Seizure frequency, patient-perceived seizure severity and the psychosocial consequences of intractable epilepsy.

It is generally recognised that the assessment of treatment effects in epilepsy using seizure frequency as the only outcome measure may lack sensitivity. A patient-based seizure severity scale has been developed and initial results confirm its reliability and validity. As part of the further development of this scale it is important to explore the relationship between seizure severity, seizure frequency and the psychosocial consequences of intractable epilepsy. One hundred patients with medically refractory partial seizures completed a quality of life questionnaire including measures of physical (seizure severity and frequency), social and psychological well-being (anxiety, depression, self-esteem, locus of control and happiness). Multivariate analysis demonstrated that individual psychological variables were best predicted by other psychological variables. However, when these were removed from analysis, seizure severity was the most significant predictor of self-esteem (P = 0.005), locus of control P = 0.039) and anxiety (P = 0.048). Seizure frequency did not contribute significantly to the variance of any of the psychological factors. These results highlight the importance of considering seizure severity when assessing treatment effects in epilepsy and provide further evidence for the construct validity of a novel patient-based seizure severity scale.     

Social anxiety and its psychosocial impact on the lives of people with epilepsy

Little is known about social anxiety among people with epilepsy (PWE), although PWE are more likely to be diagnosed with social anxiety disorder than the general population. The purpose of this study was to determine which psychosocial and seizure-related variables are associated with social anxiety. It was hypothesized that social anxiety would be positively correlated with perceived seizure severity, stigma, impact of epilepsy, fear of negative evaluation, and experiential avoidance. Further, social anxiety would be negatively correlated with epilepsy knowledge and disclosure of epilepsy. Finally, if a seizure occurred in public and others were unaware of the epilepsy, participants would report greater judgment, anxiety, and rumination compared with those in a situation where others were aware of the epilepsy. A total of 101 individuals with epilepsy participated in this online study. Social anxiety was found to correlate with both psychosocial and seizure-related variables in the expected directions. Further, social anxiety predicted significant variance in stigma and disclosure beyond known predictors of stigma. Participants in both conditions (disclosed diagnosis of epilepsy versus undisclosed diagnosis of epilepsy) were equally distressed by having a seizure in public. These findings provide an initial basis for discerning how to best assess and support PWE with social anxiety.     

Behavioural adjustment in seizure-free epilepsy patients on monotherapy

PURPOSE: Risk of depression, anxiety, and reduced quality of life is elevated in epilepsy patients, due to a range of factors including aetiology, structural brain lesions, seizure worry, epilepsy surgery, hereditary factors, psychosocial factors, and possible adverse effects of antiepileptic drugs (AEDs). Studies on the relationships between epilepsy-related variables and behavioural adjustment have been mainly conducted on patients with persisting seizures, whereas the present study investigated behavioural function in epilepsy patients seizure-free for more than 2 years on monotherapy. METHODS: Adults with epilepsy on AED monotherapy and without epileptic seizures for at least 2 years (n=126) were assessed with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), in addition to MRI and EEG. RESULTS: Group analysis found mean MMPI-2 scores on all the clinical and content scales to be within the normal range. Abnormally elevated scores on scales measuring aspects of depression, health-related concerns, low self-esteem, negative treatment indicators, and physical complaints were recorded in a higher proportion of patients than would normally be expected. Multiple regression analysis showed that MRI pathology was a significant predictor for an abnormally poor score on the low self-esteem scale, and that epilepsy onset 相似文献   

Psychosocial adjustment of epilepsy patients in Cyprus

This study investigated aspects of psychosocial adjustment in epilepsy patients in Cyprus. Sixty-three patients under 55years of age with idiopathic or symptomatic epilepsy and 89 neurologically matched healthy volunteers participated. Subjects completed the State and Trait Anxiety Inventory and the Beck Depression Inventory; patients with epilepsy also completed the Epilepsy Foundation Concerns Index. Results showed that patients with symptomatic epilepsy had significantly higher scores on state and trait anxiety and depressive symptoms. Sociodemographic characteristics including gender, marital status, and education levels contributed to differences in trait and state anxiety, depressive symptom scales, autonomy concerns, and fear for seizure recurrence. Variables such as poor seizure control and use of polytherapy were associated with lower adjustment scores and reduced psychosocial outcome. Finally, patients with epilepsy scored significantly higher on depression and anxiety symptoms. The results provide further evidence on challenges patients with epilepsy face and on the need for implementing psychosocial prevention programs.     

