. [PMID: 37155740 PMCID: PMC10523914 DOI: 10.1080/10503307.2023.2209694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE : Meditation, mindfulness, and acceptance (MMA) methods have gained popularity among psychotherapists and the public. The impact of these strategies as implemented in treatment packages (e.g., mindfulness-based interventions) has been studied extensively. However, the impact of integrating MMA strategies into individual psychotherapy has not been established. METHODS : To address this gap in the literature, we conducted a systematic review of empirical (quantitative or qualitative) studies investigating the use of MMA methods during individual psychotherapy in adult samples. RESULTS : After reviewing 4671 references, only three studies (one quantitative, two qualitative) met our inclusion criteria. The one experimental study (n = 162) provided no evidence that including mindfulness meditation improved outcomes beyond other active interventions (ds = 0.00-0.12 for effects on general clinical symptoms vs. progressive muscle relaxation and treatment-as-usual, respectively). Two qualitative studies (n = 5 therapist-patient dyads in one study, n = 9 adults in one study) provided preliminary evidence that patients may find MMA methods helpful. CONCLUSIONS : We highlight future directions for work in this area, including clarifying optimal dosage and timing, identifying patient characteristics associated with beneficial or adverse effects, investigating cultural adaptations, and clarifying how MMA constructs can be measured within individual psychotherapy. We conclude by highlighting training recommendations and therapeutic practices.
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Affiliation(s)
- Simon B. Goldberg
- Department of Counseling Psychology, University of Wisconsin – Madison
- Center for Healthy Minds, University of Wisconsin - Madison
| | - Christopher Anders
- Department of Psychological and Quantitative Foundations, University of Iowa
| | - Shannon L. Stuart-Maver
- Department of Psychological and Quantitative Foundations, University of Iowa
- Student Health and Counseling Services, University of California, Davis
| | - D. Martin Kivlighan
- Department of Psychological and Quantitative Foundations, University of Iowa
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Bauer PR, Bronnec MLA, Schulze-Bonhage A, Altenmüller DM, Fuchs T. Seizures as a Struggle between Life and Death: An Existential Approach to the Psychosocial Impact of Seizures in Candidates for Epilepsy Surgery. Psychopathology 2023; 56:417-429. [PMID: 36927809 DOI: 10.1159/000528924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/28/2022] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Mental health comorbidities such as depression and anxiety are common in epilepsy, especially among people with pharmacoresistant epilepsy who are candidates for epilepsy surgery. The Psychology Task Force of the International League Against Epilepsy advised that psychological interventions should be integrated into comprehensive epilepsy care. METHODS To better understand the psychological impact of epilepsy and epileptic seizures in epilepsy surgery candidates, we analysed interviews with this subgroup of patients using Karl Jaspers' concept of limit situations, which are characterised by a confrontation with the limits and challenges of life. These are especially chance, randomness, and unpredictability, death and finitude of life, struggle and self-assertion, guilt, failure, and falling short of one's aspirations. RESULTS In 43 interviews conducted with 15 people with drug-resistant epilepsy who were candidates for epilepsy surgery, we found that these themes are recurrent and have a large psychosocial impact, which can result in depression and anxiety. For some people, epileptic seizures appear to meet the criteria for traumatic events. CONCLUSION Understanding epilepsy and seizures as existential challenges complements the neurobiological explanations for psychological comorbidities and can help tailor psychological interventions to the specific needs of people with epilepsy, especially those who are candidates for surgical treatment.
