The role of shame in functional and epileptic seizures

BACKGROUND

Shame, a complex social emotion, may play a clinically important role in seizure disorders. Therefore, this study examined levels of shame aversion & shame proneness and their relationship with various mental health difficulties (MHDs), and seizure frequency & severity in people with functional seizures (PWFS) and epilepsy (PWE).

METHODS

In this cross-sectional study, PWFS (N = 68) and PWE (N = 70) were recruited through a neurology clinic and charities, completed online self-reported measures of shame proneness & aversion, seizure frequency & severity, depression, anxiety, somatic symptoms, and perceived socioeconomic status (PSS). Data analyses involved t-tests, correlations, and moderated regression analyses.

RESULTS

Both PWFS and PWE showed high and equivalent levels of shame aversion & proneness; mean levels of these measures were more than a standard deviation higher in PWFS and PWE, than in non-clinical populations of previous studies. Both groups had clinically high levels of depression and somatic symptoms, but not anxiety, with PWFS having significantly higher levels than PWE. Shame aversion predicted anxiety and depression in both groups, even after controlling for PSS, age, and gender. Interestingly, PSS, a demographic control variable, significantly predicted depression, anxiety, somatic symptoms, and seizure frequency in both groups.

CONCLUSION

We observed high levels of shame and MHDs in PWFS and PWE. Shame aversion predicted anxiety and depression in both groups, even after controlling for demographic variables. Our findings underline the significant role of shame in people with seizures, despite the differences between PWFS and PWE being smaller than expected.

A survey of neuropsychological assessment feedback practices among neuropsychologists

OBJECTIVE

Feedback on neuropsychological assessment is a critical part of clinical practice, but there are few empirical papers on neuropsychological feedback practices. We sought to fill this gap in the literature by surveying practicing neuropsychologists in the United States. Questions addressed how they provide verbal and written feedback to patients and referral sources. Survey questions also addressed billing practices and training in the provision of feedback.

METHODS

A survey was developed using Qualtrics XM to survey currently licensed, independently practicing clinical neuropsychologists in the United States about their feedback practices. The survey was completed by 184 individuals.

RESULTS

Nearly all respondents reported that they provide verbal feedback to patients, most often in-person, within three weeks following testing. Typically, verbal feedback sessions with patients last 45 min. Verbal feedback was provided to referrals by about half of our sample, typically via a brief phone call. Most participants also reported providing written feedback to both the patient and referring provider, most commonly via the written report within three weeks after testing. Regarding billing, most respondents use neuropsychological testing evaluation codes. The COVID-19 pandemic appeared to have had a limited impact on the perceived effectiveness and quality of verbal feedback sessions. Finally, respondents reported that across major stages of professional development, training in the provision of feedback gradually increased but was considered inadequate by many participants.

CONCLUSIONS

Results provide an empirical summary of the "state of current practice" for providing neuropsychological assessment feedback. Further experimental research is needed to develop an evidence-base for effective feedback practices.

Return on Investment and Value Research in Neuropsychology: A Call to Arms†

There is substantial empirical evidence to support the clinical value of neuropsychological evaluation and the incremental value of neuropsychological assessment, suggesting such evaluation is beneficial in the prediction and management of clinical outcomes. However, in the cost-conscious and evolving era of healthcare reform, neuropsychologists must also establish the economic value, or return on investment, of their services. There is already a modest body of literature that demonstrates the economic benefits of neuropsychological evaluation, which is reviewed in the current paper. Neuropsychologists will need to be able to communicate, and develop evidence of, economic value of their services; thus, this paper also discusses common concepts, terms, and models used in healthcare valuation studies. Finally, neuropsychologists are urged to incorporate these financial concepts in their clinical practice and research.

A brief look at diagnosing neurocognitive disorders in a VA primary care setting: Understanding the practices of our physician partners and the future of integration

OBJECTIVE

The population aged 65 and over is growing rapidly and with it are increased demands for integrative care and management of cognitive health issues. Such care models often do not include neuropsychologists or other psychology specialties.

METHODS

In this study, 72 medical charts of VA patients diagnosed with neurocognitive disorders were reviewed using best practice guidelines for diagnosing and managing neurocognitive disorders, adapted from Downs et al. (2006).

RESULTS

Results indicated that physicians typically used clinical judgment through review of medications, blood work within the past year, and a history of symptoms to make diagnostic conclusions. Cognitive assessment and consideration of other reversible causes of cognitive decline (e.g., depression) were less commonly considered.

CONCLUSIONS

The results are discussed in terms of potential implications for neuropsychologists and the integration of neuropsychology and primary care.