癫痫全身性强直阵挛发作患儿心理障碍及干预研究

目的研究全身性强直阵挛发作(GTCS)癫痫患儿的心理状态及影响因素、并给予干预措施.方法应用癫痫患儿生活质量量表对146例GTCS患儿进行心理评估,分析影响因素;并通过癫痫科普知识讲座和个别咨询相结合的方法对GTCS患儿进行心理干预.结果①65.1%(95/146)的GTCS患儿存在心理障碍,主要表现为对发作及药物副作用的担忧、生活满意度低、情绪和精力差、认知功能及社会能力低下;与正常儿童相比除生活满意度无显著性差异外,其余各项及生活质量总分均显著低下,P<0.05或<0.01.②智商、药物治疗及检测年龄对心理状态有明显影响.③干预后患儿心理状态明显改善,有各项心理障碍者的例数由干预前的64%(57/89)～92.1%(82/89)分别减少至干预后的21.3%(19/89)～51.7%(46/89),前后对比差异极为显著,P均<0.01.未经干预患儿的心理状态无显著改善.结论癫痫患儿存在心理障碍,抗癫痫药物和心理治疗不能相互替代,只有二者的综合治疗才是有效控制发作、改善患儿心理状态、提高患儿生活质量的根本途径.     

地中海贫血患儿父母心理社会状况调查

目的：了解地中海贫血患儿父母心理社会健康状况。方法：采用晤谈方式,结合自编“地中海贫血患儿父母调查问卷表”和“临床症状自评量表(SCL-90)”对3组地中海贫血患儿父母212例,其中轻型贫血组46对父母,92人;中间型贫血组35对父母,70人;重型贫血组25对父母,50人。进行调查,并将其SCL-90的评定结果与健康儿童父母对照组比较。结果：132例(62.3%)缺乏本病基本知识,对贫血现象存在许多误解;189例(89.2%)担心患病子女的生长发育受影响,甚至会过早夭折;176例(83.0%)对子女患病表示内疚、自责;126例(59.4%)不愿公开病情,害怕受到社会歧视;重型贫血组30例(60.0%)父母工作深受影响,48例(96.0%)缺乏足够经济支持,治疗信心不足。与对照组比较,SCL-90总均分及焦虑和抑郁两因子分值在3组中均明显升高(P<0.05);另外,在重型组除偏执和精神病症因子外,大部分因子分值升高,其中以总均分及躯体化、强迫症状、人际关系、敌对、恐怖等因子明显高于另外两组(P<0.05)。结论：地中海贫血患儿父母存在广泛的心理社会健康问题。     

慢性病儿童应激源 应对方式及心理状态的研究

目的：在治疗慢性病儿童的同时,了解患儿的应激源、应对方式及心理状态,对于帮助他（她）们更好地应对慢性病的挑战、适应慢性病的状态是非常有帮助的。该研究旨在了解我国慢性病儿童的应激源、应对方式、心理状态及其影响因素,为儿科工作者提供信息,为临床干预提供依据。方法：对203名8~16岁慢性病儿童进行调查,采用半结构访谈方式了解其应激源,采用CODI自评应对方式量表、儿童焦虑性情绪障碍筛查表（SCARED）、儿童抑郁障碍自评量表（DSRSC）了解其应对方式及焦虑、抑郁状态。 结果：①患儿应激源主要包括学习、疾病治疗、日常生活、与同学/伙伴关系4个方面。②患儿最常采用的应对方式是“幻想”,其次是“接受”,“负性情绪反应”使用率最少。③慢性病儿童焦虑、抑郁量表得分均高于常模。被调查者中,43.8%患儿存在焦虑障碍,30.0%存在抑郁障碍,26.1%同时存在焦虑和抑郁障碍。 结论：慢性病儿童应激源较多,虽然相对较多采用积极应对方式,但其焦虑障碍和抑郁障碍仍比较普遍而且严重,应引起关注。     

癫痫患儿的心理障碍和心理干预的效果

目的 了解癫痫患儿的心理障碍情况,研究对其心理干预的效果。方法 应用癫痫生活质量量表,对２０６例癫痫患儿的心理状态进行评估,在抗癫痫药物治疗的同时,以多种心理咨询方式对患儿进行心理干预。结果 ７０．８％的患儿存在不同程度的心理障碍,２０６例患儿中对发作担忧者１４６例（７０．９％）,对生活不满意者１４１例（６８．５％）,情绪抑郁者１７８例（８６．４％）,精力状态不佳者１７２例（８３．５％）,自感认知     