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Affiliation(s)
- Prisca R Bauer
- Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Marie L A Bronnec
- Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Epilepsy Center, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Dirk-Matthias Altenmüller
- Epilepsy Center, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Thomas Fuchs
- Phenomenological Psychopathology and Psychotherapy, Psychiatric Clinic, Heidelberg University, Heidelberg, Germany
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Bronnec MLA, Altenmüller DM, Fuchs T, Lahmann C, Schulze-Bonhage A, Bauer PR. "What is this strange sensation?" A qualitative exploration of metaphors used to verbalise hard-to-describe experiences by people with epilepsy. Epilepsy Behav 2023; 138:108963. [PMID: 36403424 DOI: 10.1016/j.yebeh.2022.108963] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/07/2022] [Accepted: 10/15/2022] [Indexed: 11/19/2022]
Abstract
Mental health comorbidities are frequent in epilepsy. Consequently, psychotherapy is becoming increasingly important. To address the psychological needs of people with epilepsy (PwE) it is essential to understand the subjective experiences of seizures better. There is little research on how people report seizures, and which psychological representations they have. We conducted a thematic analysis based on 42 (micro-phenomenological) interviews with 15 participants on their experiences of seizures. In these interviews, we identified three categories of seizure descriptions: (1) phenomena related to the body and emotions; (2) the moments that are difficult to describe; and (3) the use of figurative language and metaphors. Paroxysmal physical and psychological sensations were often reported spontaneously by the participants. The moments that were difficult to describe were expressed, among other things, through the use of paradoxes or the report of a 'strange' feeling and led participants to use figurative language. As these metaphors can reveal important information about people's subjective experiences, they were analyzed in detail. We identified the three main types of metaphors that the participants used most frequently: (1) perception, (2) nature, and (3) battle. The theme of battle was most frequently used in different forms and was closely related to the metaphors from the fields of perception and nature, thus representing a key point in the personal experience of seizures. These findings can contribute to developing psychotherapeutic approaches for the treatment of seizure disorders.
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Affiliation(s)
- Marie L A Bronnec
- Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Dirk-Matthias Altenmüller
- Epilepsy Center, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Thomas Fuchs
- Phenomenological Psychopathology and Psychotherapy, Psychiatric Clinic, Heidelberg University, Heidelberg, Germany
| | - Claas Lahmann
- Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Epilepsy Center, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Prisca R Bauer
- Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.
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Oberdhan D, Bacci E, Hill JN, Palsgrove A, Hareendran A. Developing a Conceptual Disease Model of Patient Experiences and Identifying Patient-Reported Clinical Outcome Assessments for Use in Trials of Treatments for Focal Onset Seizures. Neuropsychiatr Dis Treat 2022; 18:611-631. [PMID: 35345602 PMCID: PMC8957350 DOI: 10.2147/ndt.s354031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/09/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To identify concepts important to understanding the experiences of adults with focal onset seizures (FOS) and evaluate clinical outcome assessments (COAs) for measuring these concepts in clinical trials of treatments for FOS. METHODS A search of published qualitative research, clinical trials, and approved product labels for FOS treatments was performed to develop a conceptual disease model (CDM) of patients' experience of living with FOS. Concepts of interest (COI) were selected, and a second literature search was conducted to identify COAs measuring these concepts. Ten COAs were selected and reviewed to document their development process, evidence of measurement properties, and methods for interpreting change scores using criteria proposed in regulatory guidelines for patient-reported outcomes to support label claims. RESULTS Concepts identified from the published literature (13 articles, 1 conference abstract), 24 clinical trials, and 8 product labels were included in a novel CDM. Impacts on physical, cognitive, and social and emotional function were chosen as COI for evaluating treatment outcomes for FOS; the additional concept of social support and coping strategies was chosen to understand patients' lived experiences. From 51 unique COAs identified, 10 were selected based on their potential coverage of the COI; some symptom severity and health-related quality of life (HRQoL) COAs covered multiple COI. Of these 10, 8 COAs evaluated impacts/limitations on physical function, 8 measured social and emotional impacts, and 5 assessed social support and coping strategies. While most assessments had gaps in evidence validating their measurement properties, 2 COAs measuring symptom severity and 1 COA measuring HRQoL had evidence confirming their potential utility in clinical trials to support label claims. CONCLUSION This research provides insights into the experience of patients with FOS and identifies COAs that measure concepts considered to support endpoints in clinical trials for FOS.