Mood disturbance before and after seizure surgery: a comparison of temporal and extratemporal resections

PURPOSE: Mood disturbance is a common comorbid condition of temporal lobe epilepsy before and after seizure surgery. Few studies have examined mood disturbance in patients undergoing resections outside the temporal lobe (extratemporal resections). This study aimed to compare the early, postoperative evolution of mood disturbance in temporal and extratemporal lobe epilepsy patients to examine the effect of site of surgical resection on mood outcome. METHODS: The study used a longitudinal design and was qualitative in nature. Sixty seizure surgery patients (43 temporal resections, 17 extratemporal resections) were assessed before surgery and at discharge, 1 month, and 3 months after surgery, by using the Austin CEP Interview. Psychosocial adjustment, psychiatric difficulties, including depression and anxiety, and seizure frequency were assessed. RESULTS: Before surgery, both temporal and extratemporal patients had significant psychiatric histories with similarly high rates of depression (33 and 53%, respectively) and anxiety (23 and 18%, respectively). After surgery, significantly more temporal patients were seizure free at each of the reviews compared with extratemporal patients. Temporal patients also reported significantly higher levels of depression (26%), anxiety (42%), and psychosocial adjustment difficulties (64%) at the 1-month review than did extratemporal patients. Mood disturbance was significantly associated with adjustment difficulties in both groups, but was not related to seizure outcome at any review period. CONCLUSIONS: A general increase in mood disturbance was evident after surgery, particularly in temporal resection patients at the 1-month review. Site of surgery and psychosocial adjustment showed significant associations with postoperative mood disturbance, supporting the role of both neurobiological and psychosocial factors in mood outcome.     

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.     

Frequency of affective symptoms and their psychosocial impact in Korean people with epilepsy: A survey at two tertiary care hospitals

We investigated the frequency of affective symptoms in Korean adults with epilepsy who visited epilepsy clinics at two tertiary care hospitals and in healthy adults. We also examined the psychosocial impact of affective symptoms on people with epilepsy (PWE). Participants were asked to complete self-report questionnaires to assess depression and anxiety symptoms, felt stigma, suicidal ideation, and quality of life (QOL). Of 568 PWE, 30.5% exhibited affective symptoms. The frequencies of depression and anxiety symptoms were 27.8% and 15.3%, respectively, significantly higher than those in healthy controls. Those with poor seizure control were more likely to endorse affective symptoms at the time of study. The frequencies of felt stigma and suicidal ideation were higher in PWE with affective symptoms than in those without. Quality of life was impacted by affective symptoms, especially when depression and anxiety coexisted. Reducing affective symptoms by appropriate seizure control may ameliorate psychosocial problems in PWE.     

Internet Addiction and Its Associations with Clinical and Psychosocial Factors in Medical Students

ObjectiveExcessive internet use has been associated with various psychiatric symptoms and psychosocial factors. This study aimed to investigate the prevalence of internet addiction (IA) and its associations with clinical (depression/social anxiety) and psychosocial (self-esteem/perceived social support) factors in medical students. MethodsIn total, 408 medical students at one university in Korea were included in this study. IA symptoms were assessed with Young’s Internet Addiction Test, and scores of 50 or higher were considered to indicate IA. Participants were asked to complete the Beck Depression Inventory, Social Phobia Inventory, Rosenberg Self-Esteem Scale, and Duke-University of North Carolina Functional Social Support Questionnaire. A logistic regression model was constructed to examine the impact of clinical and psychosocial factors on IA. ResultsForty-seven participants (11.5%) were identified as having IA. Self-esteem was associated with a lower risk of IA, whereas depression and social anxiety were associated with a higher risk of IA. Depression, social anxiety, low self-esteem, and low perceived social support were found to be significant correlates of IA. Young’s Internet Addiction Test score positively correlated with Beck Depression Inventory and Social Phobia Inventory scores, but negatively correlated with Rosenberg Self-Esteem Scale and Duke-University of North Carolina Functional Social Support Questionnaire scores. Furthermore, the prevalence of IA was highest in first-year medical students. ConclusionThis study revealed the possible risk and protective factors of IA. Our findings indicate that strengthening self-esteem and reducing depression and social anxiety may contribute to the prevention and management of IA in medical students.     

