癫痫患者生活质量及其心理干预的作用

背景癫痫患者对服药副作用的担心及长期以来人们对癫痫病的误解、歧视均影响其心理、情绪和行为,导致其生活质量下降.一些发达国家的药物管理机构提出评价新型抗癫痫药的效果必须包括生活质量的内容,中国对癫痫患者生活质量的关注也已开始.目的评价广西部分地区癫痫患者的生活质量并对存在的问题进行心理干预,探讨影响癫痫患者生活质量的因素.设计病例-对照研究.单位广西医科大学第一附属医院神经内科,脑电图室和神经心理实验室.对象2002-03/2003-08广西医科大学第一附属医院神经内科、儿科门诊和住院癫痫患者78例(癫痫组),年龄8～53岁,按就诊顺序号分为心理干预组39例和非心理干预组39例.同期选择70例无神经系统及其他系统疾病健康人作为对照组.干预根据中国文化背景和特点将美国癫痫患者生活质量量表(QOLIE31)中的个别项目加以修改,包括7个分项,分别为对发作的担忧、对日常生活满意程度、情绪、精力状态、认知功能、对长期服用抗癫痫药物的顾虑、社会功能.干预前对两组患者以问卷方式进行QOLIE31进行评估(第1次评分).其中心理干预组用电话、通信、印发健康宣教资料及个别指导等形式进行心理干预.在3个月后重复上述问卷(第2次评分).主要观察指标QOLIE31中QOL总分及7个分项评分.结果癫痫患者生活质量明显低于正常对照组,主要表现在对发作的担心,生活满意度下降,认知功能下降,对用药的担心和社会功能下降(P≤0.001).经过心理干预癫痫患者的生活质量各项指标均比干预前有明显提高(P＜0.01);非心理干预组两次评分比较,QOL总分、情绪、用药担心也有提高(P＜0.01或0.05),但对发作的担心、对生活的满意度、精力、认知功能和社会功能与第1次评分相比无统计学意义(P＞0.05);心理干预组和非心理干预组患者各项指标比较差异有统计学意义(P＜0.01).结论癫痫患者生活质量普遍低下,心理干预可提高癫痫患者的生活质量.

Effect of epilepsy on quality of life and its psychological intervention

BACKGROUND: For epilepsy patients, their worries of the side effects of medication and the long-term misunderstanding and discrimination on epilepsy influent themselves in psychology, emotion and behavior, and result in declined quality of life (QOL). The drug administrative organizations in some developed countries propose that the evaluation on the effects on new-type anti-epilepsy drugs must include the content of life quality. China has begun paying attentions to the QOL for epilepsy patients.OBJECTIVE: To evaluate the life quality on epilepsy patients in a part of regions in Guangxi and carry on psychological intervention on the existed questions so as to probe into the factors to the life quality of epilepsy patients.DESIGN: Case-controlled study.SETTING: Department of Neurology of the First Affiliated Hospital of Guangxi Medical University, EEG Room and Neuro-psychological Experimental Room.PARTICIPANTS: A total of 78 patients(epilepsy group) were collected from March 2002 to August 2003 in Department of Neurology, Pediatric Department and Inpatients in the First Affiliated Hospital to Guangxi Medical University, aged varied from 8 to 53 years. They were divided into psychological intervention group(39 patients) and non-psychological intervention group(39 patients) according to the sequences of visits. At the same period,70 patients of healthy persons without disorders in neurological system and other systems were collected as the control group.INTERVENTIONS: According the culture background in China, some specific items in American QOLIE31 were modified, including 7 items, named as worries about seizure, satisfaction with dally hfe, emotions, spiritual state,recognition, misgivings about the long-term taken anti-epilepsy drugs and social function.QOLIE31 evaluation was carried on(the 1st scoring) by question-answer methods in two groups before intervention. Of which, in psychological intervention group, the psychological intervention was given by telephone calling, writing letters, distributing healthy materials and individual guiding, etc. 3 months later, the above-mentioned question-answer was repeated(the 2nd scoring).MAIN OUTCOME MEASURES: Total scores of QOL and scores of 7items in QOLIE31.RFSULTS: The QOL for epilepsy patients was obviously lower than the normal control, mainly manifested as worries about seizures, declined satisfaction with the life, declined recognition, misgivings about the drugs prescribed and declined social function( P ≤0. 001 ) . By psychological intervention, every item of the life quality for epilepsy patients was remarkably increased( P ＜ 0. 01 ) . In the comparison of twice evaluations in non- psychological intervention, the total scores of QOL and scores for emotions and misgivings about the drugs were increased(P ＜ 0.01 or 0.05); but the scores for worries on seizures, satisfaction to life, spiritual state, recognition and social filnction did not show statistical significance compared with the 1st scores ( P ＞ 0. 05). The differences by the comparison between psychological intervention group and non-psychological intervention group indicated statistical significance( P ＜ 0. 01 ).CONCLUSION: The QOL for epilepsy patients is lower in generally, but the psychological intervention can improve the quality of their lives.