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Affiliation(s)
- Dorothee Oberdhan
- Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, MD, USA
| | | | | | - Andrew Palsgrove
- Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, MD, USA
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Michaelis R, Schiepek G, Heinen GM, Edelhäuser F, Viol K. Process-oriented and personalized psychotherapeutic care for epilepsy: Interim results of a feasibility study. Epilepsy Behav 2021; 124:108313. [PMID: 34560360 DOI: 10.1016/j.yebeh.2021.108313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is great scientific and clinical interest in the effective integration of psychological treatments into comprehensive epilepsy care to optimize treatment outcomes and psychosocial functioning in people with epilepsy. Stepped care is a promising approach to accommodate personalized psychotherapeutic care in academic and regular outpatient settings. It aims at providing patients with the most adequate treatment duration, number of sessions, and treatment method while systematically monitoring their treatment processes. METHODS This is an uncontrolled feasibility study of process-oriented and personalized psychotherapeutic care for epilepsy in a naturalistic setting. The objective of this study was to evaluate individual changes of health-related quality of life (QOLIE-31) and psychiatric comorbidity (BDI-II, BSI) in participants by applying the concept of the reliable change index (RCI) to outcomes that were obtained at baseline and six months after the beginning of the intervention. Additionally, we assessed the relationship between outcome scores, the number of attended sessions, and history of childhood trauma by linear regression models. RESULTS Twenty patients [15 women/5 men, median age 48 years (range: 23-73 years)] were recruited. The median number of scheduled sessions was 11 (range: 6-22); there were no drop-outs. After psychotherapy quality of life (QOLIE-31), global distress (BSI) and depression (BDI-II) scores improved significantly (p-values: QOLIE-31: 0.03; BSI: 0.01; BDI-II: 0.01). The largest improvements were achieved for the emotional well-being subscale of the QOLIE-31 (47%, p-value: 0.02), the global severity index of the BSI (83%), and depression severity (BDI-II) (60%). Linear regression models did not reveal any significant association between interim changes, number of attended treatment sessions, and history of childhood trauma. CONCLUSION The results suggest that process-oriented and personalized psychotherapeutic has low attrition and results in improved quality of life and reduced psychiatric symptoms in people with epilepsy. Our findings indicate that responsiveness to psychotherapy is not dependent on the number of attended treatment sessions. Participants with childhood trauma did not need more treatment sessions to achieve an improvement. More research is needed to understand and address mechanisms and precursors of responsiveness to psychotherapy.
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Affiliation(s)
- Rosa Michaelis
- Integrated Curriculum for Anthroposophic Medicine, Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Germany; Department of Neurology, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany; Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany.
| | - Günter Schiepek
- Faculty of Psychology and Educational Sciences, Ludwig-Maximilians-University Munich, Germany; Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria; University Hospital of Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | | | - Friedrich Edelhäuser
- Integrated Curriculum for Anthroposophic Medicine, Institute for Integrative Medicine, Faculty of Health, Witten/Herdecke University, Germany; Department of Neurology, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany; Department of Early Rehabilitation, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Kathrin Viol
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria; University Hospital of Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
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High-frequency monitoring of personalized psychological variables during outpatient psychotherapy in people with seizures: An uncontrolled feasibility study. Epilepsy Behav 2021; 122:108119. [PMID: 34139618 DOI: 10.1016/j.yebeh.2021.108119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/21/2021] [Accepted: 05/28/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND This feasibility study applied the concept of daily systematic monitoring of personalized psychological variables and investigated patients' compliance in order to evaluate if its integration in outpatient psychotherapy is feasible and if patients found the development and daily application of personalized questionnaires user-friendly and useful. METHODS A naturalistic sample of patients with epilepsy (PWE) was enrolled to participate in an outpatient psychotherapy program. A personalized process questionnaire was developed with each patient based on an individual psychological system's model at the outset of therapy. Daily time-stamped self-assessments were collected during outpatient psychotherapy. This process-monitoring was technically realized by an internet-based device for data collection and data analysis, the Synergetic Navigation System (SNS). The reflection of person-specific time series informed by patients' replies to their personalized process questionnaire was integrated in the therapy process. Compliance rates were assessed during a period of six months (i.e., 180 days) after the first entry of the questionnaire [compliance rate = (number of completed questionnaires/180) × 100]. User-friendliness and usefulness of this process monitoring were evaluated quantitatively. RESULTS Twenty patients [15 women/5 men, median age 48 years (range 23-73 years)] were recruited. Compliance rates were high (median: 93%, range 31-100%) among the participants. Participants reported a high overall satisfaction with the application and user-friendliness of SNS. CONCLUSION The results support the feasibility of high-frequency monitoring of personalized psychological processes during outpatient psychotherapy. Repeated daily assessments of a personalized questionnaire yield highly resolved, equidistant time series data, which gives insight into individual psychological processes during outpatient psychotherapy.