癫(癎)患儿共患情绪与行为障碍及其对生活质量的影响

目的 观察癫癎患儿的抑郁、焦虑障碍、注意缺陷多动障碍(ADHD)症状的共患率,分析相关影响因素及其对患儿生活质量的影响.方法 对142例8～16岁不同类型癫癎患儿进行神经心理评估,对100例正在服药的患儿进行美国癫癎患者生活质量量表(QOLIE-31)问卷测试,观察共患情绪、行为障碍状况及影响因素.结果 (1)癫癎患儿情绪、行为障碍症状的共患率:142例癫癎患儿,共患一种或以上情绪、行为障碍者82例,占57.7%,其中抑郁、焦虑障碍及ADHD症状患病率分别为14.8%、44.4%及17.6%.(2)情绪、行为共患病的影响因素:共患病与性别、年龄及与癫癎疾病相关诸因素均无明显相关,共患病间存在相互影响.(3)共患病对癫痫患儿生活质量的影响:共患病组患儿总的生活质量及7个分项的分值均明显低于无共患病组(P<0.05).结论 癫癎儿童的抑郁、焦虑障碍及ADHD共患率颇高,与性别、年龄及癫癎疾病相关诸因素无明显相关,共患病间可互为影响因素,共患病是导致癫癎患儿生活质量低下的重要因素之一,故应对癫癎患儿进行全面的神经心理评估,在控制发作的同时治疗共患的情绪、行为障碍,以提高癫癎患儿的生活质量.     

癫痫儿童的心理障碍

癫痫儿童的心理障碍是影响其生活质量的重要因素。本文就学龄期癫痫儿童的心理状态、影响因素及干预措施进行综述。     

哮喘儿童及家长心理健康状况调查

目的 了解哮喘儿童及其家长的心理健康状况.方法 采用艾森克人格问卷(儿童)、Rutter's儿童行为量表(父母问卷)对36例6～14岁哮喘儿童进行个性、行为心理测试.采用90项症状自评量表(SCL-90)对其家长进行心理卫生状况调查.结果 哮喘儿童E、N值均高于正常对照组(P<0.05),行为问题发生率为33.3%,哮喘家长SCL-90各项因子分均高于对照组,以抑郁、焦虑、躯体诉述及恐怖因子得分最明显(P<0.05).结论 哮喘儿童及家长的心理问题均较健康对照人群高,应引起高度重视,积极进行心理干预.     

癫痫儿童的心理障碍

癫痫儿的心理障碍是影响其生活质量的重要因素。本文就学期癫痫儿童的心理状态，影响因素及干预措施进行综述。     

儿童哮喘对父母情绪的影响及相关因素分析

哮喘是一种多因素参与、发病机制复杂的身心疾病。随着医学模式的转变,情绪心理因素在其发病中的作用越来越受到重视。许多研究证实,哮喘儿童存在心理障碍,同时心理精神因素可以加重诱发儿童哮喘。目前关于患儿情绪心理与哮喘关系的研究较多,涉及家长情绪与哮喘的相关研究较少,特别是儿童哮喘对父母情绪的影响很少被人认识。本文针对哮喘儿童父母的焦虑、抑郁情绪及其相关因素进行了研究分析,报告如下。     

白血病儿童心理行为特征及其对父母情绪的影响

目的探讨白血病儿童心理行为特征及其对父母情绪的影响。方法2004—2005于山西省妇幼保健院儿童医院采用Piers-Harris儿童自我意识量表(PHSCS)、少儿主观生活质量问卷和少儿艾森克个性问卷(EPQ)对白血病组(20例)和非白血病组(51例)2组患儿的自我意识水平、主观生活质量以及个性特征调查比较;采用医院焦虑抑郁量表(HAD),对2组儿童的父亲和(或)母亲的抑郁和焦虑情绪进行调查和比较。结果白血病组与非白血病组儿童在自我意识水平、主观生活质量以及个性特征方面的差异无显著的统计学意义(P>0.05),白血病组儿童的父母在焦虑[A分值,(10.25±3.34)分]、抑郁[D分值,(9.44±3.92)分]和总分[T分值,(19.69±6.61)分]均显著高于非白血病组父母得分[(8.06±4.36)、(6.48±4.57)、(14.54±7.98)分,P<0.01]。结论儿童期白血病与非白血病患儿在心理行为特征方面差异无显著性,白血病儿童父母较非白血病儿童父母有更多的抑郁和焦虑情绪。因此,在治疗儿童躯体疾病的同时,对白血病儿童及其家庭进行社会心理干预非常必要。     

