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

OBJECTIVE: A person's health locus of control orientation is one of several factors that determine which health-related behaviors a person will perform. The aim of this study was to determine the health locus of control in patients with epilepsy and its relationship to anxiety, depression, and seizure control. METHODS: Adults aged 18 and older who had had epilepsy for at least 1 year were recruited in either the inpatient epilepsy monitoring unit or the outpatient epilepsy clinic at Thomas Jefferson University in 2006. Patients anonymously filled out a questionnaire, which elicited data on age, sex, education, and seizure control. The Hospital Anxiety and Depression (HAD) scale was used to evaluate anxiety level and depression, and Form C of the Multidimensional Health Locus of Control (MHLC) scales was used to evaluate the health locus of control. Statistical analyses were performed using regression analyses to determine potentially significant associations. RESULTS: Two hundred patients with a mean age of 40.3 +/- 16 participated. Patients had low mean scores on the Internal, medium mean scores on the Chance, and high mean scores on the Powerful Others MHLC subscales. Patients with epilepsy with higher Internal MHLC scores more frequently had controlled seizures. Patients with higher Powerful Others MHLC scores had higher scores on the Anxiety subscale of the HAD scale. CONCLUSIONS: Patients with epilepsy in our study had weak perceptions of internal and strong perceptions of external health locus of control. This probably means patients with epilepsy might adapt less effectively to their illness and have lower levels of engagement in beneficial health behaviors and active coping strategies.     

The relative impact of anxiety, depression, and clinical seizure features on health-related quality of life in epilepsy

PURPOSE: To determine the independent effects of depression and anxiety on health-related quality of life (HRQOL) in epilepsy as well as the relative explanatory power of psychiatric comorbidity compared with demographic and clinical epilepsy variables (e.g., seizure frequency, severity, and chronicity). METHODS: Subjects (n = 87) with temporal lobe epilepsy completed self-report measures of depression, anxiety, HRQOL, and seizure severity. Information was derived regarding subjects' seizure frequency, duration, and treatment. HRQOL status (QOLIE-89) was examined in relation to self-reported symptoms of anxiety and depression, clinical seizure features, and demographic characteristics. RESULTS: Depression and anxiety were independently associated with reduced HRQOL. Psychiatric comorbidity explained more variance in HRQOL than did combined groups of clinical seizure or demographic variables. Although weaker in explanatory power than psychiatric comorbidity, several epilepsy factors were nonetheless significantly related to HRQOL, including seizure frequency, severity, and chronicity. CONCLUSIONS: Interictal anxiety and depression exert independent adverse effects on HRQOL. In addition, frequent, severe, and chronic seizures reduce HRQOL, but appear less powerful predictors of HRQOL than interictal psychiatric symptoms. Recognition and treatment of comorbid depression and anxiety is an important consideration in improving quality of life in epilepsy.     

Relation between anxiety, depression and locus of control of patients with multiple sclerosis

This study was concerned with examining relation between anxiety, depression and locus of control (LC) in Croatian multiple sclerosis (MS) patients in order to determine an indication for psychotherapeutic intervention. The participants were 457 MS patients attending central state medical rehabilitation program at VaraZdinske Toplice, asked to fill in the locus of control inventory and Crown-Crisp Experiential Index (CCEI) questioner of personality in the clinical setting. In order to determine whether locus of control changes along natural course of MS, patients were grouped according to the duration of the disease: less than five years, five to 10 years and more than 10 years. The results demonstrated that 405 (88.6%) MS patients exhibited external locus of control while 52 (11.4%) had internal locus of control. Moreover, as the disease progressed, locus of control shifted more to externality. Analysis of gathered data confirms connectivity of external locus of control with anxiety and depression. Results of anxiety and depression level on CCEI questionnaire show continuously increased values regardless on duration of illness. Croatian MS patients like other chronically ill externally oriented patients' show more maladaptive behaviour, which has been strongly linked to anxiety and depression and this, is indication for psychotherapeutic support.     