Socioeconomic status and self-management in epilepsy: comparison of diverse clinical populations in Houston, Texas

We compared the scores on self-management and associated psychosocial scales of patients with epilepsy at two clinics in Houston, TX, USA, to determine if there were systematic differences associated with socioeconomic status (SES). Patients of low SES reported higher scores on overall, information, and safety management (P<0.03) and no differences on medication, seizure, and lifestyle management. The two groups were similar with respect to the pattern of high and low scores. Reported levels of self-efficacy, depression, social support, stigma, desire for control, and outcome expectations were higher for those of high SES (P<0.01). Knowledge of epilepsy and satisfaction with care were lower (P<0.01). Again, the patterns of high and low scores were similar. Tests of association between psychosocial factors and self-management revealed that people with higher levels of self-efficacy and social support also reported higher self-management (P<0.01) regardless of demographics, seizure frequency, and SES (P<0.05). These findings provide little support for SES-related disparities in self-management and suggest that the focus of strategies to improve self-management may be similar across diverse populations.     

Epilepsy surgery: patient-perceived long-term costs and benefits

PURPOSE: The goal of this study was to assess the patient-perceived costs and benefits associated with the longer-term outcomes of epilepsy surgery in patients who underwent anterior temporal lobectomy or selective amygdalohippocampectomy. METHODS: Surgery patients who were assessed in 1997 were reassessed in 2003. Demographic, clinical, and psychosocial details were collected using a validated self-completion questionnaire. Data were collected from 67 patients who had undergone surgery. RESULTS: Forty-five percent were seizure-free. There were significant differences (P<0.001) between the seizure-free (SF) and continuous seizure (CS) groups with respect to anxiety, depression, impact of epilepsy, self-esteem, mastery, stigma, affect balance, self-reported health, and quality of life. More SF patients were also employed and driving (P<0.001). Despite these differences there were no differences for regret over surgery but there were differences for satisfaction and success ratings. CONCLUSIONS: Patients who were not SF, in the longer term, had little regret undergoing surgery but were less likely to be satisfied and had a poorer psychosocial profile.     

#Sleepyteens: Social media use in adolescence is associated with poor sleep quality,anxiety, depression and low self-esteem

This study examined how social media use related to sleep quality, self-esteem, anxiety and depression in 467 Scottish adolescents. We measured overall social media use, nighttime-specific social media use, emotional investment in social media, sleep quality, self-esteem and levels of anxiety and depression. Adolescents who used social media more – both overall and at night – and those who were more emotionally invested in social media experienced poorer sleep quality, lower self-esteem and higher levels of anxiety and depression. Nighttime-specific social media use predicted poorer sleep quality after controlling for anxiety, depression and self-esteem. These findings contribute to the growing body of evidence that social media use is related to various aspects of wellbeing in adolescents. In addition, our results indicate that nighttime-specific social media use and emotional investment in social media are two important factors that merit further investigation in relation to adolescent sleep and wellbeing.     

The impact of posttraumatic stress disorder on partners and children of Australian Vietnam veterans