Sleep habits and disturbances in Malaysian children with epilepsy

Aims: To compare sleep habits and disturbances between Malaysian children with epilepsy and their siblings (age range 4–18 years) and to determine the factors associated with greater sleep disturbance. Methods: The Sleep Disturbance Scale for Children (SDSC) questionnaire was completed by the primary caregiver for 92 epileptic children (mean age 11.1 years, 50 male, 42 females) and their healthy siblings (mean age 11.1 years, 47 males, 45 females). Details of sleep arrangements and illness severity were obtained. Multiple regression analysis was used to determine factors associated with high Total SDSC scores in epileptic patients. Results: Compared with their siblings, epileptic children had significantly higher total SDSC score (difference between means 8.7, 95% confidence interval (CI) 6.4–11.1) and subscale scores in disorders of initiating and maintaining sleep (3.9, 95% CI 2.8–5.2), sleep–wake transition disorders (2.1, 95% CI 1.3–2.9), sleep‐disordered breathing (0.7, 95% CI 0.3–1.1) and disorders of excessive sleepiness (1.5, 95% CI 0.6–2.4). Epileptic children had a higher prevalence of co‐sleeping (73.7% vs 31.5%) and on more nights per week (difference between means 3, 95% CI 2.0–3.9) than their siblings. Higher Epilepsy Illness Severity scores were associated with higher total SDSC scores (P= 0.02). Conclusion: Co‐sleeping was highly prevalent in children with epilepsy, who also had more sleep disturbances (especially problems with initiating and maintaining sleep and sleep–wake transition disorders) than their siblings. Epilepsy severity contributed to the sleep disturbances. Evaluation of sleep problems should form part of the comprehensive care of children with severe epilepsy.     

Regression in pervasive developmental disorders: seizures and epileptiform electroencephalogram correlates

BACKGROUND: Approximately one third of the parents of children with pervasive developmental disorders or autistic spectrum disorders reports an early regression of unknown cause in their children's language, sociability, and play. Seizures or an epileptiform electroencephalogram (EEG) are associated with language regression in acquired epileptic aphasia (Landau-Kleffner syndrome) and some other pediatric epileptic syndromes. The importance of epilepsy or epileptic EEGs as contributors to autistic regression is not known. METHOD: Subjects were 482 boys and 103 girls on the autistic spectrum seen consecutively in consultation by one child neurologist. Data on autistic regression, seizures, sleep EEGs, and cognitive function were entered prospectively into a data base. RESULTS: Of the 585 children, 176 (30%) had a history of regression, and 66 children (11%) had a history of epilepsy, defined as two or more unprovoked seizures. Among 392 children with available sleep EEGs, the EEG was epileptiform in 59% of the 66 epileptic children and 8% of the 335 nonepileptic children. Regression had occurred equally among children without seizures and in those with epilepsy. Regression was associated with an epileptiform EEG in 14% of 155 nonepileptic children who had undergone a regression, as opposed to 6% of 364 children with neither regression nor epilepsy. Mean age at regression was 21 months. There was no difference in the proportion of children with epilepsy or epileptiform EEGs who had regressed before or after 2 years of age. Approximately half of the epileptiform discharges were centrotemporal, whether or not the child was epileptic or had regressed. Children with lower cognitive function were more likely to have undergone regression than those with better cognitive skills (34% vs 20%). CONCLUSION: Epilepsy or epileptiform EEGs occur in a significant minority of autistic children with a history of regression and in a smaller minority without regression. Prompt recognition of regression and recording of prolonged sleep EEGs is recommended, even though information on the potential efficacy of antiepileptic treatment to improve language and behavior in autistic children with epilepsy or an epileptiform EEG is still lacking.     