The relationship of seizure focus with depression,anxiety, and health-related quality of life in children and adolescents with epilepsy

For youth with epilepsy, comorbid psychiatric conditions, such as depression and anxiety, require further examination as they carry increased risk for reduced health-related quality of life (HRQOL). The current study assessed whether rates of depression, anxiety, and withdrawal behaviors differed based on seizure location. Data included parental ratings on the Behavior Assessment System for Children (BASC-2) and the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire for 132 children and adolescents (mean age = 11.34, SD = 3.95) with generalized or partial (i.e., frontal [FLE] or temporal lobe epilepsy [TLE]) epilepsy. Our results identified clinically significant internalizing psychopathology in nearly half of our sample (41%). Although rates of internalizing behavior were similar between generalized and partial groups, children and adolescents with TLE demonstrated higher rates of depression compared to youth with FLE. No effects of laterality on internalizing behaviors were identified between TLE and FLE groups. Finally, for youth with TLE, parental depression ratings along with current number of antiepileptic medications (AEDs) were found to be significant barriers to HRQOL above and beyond anxiety, withdrawal, and epilepsy-specific variables. Temporal lobe epilepsy was associated with a two-fold risk of clinically significant depression ratings. These findings highlight the high prevalence of internalizing psychopathology features in pediatric epilepsy and offer further support for the relationship between depression and TLE in children and adolescents with epilepsy.     

Anxiety sensitivity,anxiety, and depression in older patients and their relation to hypochondriacal concerns and medical illnesses

This study examined the role of anxiety sensitivity (the fear of anxiety symptoms because such symptoms are believed to have harmful consequences), anxiety, and depression in older adults and their relation to hypochondriacal concerns and medical illnesses. The sample included 53 clinic-referred ( M age = 78.8 years), and 53 non-clinic referred ( M age = 70.9 years) older adults. It was examined whether (1) anxiety sensitivity was elevated in the clinic-referred group relative to the non-referred group, (2) symptoms of anxiety, anxiety sensitivity and depression were related to number of medical illnesses and/or to hypochondriacal concerns, and (3) anxiety sensitivity was a better predictor of hypochondriacal concerns relative to depression or trait anxiety. The results indicated that anxiety sensitivity was significantly elevated in the clinic-referred group relative to the non-clinic referred group, was negatively associated with history of medical illnesses, was strongly associated with hypochondriacal concerns, and was a better predictor of hypochondriacal concerns than depression and trait anxiety. The findings are discussed in terms of problems facing older adults as they relate to the constructs of anxiety sensitivity and hypochondriacal concerns.     

Repertoires of response to potential precipitants of depression.

A study that would appear to overcome two weaknesses in previous investigations of what have been termed 'antidepressive behaviours' is reported, from patients routinely attending two general practices. Questionnaires were designed to measure such behaviours and their reported effectiveness in response to potential precipitants of depression. While the subjects revealed no sex differences on a trait depression measure, in previous recourse to professional help for depression, or in their appraisal of two given situations, a number of sex differences in their reported antidepressive responses were found. Females scored as less reckless, and they scored higher on help-seeking and self-consolation dimensions ; they were also less likely to regard reckless behaviours as being effective. Higher social class was associated with higher scores on the self-consolation behavioural dimension and in higher scores on socializing. Younger subjects scored higher on socializing and found reckless behaviours more effective than did the older subjects.     

Difference in anxiety symptoms between children and their parents facing a first seizure or epilepsy

Many studies have shown that anxiety disorders are common in children with epilepsy. We explored symptoms of anxiety simultaneously in children and their parents. We conducted a cross-sectional study using the Revised Children's Manifest Anxiety Scale in children and the State-Trait Anxiety Inventory for Adult in parents. We included 118 parents and 67 children, who were divided into three groups: (1) first seizure, (2) epilepsy, and (3) nonepileptic paroxysmal event. We found that the level of anxiety in parents and children differed. We observed a significant increase in the anxiety level of parents whose children have had a first seizure, while we found a significant increase in the anxiety level of children and adolescents followed for epilepsy. These findings suggest that there is no direct relationship in the anxiety of the parents and their child. Further studies are needed to understand this variation over time.     

A prospective study of anxiety with respect to seizure outcome after epilepsy surgery.

PURPOSE: To evaluate if degree of anxiety proneness is affected by seizure outcome after epilepsy surgery. METHODS: Five scales related to anxiety, which are part of the Karolinska Scales of Personality (KSP), were administered pre-operatively and 2-8 years post-operatively to 31 female and 26 male patients. High scores indicate a high degree of anxiety. Seizure outcome was either Engel I or Engel II-IV. RESULTS: Mean age of the patients was 39 years (S.D. 10). Forty-seven patients had temporal surgery and 10 patients had extra-temporal surgery. The outcome in 34 patients was classified as Engel I and in 23 patients as Engel II-IV. There were statistically significant decreases (paired t test) in t scores for the Somatic Anxiety scale (expected mean 50, from 55.4 to 50.2, P = 0.001) and the Psychic Anxiety scale (expected mean 50, from 56.2 to 51.6, P = 0.006) in patients in Engel I. No other significant differences were observed. After taking baseline imbalances into account (ANCOVA), there were no statistically significant differences in the change in degree of anxiety proneness between patients in the two outcome groups. CONCLUSION: Patients undergoing successful epilepsy surgery experienced small decreases in somatic anxiety and psychic anxiety. Since there were important pre-operative imbalances between the two outcome groups, these differences could not be attributed to the effect of seizure freedom after epilepsy surgery.     