OBJECTIVE: This study explored the emotional and physical health of a group of families of Australian Vietnam veterans suffering posttraumatic stress disorder (PTSD). The aim was to study the impact of PTSD upon the families of the sufferers. METHOD: The families of a random sample of Vietnam veterans receiving treatment at a specialist PTSD Unit were invited to participate in this study. Partners of the veterans and children over the age of 15 years were eligible to participate. Four self-report psychometric inventories were administered assessing psychological distress, social climate within their families, self-esteem, and a range of lifestyle issues, including physical health. A control group, consisting of a sample of volunteers, was also surveyed. RESULTS: The partners of the Vietnam veterans showed significantly higher levels of somatic symptoms, anxiety and insomnia, social dysfunction and depression than the control group. They reported significantly less cohesion and expressiveness in their families and significantly higher levels of conflict. The partners also had significantly lower levels of self-esteem. The children of the veterans reported significantly higher levels of conflict in their families. However, the children showed no significant differences on measures of psychological distress and self-esteem from their matched counterparts. CONCLUSIONS: These findings support overseas studies that indicate that the families of PTSD sufferers are also impacted by the disorder. In this study, the families of Australian Vietnam veterans experienced more conflict and their partners were significantly more psychologically distressed (i.e. somatic symptoms, anxiety, insomnia, social dysfunction, depression and low self-esteem) than a matched control group.     

Changes in quality of life and self-perspective related to surgery in patients with temporal lobe epilepsy

PURPOSE: To evaluate changes in intractable epilepsy patients in terms of quality of life, depression, anxiety, stigma, and impact of epilepsy before and after surgery. METHODS: Twenty patients with intractable temporal lobe epilepsy who were waiting for surgery (pre-SAH group) and 21 patients who had already undergone surgery (post-SAH group) were studied. All patients received SF-36, Beck Depression Inventory, State-Trait Anxiety Inventory, stigma and impact of epilepsy inventories, and a form asking their own perspectives about epilepsy and surgery. RESULTS: Post-SAH group scored higher on all subscales of SF-36, with only RE scores being significantly better (t=-1.98, P=.05). Although depression, anxiety, and stigma scores were higher in pre-SAH group, only impact of epilepsy scores were significantly higher in pre-SAH group (t=-2.951, P=.005). Seizure frequency and comorbidity had significant effects on QOL where amount of AEDs and QOL were negatively related (r=-0.318, P<0.05). Both groups stated lack of independence and social activities as the main concern (48.8%) and recovery from epilepsy as the most important expectation from surgery (85.4%). Post-surgical group mentioned the difference in their life after surgery as independence and increase in social activities (47.6%). CONCLUSION: QOL of patients after surgery was found to be better than before surgery. Results also revealed that seizure frequency, comorbidity, and anti-epileptic medication affected health related QOL negatively. Impact of epilepsy levels was found to be higher among the pre-SAH patients. Finally, independence seemed to be the most important concern and gain for Turkish epilepsy patients.     

The Clinical Course of Epilepsy and Its Psychosocial Correlates: Findings from a U.K. Community Study

As part of a large community-based study, we retrospectively examined the clinical course of epilepsy in an unselected population of people who had a recent history of seizures or were receiving antiepileptic drugs (AEDs). Clinical information was collected from medical records, and information about psychosocial functioning was obtained by means of postal questionnaires sent to identified subjects. The response rate to the postal questionnaire was 71%. There were some deficiencies in the recording of clinical data, which is not unusual since data were taken from records held by primary physicians rather than from hospital clinics. Nevertheless, findings regarding the clinical course of epilepsy corresponded to those of earlier studies. Fifty-seven percent of the sample had had at least a 2-year seizure-free period and 46% of subjects were currently in a remission of at least 2-year duration. There was a clear relationship between current seizure frequency and levels of anxiety and depression, perceived impact of epilepsy, perceived stigma, and marital and employment status. The relationship of seizure frequency and other clinical variables to psychosocial function was explored by multivariate analysis techniques. The amount of variation in scores on the various measures of function accounted for by the clinical variables was small. The most important predictor was current seizure activity, which was the first variable to enter the regression analyses for six of the eight measures of psychosocial function considered. Age at epilepsy onset also emerged as a significant predictor for depression, stigma, and marital status. In individuals with epilepsy in remission, there was little evidence that psychosocial functioning was associated with length of remission, a finding which may in part reflect the nature of this study population. The results indicate that there are several more important predictors of psychopathology and social dysfunction in epilepsy and suggest several implications for treatment interventions.     