Parents'reports of disturbed sleep in 5—7-year-old Swedish children

Parents’reports on 1844 five to seven year olds from the general population were used to provide a detailed update about prevalence and correlates of sleep disturbances in children. Five different sleep disturbances were focused on: difficulty falling asleep, reported in 5.6% of the children; night waking in 15.5%; snoring in 7.7%; nightmares in 3.1%, and bedwetting in 5.3% of the children. Coexisting sleep disturbances were frequent in children with difficulties falling asleep, night waking and nightmares, but bedwetting usually emerged as a singular sleep disturbance. Nightmares were associated with serious health problems or handicaps, sleep problems in conjunction with life events, and female gender. Snoring as well as bedwetting were associated with reports of “very active” children. In 6.7% of the total sample, parents had previously consulted the healthcare services for a sleep problem in their child. These children had reports of colic during infancy, eczema, serious health problems or handicaps, current snoring and current nightmares. Only 1.1% (n = 21) of the children were said to have a present need to remedy sleep problems. The reports on these children included coexisting sleep disturbances, previous consultations for sleeping problems, parents’perceptions of “very active” children, diagnoses of attention deficit hyperactivity disorder, and major life events which had triggered sleep problems. In conclusion, although sleep disturbances are common in 5—7-y-old children, parents seldom express a need to remedy sleep problems in their children of this age. □ Children, parents, sleep behaviour, sleep disturbances, survey     

癫痫儿童生活质量的研究

目的研究癫痫儿童的生活质量。方法应用美国癫痫生活质量量表，对１９２例癫痫儿童进行生活质量的评估，探讨影响因素并与正常儿童进行比较。结果癫痫儿童的生活质量明显低于正常儿童，主要表现在对发作的恐惧、长期用药的担忧、认知功能的障碍及社会交往的困难。即使发作已被控制，其生活质量并无明显改善。生活质量高低因发作类型不同而各异。结论对癫痫儿童应加强综合治疗，特别要进行心理干预，才能提高其生活质量。     

The health-related quality of life of childhood epilepsy syndromes

Objective:    There is increasing awareness of the importance of assessing physical, psychological, social and behavioural well-being in chronic disease. The aim of this study was to examine the health-related quality of life (HRQoL) of children with common epilepsy syndromes and to explore if there are HRQoL differences between those syndromes.
Methods:    Each child had their epilepsy syndrome defined according to the International League Against Epilepsy classification. Epilepsy syndromes included symptomatic frontal, temporal, parietal/occipital lobe and partial unlocalized epilepsy, and two idiopathic epilepsies, childhood absence epilepsy (CAE) and benign rolandic epilepsy (BRE). Seizure semiology and ictal/interictal electroencephalogram (EEG) were determined for symptomatic partial epilepsy syndromes by video-EEG monitoring. HRQoL was evaluated with an epilepsy-specific instrument, the Quality of Life in Childhood Epilepsy Questionnaire, and two generic instruments, the Child Health Questionnaire and Child Behavior Checklist.
Results:    Children with symptomatic partial epilepsy syndromes were affected by epilepsy in a similar way and did not have unique HRQoL profiles. However, these children had significantly lower HRQoL scores compared to those with CAE or BRE. All children with epilepsy regardless of syndrome had a higher frequency of behavioural problems compared to normative data.
Conclusion:    These results indicate that children with epilepsy regardless of syndrome require evaluation of the psychosocial implications. There is a greater impact on HRQoL in symptomatic epilepsy compared to idiopathic epilepsy. Specific symptomatic partial syndromes did not differ in the degree they affect HRQoL. These findings have important implications for clinicians caring for children with epilepsy.     

The psychological development of children of epileptic parents. I. Study design and comparative findings

We studied the genetic, neurobiological, teratogenic and psychosocial risks for the development of children born to epileptic parents in (a) children of epileptic mothers with intrauterine exposure to anticonvulsants, (b) children of epileptic mothers without intrauterine exposure to anticonvulsants and (c) children of epileptic fathers. In addition, three matched control groups were also considered. The longitudinal design of the study covered newborns to children of six years of age. A wide range of developmental and psychological tests and a structured interview for the assessment of psychiatric symptoms were used. It was shown that teratogenic factors are operant, whereas there was no indication that the condition of epilepsy in the parents per se had any effect on the developmental outcome of the children. The possible teratogenic effect of anticonvulsants should be studied in more detail.     

How Do Parents Think about the Effect of Food and Alternative Medicine on their Epileptic Children?

Objective

Parents of epileptic children are willing to know if specific foods precipitate or aggravate their kids'' seizures. Nonetheless conclusive data are limited. Alternative medicine has become a popular approach to many diseases in the world and there are limited data about this approach to epilepsy in Iran. We tried to evaluate attitude of parents of epileptic children to food-epilepsy relationship and alternative therapeutic approach to epilepsy.

