The Contribution of Psychological Intervention to the Management of Epilepsy

Gillham, Ruth Alison (1988) The Contribution of Psychological Intervention to the Management of Epilepsy. PhD thesis, University of Glasgow.

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The conventional treatment of epilepsy is pharmacological, but anticonvulsant drugs are not effective in every case and their use may be limited by side-effects. There are. a wide range of psychiatric, psychological and social problems associated with epilepsy and it is argued that they frequently require intervention in their own right. There are many examples of psychological methods applied to seizure control in the literature, but unfortunately not all have adequate operational definitions and the application of such treatments has yet to be established. A standarised interview schedule was presented to 105 consecutive patients with epilepsy attending neurology review clinics. The prevalence of psychological disturbance, in terms of standard scales, and poor seizure control, was measured. The proportion of patients experiencing various seizure related phenomena which might be of use in seizure interruption strategies was recorded. It is concluded that there are sufficient numbers of patients with refractory epilepsy and significant psychological disorder in this population for a treatment study to be viable. The design of the treatment study is described. Two types of treatment are evaluated in a form of cross-over design. Treatment A teaches patients seizure interruption and avoidance strategies. Treatment B focuses exclusively on alleviating anxiety and depression by standard psychological techniques. The main outcome measures are seizure frequency and scores on standard rating scales of anxiety and depression. The main purpose is to evaluate the effectiveness of these techniques in improving seizure control. The effect on psychological disorder will be also be assessed and an attempt will be made to identify factors predicting good and poor treatment outcomes. Three groups of patients were studied. The first group (n = 19) had no significant psychopathology and received Treatment A only. The second and third groups, (n = 21, and n = 19) had both treatments administered consecutively. Group 2 had Treatment A then Treatment B and Group 3 B then A. Results showed a significant improvement in seizure frequency in all three groups after a stable baseline. Improvement was about 50% in 50% of cases and was maintained during six months follow-up. There was no difference between the groups in terms of outcome, no difference between the treatments and no treatment order effect. Groups 2 and 3 showed significant improvement in measures of anxiety and depression and all three groups showed a reduction in the numbers of work related and social activities they felt barred from as result of their epilepsy. It is noted, however, that at the end of treatment the overall mean weekly seizure rate is still above 2 and that score on anxiety and depression scales remaons above "normal'. Further analysis of the data shows evidence that anxiety, but probably not depression, may play a part in maintaining a high seizure frequency. It appears that depression is associated with lack of warning that a seizure is about to occur and with lack of independence, as defined in this study. Discriminant analysis showed that the best predictors of a good treatment outcome in terms of fall in seizure frequency, were presence of some form of warning of a seizure, and moderate pre-treatment levels of anxiety and depression. The theoretical and practical implications of these results are discussed, with particular reference to possible treatment mechanisms. Some speculations which might explain the apparent relationship between anxiety and high seizure frequency are presented. It is concluded that psychological intervention has a potential application in the management of epilepsy but that future evaluations should use a longer follow-up period and should assess effectiveness of treatments when more than one therapist is employed.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Keywords: Neurosciences, Physiological psychology
Date of Award: 1988
Depositing User: Enlighten Team
Unique ID: glathesis:1988-77714
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 14 Jan 2020 11:53
Last Modified: 14 Jan 2020 11:53

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