Influences on anxiety in later life: The role of health status,health perceptions,and health locus of control

This study examined the linkages between health status, health perceptions and health locus of control, and three dimensions of anxiety in a group of community-dwelling elders (N=91). Findings show that whereas medical conditions (e.g. high blood pressure, diabetes) did not relate to anxiety, poorer actual and perceived health were related to increased distress and hypochondriacal concerns. Both internal and external (i.e. powerful others, chance) locus of control over health were differentially predictive of anxiety. Loss of internal control and attributions of control to chance increased distress, attribution to powerful others and chance increased anxiety sensitivity, and attributions to powerful others and health perceptions increased hypochondriasis. Findings are discussed in terms of the relative influence of biological (i.e co-morbid) and psychosocial (i.e. reactive) factors in the experience of anxiety in later life. Potential implications with respect to psychosocial interventions are discussed.     

The impact of depression,seizure variables and locus of control on health related quality of life in a community dwelling sample of older adults

Few studies have examined the impact of epilepsy on the quality of life of older people, although epilepsy is one of the most common neurological disorders of old age. This study investigated the association of depression, seizure type and frequency and locus of control on health related quality of life in community dwelling adults aged over 60 years. Sixty-four participants were administered a clinical diagnostic interview to assess depression and dysthymia, and completed measures of HRQOL (QOLIE-31), locus of control and provided information on seizure variables. Depression, dysthymia and more frequent seizures were important predictors of HRQOL, accounting for 63% of the variance, with dysthymia the strongest individual predictor of impaired HRQOL. This study has highlighted the negative consequences of depression, dysthymia and seizure frequency on HRQOL for older people with epilepsy. Importantly, these results indicate that rather than major depression, it is the more chronic symptoms of dysthymia that are most disruptive of HRQOL. Seizure frequency, but not seizure type, was also associated with reduced HRQOL. The results of this study suggest that clinical treatment in late adulthood should address seizure control while concurrently focusing on the management of depressive symptomatology to improve overall HRQOL.     

Defensive flexibility and its relation to symptom severity, depression, and anxiety

Numerous studies have examined which individual defense mechanisms are related with mental health, and which are linked with psychopathology. However, the idea that a flexible use of defensive mechanisms is related to psychological wellbeing remained a clinical assumption, which this study sought to test empirically. A total of 62 (N = 62) outpatients participated in the study and were assessed with the Symptom Checklist-90R and the Social Adjustment Self-rated Scale. A subsample of 40 participants was further assessed using the Hamilton Depression (HAMD-21) and Anxiety scales (HAMA-21). The first therapy session of all participants was transcribed and rated using the Defense Mechanisms Ratings Scales (), and the Overall Defensive Functioning (ODF) score, which indicates the maturity of one's defensive functioning, was computed. An indicator of flexible use of defenses was also calculated based on the Gini Concentration C measure. Results showed that defensive flexibility, but not ODF, could predict anxiety scores. Symptom severity was predicted by both ODF and defensive flexibility, although in directions opposite to our predictions. Results suggest that defensive flexibility captures another aspect of an individual's functioning not assessed by the ODF, and that it is a promising new way of documenting defensive functioning.     

Symptoms of anxiety and depression in childhood absence epilepsy

Childhood absence epilepsy (CAE) has been recently linked to a number of cognitive, behavioral, and emotional disorders. Identification of affective disorders (anxiety and depression) presents unique challenges in pediatric populations, and successful early intervention may significantly improve long-term developmental outcomes. The current study examined the specific anxiety and depression symptoms children with CAE experience, and explored the role of disease factors in the severity of their presentation. Forty-five subjects with CAE and 41 healthy matched controls, ages 6-16 years, participated in the study. The Behavior Assessment System for Children (BASC) was completed by parents, and the Anxiety and Depression subscales were used to characterize problems. Item analysis within the subscales revealed that children with CAE demonstrated higher rates of symptoms of anxiety (nervousness and thought rumination) and depression (sadness and crying), as well as more general psychosocial problems including isolation and low self-esteem. Disease duration, intractability, and medication effects were not associated with higher rates of affective problems in this limited patient sample. Screening of patients with CAE for comorbid psychiatric disorders early by focusing on specific symptom profiles unique to this population may enhance overall treatment and developmental outcomes.     