Methods

We carried out a cross-sectional study with analytic aspect at Children''s Medical Center, Tehran, Iran in 2008, by asking the parents of epileptic children to fill out a valid and excellently reliable questionnaire. We collected parents‘ attitude and analyzed it using SPSS software.

Findings

One-hundred and fifty one families participated in the study. Fifty-nine of participants (39.1%) believed that foods had no effect on epilepsy. Fifty one cases (33.8%) said that foods might have negative or positive effect on epilepsy and 27.1% (41 cases) had no idea. Higher percent of parents believed in food-epilepsy relation in cases that fathers had educational levels above high school graduation. Sixteen cases (10.6%) said that alternative medicine might improve epilepsy and 55% had no idea about efficacy of this approach to epilepsy.

Conclusion

Compared with previous published study from Iran, parents of epileptic children believed less in food-epilepsy relation. Majority of parents either believed that foods had no effect on epilepsy or had no idea. More than half of parents had no idea about efficacy of alternative medicine to epilepsy. Only a few of them believed in ameliorating effects of alternative medicine on epilepsy.     

Psychopathology and self-esteem in chronic illness

Objective : To evaluate psychopathology and self-esteem in chronic illness. Methods: 60 children and their parents were selected to participate in an open study. 30 children had epilepsy and the other 30 had thalassemia. Both the groups consisted of children randomly selected from the Epilepsy Clinic and Thalassemia Centre respectively, of a teaching general hospital. The children and their parents were interviewed and also rated on Childhood Psychopathology Measurement Schedule (CPMS) and Rosenberg’s self esteem scale. The data was analysed using Pearson’s chi square test and Pearson’s correlation coefficient.Results : The children were seen to have high psychopathology on CPMS (average score: thalassemia group = 28.56, epilepsy group = 26.06). Depression was the subscale with the maximum elevation in both groups. Behavior problems were high in epilepsy. In addition, sadness and disinterest in life were common symptoms in thalassemia while irritability and panic were high in epilepsy. Children with epilepsy perceived a change in lifestyle after diagnosis. Self-esteem was moderately affected in both groups and this affected compliance with treatment in thalassemia.Conclusion : Chronic illness affects psychological health and self esteem in children. Hence, in addition to the physical aspects it is necessary also, to focus on the psychological health of the child in order to ensure compliance and thus treat the child comprehensively.     

Parental attitudes towards epilepsy.

Parents of 352 children with history of epilepsy were interviewed by a pretested, open ended questionnaire to ascertain the nature of first aid care during an epileptic fit, complications arising out of this care, and parents' perceptions regarding causes of epilepsy. The commonest form of care provided was to force liquids by mouth (50.6%), followed by pressure over body to restrain convulsive movements (13.0%) or to put some object to force the teeth open (11.9%). The various causes of epilepsy according to the parents were: due to an evil spirit (26.7%0, heritable causes (13.9%), physical or mental weakness (6.6%) and brain damage (5.9%). The need of imparting knowledge and clear understanding about epilepsy among parents is emphasized.     

Parental perception, worries and needs in children with epilepsy

Despite advancement in medical care, prejudice and misunderstanding of epilepsy still exist. In this study, we investigate the problems faced by epileptic children, at home and in school, and make suggestions for improvement. Questionnaires were randomly distributed to parents of epileptic children attending normal and special classes (groups A and B, respectively). Return of questionnaires was anonymous. Ninety-one percent responded. Of the responders, 56 children were in Group A and 30 in Group B. Chronic and intractable epilepsy was more frequently observed in Group B than in Group A patients (47% vs 14%, p < 0.05). Main family concerns were seizures, school performance and side effects of medication. Half of the parents complained that their children were more restless and short-tempered. Only 43% of parents were aware that seizures were caused by abnormal brain discharges. Twenty percent thought swimming should be prohibited even if seizures could be controlled. Schools were informed of the disease by 84% of the families. Only 29% of parents knew the name and dose of the current medication. Information was considered adequate in 27% of patients. Drug compliance was better in epileptic children with associated handicaps than in those without handicaps. Half of the parents requested more information about epilepsy and closer communication between teachers and physicians. CONCLUSIONS: To establish comprehensive care that satisfies the needs of epileptic children and their families, further training of medical specialists in epilepsy and enhancement of networks among relevant organizations are needed.