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Mlinar S, Rener Primec Z, Petek D. Psychosocial Factors in the Experience of Epilepsy: A Qualitative Analysis of Narratives. Behav Neurol 2021; 2021:9976110. [PMID: 34354774 PMCID: PMC8331301 DOI: 10.1155/2021/9976110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/20/2021] [Accepted: 07/15/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Epilepsy is a complex disease. The consequences of epilepsy are varied and manifested in all aspects of people with epilepsy's (PWE) lives. The purpose of this study was to define individual experiences of epilepsy, expressed in narratives, and to find the stem of each narrative-a core event in the PWE's experience of the disease around which they structure their overall narrative. METHOD A qualitative, phenomenological research method was used. We conducted semistructured interviews with 22 PWE and analysed the content using a combination of inductive and deductive methods, based on which we determined the stem narratives. RESULTS The stem narrative of the epilepsy narrative is an important life experience of PWE. We divided the stem narratives into four groups: lifestyle changes, relationship changes, the consequences of the inciting incident, and the limitations of the disease. In our study, we found that the stem narrative was, in all but one case, a secondary (psychosocial) factor resulting from epilepsy, but not its symptom (epileptic seizure). The stem narrative, where aspects of life with epilepsy are exposed, points to a fundamental loss felt by PWE. CONCLUSION The narrative of the experience of epilepsy has proven to be an important source of information about the disease and life of PWE and also about the aspects at the forefront of life with epilepsy. The secondary epilepsy factors that we identified in the stem narratives were the greatest burden for PWE in all cases but one.
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Affiliation(s)
- Simona Mlinar
- University of Ljubljana, Faculty of Medicine, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Zvonka Rener Primec
- University of Ljubljana, Faculty of Medicine, Department of Child, Adolescent and Developmental Neurology, Children's Hospital, University Medical Centre, Bohoričeva 20, 1000 Ljubljana, Slovenia
| | - Davorina Petek
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000 Ljubljana, Slovenia
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Gao Y, Shan Y, Wang S, Li X, Jiang T, Cai L, Jiang X, Wang H. Decisional control preference among Chinese patients with advanced kidney disease: the role of mastery, perceived social support and self-efficacy. PSYCHOL HEALTH MED 2021; 27:2126-2137. [PMID: 34241551 DOI: 10.1080/13548506.2021.1952282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Although previous studies have shown a correlation between mastery, self-efficacy, and perceived social support among Chinese patients with advanced kidney disease, few studies have examined their relationship pathways. This study aimed to examine decisional control preference and the relationship between mastery, perceived social support, and self-efficacy among patients with advanced chronic kidney disease. A cross-sectional survey was conducted, and 350 participants were investigated using Control Preference Scale, Personal Mastery Scale, Perceived Social Support Scale, and Self-efficacy Scale. The mediating relationships were determined via structural equation modeling. Results showed that education and economic status were demographic factors influencing patients' decisional control preference. The model showed that mastery and self-efficacy had a direct effect on decisional control preference while perceived social support had an indirect effect mediated via mastery and self-efficacy. Therefore, improving self-efficacy can increase patient willingness to involve in medical decision-making. This study provides new interventions and future directions for promoting decisional control preference.