Depression and anxiety in childhood epilepsy: A review

Population based studies suggest that symptoms of depression and anxiety are more frequent in children and adolescents with epilepsy compared with the general population. In terms of the manifestations of symptoms of depression and anxiety, there would appear to some symptoms unique to epilepsy in that they are associated with seizures and/or antiepileptic medications but these idiosyncratic symptoms remain under reported and have not been extensively studied. In terms of correlates of significant symptoms of depression and anxiety in children with epilepsy, some reports indicate that seizure variables (e.g., seizure frequency) and use of polytherapy are associated with increases in symptoms whereas other studies have not found this relationship. Child and family attitude/adaptation to epilepsy may also be risk factors for depression and anxiety but more research is needed in this area. The assessment of symptoms of depression and anxiety in children with epilepsy can be challenging given the possible role of seizures and AEDs, and comprehensive assessment will involve the use of screening measures, diagnostic interviews and a consideration of epilepsy specific factors. There have been few studies carried out with respect to the treatment of symptoms and depression and anxiety in children and adolescents with epilepsy. There is a significant need for a greater understanding of the nature of symptoms of depression and anxiety in children with epilepsy to inform treatment decisions. While treatment of epilepsy specific symptoms of depression and anxiety may involve an evaluation of the current epilepsy treatment protocols, there may also be a need for pharmacological and/or psychotherapeutic interventions in the treatment of symptoms of depression and anxiety which are not epilepsy specific.     

Longitudinal follow-up of naturalistic treatment outcome in patients with trichotillomania

BACKGROUND: Little is known about the longitudinal course of treatment outcome in patients with trichotillomania. The authors conducted a second follow-up assessment on a cohort of hair pullers previously studied. METHOD: Forty-four subjects completed a hair-pulling questionnaire and paper-and-pencil measures of hair-pulling severity and impact, psychosocial functioning, depression, anxiety, and self-esteem. Mean time elapsed between the first and second follow-up assessment was 2.5 years (index evaluation to first follow-up = 3.5 years). RESULTS: Twenty-seven subjects (61.4%) had active treatment since the first follow-up. No significant changes in hair pulling, depression, anxiety, or psychosocial functioning were reported from first to second follow-up. Self-esteem scores significantly worsened during this period (p = .000). A trend toward worsening also existed for psychosocial impact scores. Comparison of scores at index evaluation with second follow-up still showed significant improvement over time for hair pulling (p = .001) but significant worsening in self-esteem (p = .000). Treatment and responder status were unrelated to clinical functioning, with the exception of depression and psychosocial impact. CONCLUSION: Although hair pullers exhibit initial improvement with treatment, scale scores plateau or worsen by second follow-up. Significant worsening in self-esteem at second follow-up may be related to the absence of further improvements in hair-pulling severity. Future research should focus on the interrelationships among self-esteem, depression, and hair pulling during treatment for this disorder.     

Self-esteem in adolescents with epilepsy: Psychosocial and seizure-related correlates

PurposeThis study evaluated self-esteem in adolescents with epilepsy and its association with psychosocial and disease-related variables.MethodsThis was a cross-sectional study with patients enrolled between January and June 2010. Culture-Free Self-Esteem Inventory for Children (CFSEI-2) was administered to 140 children with epilepsy and 50 children with asthma, aged 10–18 years attending mainstream schools.ResultsAdolescents with epilepsy had a significantly lower overall self-esteem score when compared with those with asthma, 17 ± 5.21 versus 19.4 ± 3.83, respectively (P = 0.005). Thirty-one (22.1%) children with epilepsy compared with 4 (8.3%) with asthma had overall self-esteem score below the cutoff (P = 0.034). There was a significant correlation between overall self-esteem score and duration of epilepsy, Hospital Anxiety and Depression Scale (HADS) anxiety score, HADS depression score, and Strengths and Weaknesses of ADHD symptoms and Normal-Behaviors (SWAN) rating combined score. The impact of various correlates on individual domains was not identical. Independent factors associated with low overall self-esteem were HADS depression score (OR: 1.62; 95% CI: 1.2, 2.2; P = 0.002), duration of epilepsy (OR: 1.4; 95% CI: 1.04, 1.88; P = 0.024), and father employment status economically inactive (OR: 11.9; 95% CI: 1.07, 125; P = 0.044). Seizure-free ≥ 12 months was a favorable factor that was less likely to be associated with low self-esteem (OR: 0.14; 95% CI: 0.02, 0.81; P = 0.028).ConclusionSelf-esteem was compromised in adolescents with epilepsy. A significant correlation between self-esteem and psychological comorbidities was demonstrated. Enhancing social support and education programs may improve the self-esteem and, ultimately, the lives of adolescents living with epilepsy.     