A psychosocial view of anxiety and depression in epilepsy

The aim of this study was to study anxiety and depression in patients with epilepsy and evaluate their relationships with neuroepilepsy and psychological variables. neuroepilepsy and psychological variables. Sixty patients and 60 healthy subjects were interviewed at the outpatient clinic for epilepsy, using the Beck Depression Inventory and State-Trait-Anxiety Inventory. The objective of the semistructured interview was to identify the patients' perception of the disease, self-concept, personal strategies, and perception of seizure control. There was a significant difference in anxiety and depression between the groups, as well as a strong relationship between perception of seizure control and depression and anxiety, independently assessed. Epilepsy was associated with disease (63.4%), mental problems (11.6%), feelings of shame, fear, worry, and low self-esteem (56.6%), and perception of stigma (26.6%). The strategies were: looking for social support, seeking medical treatment, withdrawal, denial, and spiritual support. There was a significant association between psychological symptoms and perception of seizure control, which reinforces the importance of subjective aspects involved in epilepsy.     

癫(疒间)患者焦虑抑郁情绪研究

目的:探讨癫(疒间)患者焦虑抑郁情绪的有关因素. 方法:80例成年癫疒间患者,前期诊疗不规范,采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评估. 结果:癫疒间合并焦虑情绪者25%,合并抑郁情绪者45%.多因素回归分析结果显示,病程越长,发作程度越严重,男性患者更易产生焦虑情绪,而居住在农村的癫疒间患者更易产生抑郁情绪. 结论:癫疒间患者焦虑抑郁情绪明显高于正常人群,性别、病程、发作严重程度和生活居住地是影响癫疒间患者焦虑抑郁情绪的独立危险因素.     

癫患者焦虑抑郁情绪研究

目的：探讨癫癎患者焦虑抑郁情绪的有关因素。方法：80例成年癫癎患者，前期诊疗不规范，采用焦虑自评量表（SAS）和抑郁自评量表（SDS）评估。结果：癫癎合并焦虑情绪者25％，合并抑郁情绪者45％。多因素回归分析结果显示，病程越长，发作程度越严重，男性患者更易产生焦虑情绪，而居住在农村的癫癎患者更易产生抑郁情绪。结论：癫癎患者焦虑抑郁情绪明显高于正常人群，性别、病程、发作严重程度和生活居住地是影响癫癎患者焦虑抑郁情绪的独立危险因素。     

The relation of essential hypertension to feelings of anxiety, depression and anger

Franz Alexander (1939) offered the hypothesis a number of years ago that hypertension can result from the inhibition of feelings of anger. Although a great deal of research has been done to test this hypothesis, the results remain equivocal. Part of the difficulty is that usually only anger was examined, making it impossible to determine the extent to which the results were specific to anger and not general for other negative emotions. A second prevalent problem has been the failure to match hypertensive and control groups on demographic variables that may be relevant to the relationship of hypertension to anger and its expression, such as education, economic level, and age. A third problem is that most studies have investigated only male hypertensives, thereby limiting the generality of the findings. The present study compares male and female hypertensives with carefully matched controls on measures of anxiety, depression, and anger and its suppression.     

Sleeping difficulties in relation to depression and anxiety in elderly adults

In Europe, 10-20% of all women and 3-10% of all men have experienced sexual abuse before the age of 18, according to surveys. Psychosocial problems are often seen as both short- and long-term consequences of such abuse. Family dysfunction may be seen as both a risk factor for abuse and a result of the disclosure of abuse. The aim of this research was to study how adolescents and adults, sexually abused during their childhood, experienced their family life and family climate in their family of origin. A clinical sample of 18 adolescent girls and 20 adult women comprised the study group. The methods used were a semi-structured interview and the questionnaire Family Climate Test. The majority of the participants kept quiet about the abuse during their childhood. The abuse took place for an average of 2.5 years among the adolescents and 6 years in the adult group. Secrecy, isolation and family problems were typical attributes in the interviews. The majority of both adolescents and women described their relationships in the family of origin as deviant or interrupted, with a reversed (negative) pattern on the Family Climate Test. This meant a low level of closeness and a high level of distance in the families combined with a low level of spontaneity and a high level of chaos. The study, even if relatively small and based on clinical cases, gives support to earlier research, which shows that sexual abuse in general, but especially intra-familial sexual abuse, is associated with family dysfunction.