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Affiliation(s)
- Yajing Gao
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Yan Shan
- Medical College of Zhengzhou University
| | | | - Xue Li
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | | | - Li Cai
- Renji Hospital Affiliated to Shanghai Jiao Tong University
| | - Xinxin Jiang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Hong Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
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Rösche J, Dudek MIR, Kohnen O. [Self-induced epileptic seizures: Prevalence, Causes and Treatment]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 90:147-162. [PMID: 34198356 DOI: 10.1055/a-1484-0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Self-induced seizures were first described in 1827. A majority of authors found that in unselected patients with epilepsy, the prevalence rate of these seizures was 1%. In patients with photosensitive epilepsy, there was roughly a 25% prevalence. Apart from visual stimulation, many other mechanisms of self-induction have been described. A feeling of pleasure or relaxation during seizures may be a reason for self-inductive behaviour. But often the procedure of self-induction is experienced as involuntary. Treatment is always difficult. Behavioral therapy has been proven effective in some patients. In patients with photosensitive epilepsy, sunglasses are recommended. Fenfluramine, clonazepam and valproate seem to be a bit more effective than other drugs. After all, the treatment effect depends on the motivation of the patient to change the condition.
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Affiliation(s)
- Johannes Rösche
- Klinik, Hephata Diakonie, Schwalmstadt-Treysa, Germany.,Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock, Rostock, Germany
| | - Maria Iracema Rocha Dudek
- Klinik für Psychiatrie und Psychotherapie/Ludwig-Noll-Krankenhaus Klinikum Kassel GmbH, Kassel, Germany
| | - Oona Kohnen
- Schweizerische Epilepsieklinik, Klinik Lengg AG, Zürich, Switzerland
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Nicholson TR, Carson A, Edwards MJ, Goldstein LH, Hallett M, Mildon B, Nielsen G, Nicholson C, Perez DL, Pick S, Stone J, Aybek S, Baslet G, Bloem BR, Brown RJ, Chalder T, Damianova M, David AS, Epstein S, Espay AJ, Garcin B, Jankovic J, Joyce E, Kanaan RA, Kozlowska K, LaFaver K, LaFrance WC, Lang AE, Lehn A, Lidstone S, Maurer C, Morgante F, Myers L, Reuber M, Rommelfanger K, Schwingenshuh P, Serranova T, Shotbolt P, Stebbins G, Tijssen MAJ, Tinazzi M. Outcome Measures for Functional Neurological Disorder: A Review of the Theoretical Complexities. J Neuropsychiatry Clin Neurosci 2020; 32:33-42. [PMID: 31865871 DOI: 10.1176/appi.neuropsych.19060128] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The development and selection of optimal outcome measures is increasingly recognized as a key component of evidence-based medicine, particularly the need for the development of a standardized set of measures for use in clinical trials. This process is particularly complex for functional neurological disorder (FND) for several reasons. FND can present with a wide range of symptoms that resemble the full spectrum of other neurological disorders. Additional physical (e.g., pain, fatigue) and psychological (e.g., depression, anxiety) symptoms are commonly associated with FND, which also can be highly disabling with implications for prognosis, and warrant concurrent assessment, despite an unclear etiological relationship with FND. Furthermore, several unique clinical aspects of FND make it likely that the usual prioritization of "objective" (or clinician-rated) over "subjective" (or patient-rated) measures might not be appropriate. Self-report measures may be more clinically meaningful in this patient population. Despite being a common and disabling disorder, there has been little research into outcome measures in FND, and to date trials have largely used measures designed for the assessment of other disorders. An international FND Core Outcome Measure group (FND-COM) has been established to develop a consensus battery of outcomes for FND: a "core outcome set." In this perspective article, the authors reviewed the process of outcome measure development and selection before considering the specific features of FND affecting the development of a core outcome set, as well as a research agenda to optimize outcome measurement in this complex neuropsychiatric disorder.