Attachment style,relationship quality,and psychological distress in patients with psychogenic non-epileptic seizures versus epilepsy

ObjectivesPsychopathology levels are elevated in patients with psychogenic non-epileptic seizures (PNES) and those with epilepsy. However, patients with PNES report higher rates of trauma and neglect, poorer health-related quality of life (HRQoL), and an increased prevalence of insecure attachment. We examined to what extent attachment style and relationship quality with their main informal carer impact on levels of HRQoL, depression, and anxiety in patients with PNES versus those with epilepsy.MethodConsecutive patients with PNES (N = 23) and epilepsy (N = 72) completed questionnaires about attachment style, quality of their relationship with their main informal carer, seizure severity, HRQoL, depression, and anxiety.ResultsPatients with PNES reported higher levels of anxiety and depression and lower HRQoL than those with epilepsy. PNES: No significant correlations were found with HRQoL but depression correlated positively with attachment avoidance, attachment anxiety, and relationship conflict. Anxiety correlated positively with attachment avoidance, attachment anxiety, and relationship conflict, and negatively with relationship depth and support. Epilepsy: HRQoL correlated negatively with seizure severity, depression, anxiety, attachment avoidance, and attachment anxiety. Depression correlated positively with attachment avoidance, attachment anxiety, and relationship conflict. Anxiety correlated positively with seizure severity, attachment avoidance, and attachment anxiety. Correlations between measures of relationship quality and anxiety were stronger in patients with PNES versus those with epilepsy (zs = 2.66 to 2.97, ps < 0.004). Attachment style and relationship quality explained larger amounts of variance in depression (45%) and anxiety (60%) in the patients with PNES than those with epilepsy (16% and 13%).SignificanceLevels of anxiety and depression were higher in patients with PNES than those with epilepsy. Interpersonal problems were much more closely associated with anxiety and depression in patients with PNES than those with epilepsy. The findings support the use of therapeutic interventions for PNES focusing on attachment and relationship issues.     

Depression and schizophrenia in epilepsy: social and biological risk factors

BACKGROUND: In a retrospective study we investigated the role of social and biological risk factors for the development of major depression and schizophreniform psychoses in epilepsy. We tested the hypotheses that social risk factors are associated with depression and biological risk factors are associated with schizophreniform psychoses. METHOD: We studied 25 patients with epilepsy and paranoid-hallucinatory psychosis, 25 patients with epilepsy and major depression, and 50 non-psychiatric epilepsy patients (controls) with respect to biological and psychosocial variables. RESULTS: Schizophrenic patients had an earlier age of onset of epilepsy and a more severe epilepsy as characterised by history of status epilepticus, multiple seizure types and severity of seizures compared to non-psychiatric controls. Simple seizure symptoms were often vegetative and EEGs showed various abnormalities including temporal lobe discharges but no lateralisation to either side. With respect to antiepileptic drugs (AED) there were only few significant differences between groups: Polytherapy as well as treatment with phenytoin (DPH) was more frequent in psychotic patients as compared to non-psychiatric patients. Patients with psychoses were also characterized by a disturbed familial background, lack of interpersonal relationships, social dependency and professional failure. Depressive patients were significantly older than non-psychiatric controls and they suffered more frequently from focal epilepsies arising from the temporal lobe. They did not differ from controls with respect to severity of epilepsy. Treatment with valproate (VPA) was inversely linked with depression, suggesting that VPA may have prophylactic antidepressive properties in epilepsy patients. There were no psychosocial variables significantly linked with depression. CONCLUSIONS: In this study, patients with different forms of psychiatric complications in epilepsy could clearly be distinguished from controls. However, we could not confirm the simple hypothesis that there are biological predictors for schizophreniform psychoses and psychosocial predictors for major depression. Neurological and sociological variables seem linked with both, suggesting a multifactorial etiology.     

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.