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Affiliation(s)
- Timothy R Nicholson
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Alan Carson
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Mark J Edwards
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Laura H Goldstein
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Mark Hallett
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Bridget Mildon
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Glenn Nielsen
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Clare Nicholson
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - David L Perez
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Susannah Pick
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Jon Stone
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
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- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
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Martin D. 100-Year Anniversary of Anthroposophic Medicine as an Integrative Medical System. Complement Med Res 2020; 27:375-378. [DOI: 10.1159/000511668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 09/18/2020] [Indexed: 11/19/2022]
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Michaelis R, Meyer S, Reuber M, Schöne C. Development of a patient-reported outcome measure for psychotherapeutic interventions in people with seizures: A mixed methods study. Epilepsy Behav 2019; 99:106464. [PMID: 31421518 DOI: 10.1016/j.yebeh.2019.106464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/28/2019] [Accepted: 07/28/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Generic or even disease-specific quality of life measures are unlikely to be equally responsive to different epilepsy treatment modalities, such as pharmacotherapy, surgery, or psychotherapy. The purpose of the present study was to summarize the development of a patient-reported outcome measure (PROM) designed to be particularly sensitive to change mediated by psychotherapeutic interventions in people with seizures. METHODS The development of this instrument involved seven steps: (1) Development of a candidate item set based on the outcome of previous qualitative research, (2) initial quantitative-descriptive study yielding an assessment of content validity by clinical experts, (3) qualitative-descriptive posttherapy cognitive debriefing interviews with patients with epileptic and/or nonepileptic seizures (NES), (4) English translation, (5) elicitation of qualitative feedback from international experts, (6) assessment of internal consistency and correlation with similar previously validated generic and epilepsy-specific measures in a pilot study, and (7) final expert content validity rating. RESULTS (1) The candidate item set comprised 29 stem items; five of which were followed by a follow-up (FU) item that refers to the statement of the stem item. (2) Eight clinical experts assessed content validity. Informed by rating and experts' qualitative comments, 15 items remained unchanged, eleven underwent substantial revisions, three were excluded, and six added. (3) Cognitive debriefing interviews were conducted with 14 patients with epilepsy and/or NES. Based on the interviewees' feedback, 29 of 32 items remained unchanged, two were excluded, one reworded, and four added. (4) The forwards-backwards English translation prompted substantial revision of two items because the verbatim back translation of the corresponding English items was conceptually more convincing than the original German wording. (5) The international experts identified problems with item comprehensibility/clarity of four stem and three FU items that were subsequently reworded. Ten items were added to incorporate their qualitative feedback resulting in a total of 44 items. (6) Thirty-one patients with epilepsy participated in the pilot study. The overall internal consistency of the self-Efficacy, Assertiveness, Social support, self-awareness, and hElpful thinking in people with seizures (EASE) was very good (α = 0.92). Analysis at item-level revealed problems with inverted and self-evident items. Based on this analysis, three items were eliminated and two items were revised (one FU item was turned into a stem item) resulting in a total of 42 items. (7) The second content validity rating showed final item-content validity indices (I-CVIs) between 0.38 and 1 and an excellent mean CVI of 0.92 at scale level (S-CVI/ave). Fourteen stem items were substantially revised by incorporating the experts' qualitative feedback, three items with low I-CVIs were excluded, and one item was added. The final questionnaire consisted of 40 stem items; eight of which include at least one FU item. CONCLUSION Based on these results, the EASE is valid in terms of content, internally consistent, clear, and acceptable to patients with seizures. The measure has now been developed to the stage at which the validity and reliability as well as the psychometric properties and factorial structure of the new instrument can be assessed in larger patient groups in a prospective clinical study.
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Affiliation(s)
- Rosa Michaelis
- Department of Neurology, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany; Integrated Curriculum for Anthroposophic Medicine (ICURAM), Witten/Herdecke University, Herdecke, Germany.
| | - Stephanie Meyer
- Department of Psychology, University of Kassel, Kassel, Germany
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Catrin Schöne
- Hephata Klinik Schwalmstadt-Treysa, Schwalmstadt-Treysa, Germany
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