Lawrence W. Batzel

An Objective Method for the Assessment of Psychological and Social Problems Among Epileptics

Summary: Numerous investigators have identified psychological and social problems among epileptics and in many instances these appear to be more debilitating than the seizures themselves. However, assessment of these problems has most frequently been done by subjective means and when objective tests have been used, they were almost always developed for and standardized on populations other than epileptics. The development of the Washington Psychosocial Seizure Inventory (WPSI) is presented in this paper. After pilot work, 127 adult epileptics were evaluated for psychosocial problems and they completed the 132‐item Inventory. Professional assessment of difficulties was made with respect to family background, emotional adjustment, interpersonal adjustment, vocational adjustment, financial status, adjustment to seizures, and medical management. Finally, an assessment of overall psychosocial functioning was made. Through an item‐by‐item correlation technique, scales were empirically developed for each of these areas and a profile was produced which gives both the absolute and the relative extents of difficulties for each patient with respect to each area. Potential applications for the WPSI are presented.

Neuropsychological Abilities of Children with Epilepsy

Summary: One hundred eighteen epileptic children, aged 6–15 years, underwent detailed neuropsychological testing including the Wechsler Intelligence Scale for Children‐Revised and the age‐appropriate Halstead‐Reitan battery. Eight had classical absence seizures only, eight had classic absence seizures and generalized tonic‐clonic seizures, 30 had generalized tonic‐clonic seizures only, 31 had partial seizures only, 20 had partial seizures and generalized seizures, 15 had atypical absence seizures, and five had minor motor seizures. A control group of 100 children without seizures, matched to the general population for intelligence and matched to the seizure cases for age, underwent identical testing. The Wechsler full‐scale intelligence quotient (FSIQ) of cases was significantly (p = 0.01) lower than that of controls and was related to seizure type. Children with minor motor or atypical absence seizures had the lowest average FSIQ (70 and 74, respectively). All seizure types were associated with below‐control intelligence except classic absence only. Intelligence was also correlated with degree of seizure control. A highly significant inverse correlation between years with seizures and intelligence was found (p < 0.0001). A rating of neuropsychological impairment, derived from all measures of brain function, was assigned to each child. Epileptic children had significantly more impairment than controls (p < 0.0001). Children with seizures had been placed in special education or had repeated a grade in school almost twice as frequently as controls (p < 0.001). Even though often placed in a class of younger children, their academic achievement was behind grade placement more often than in controls. Children with seizures differed significantly from controls in making more errors on language‐related tasks.

Interictal Behavioral Features of Patients With Epilepsy

Summary: Three questions are dealt with in this paper. (1) Do patients with epilepsy differ behaviorally from normal control groups and from persons with other medical and neurological conditions with respect to emotional adjustment, and if so, in what ways? (2) Are patients with temporal lobe epilepsy different emotionally or behaviorally from patients with other types of epilepsy? (3) To what degree does underlying brain dysfunction create a substrate for abnormal and maladaptive behavior? A review of the literature reveals the following. (1) Persons with epilepsy demonstrate more emotional and psychiatric problems than normal individuals and more difficulties than other patient groups having nonneurological disorders, but have about the same incidence of these problems as persons with other neurological disorders. (2) Increased emotional and psychiatric problems are not found among patients with temporal lobe epilepsy in comparison to patients with other types of epilepsy, although there are some behavioral peculiarities which appear in a small proportion of these patients. (3) There is a mild tendency for impairment on neuropsychological tests to be associated with emotional and psychiatric problems in epilepsy.

An Objective Method for the Assessment of Psychosocial Problems in Adolescents with Epilepsy

Summary: Psychosocial problems in adolescents with epilepsy have béen of concern for many years, but have béen difficult to assess. This article presents the multi‐center development of the Adolescent Psychosocial Seizure Inventory (APSI), an empirically based self‐report test patterned after the Washington Psychosocial Seizure Inventory, which is used to evaluate psychosocial problems in adults. After pilot work, 120 adolescents with epilepsy from five centers in North America took the APSI and were interviewed by professionals with respect to adequacy of adjustment in eight psychosocial areas. At least one parent or guardian was also interviewed. Inter‐ rater reliability of professional ratings in each area was established. Using an item‐by‐item, empirically based technique, eight psychosocial scales were developed as well as thrée validity scales. Reliability of the scales was established by both internal consistency and test‐rétést procedures. Results for each adolescent are presented in profile form. These results give a visual display of the types and extent of problems that likely would be identified in a detailed professional assessment. It is anticipated that the APSI will be of value in a variety of treatment and research contexts.

Further Validation of the WPSI Vocational Scale: Comparisons with Other Correlates of Employment in Epilepsy

Summary: The present study evaluates the relationships between employment status and five types of variables: years of education, intelligence, emotional adjustment, neuropsychological impairment, and psychosocial adjustment. The latter two areas were evaluated by procedures specifically developed for work with seizure patients and include use of the Neuropsychological Battery for Epilepsy and the Washington Psychosocial Seizure Inventory. Fifty‐eight patients were divided into groups based on their employment histories and classified as unemployed, underemployed, and employed. Results indicated that the two types of procedures developed specifically for work with clients having seizures demonstrated the most potent and consistent relationships with employment status. The study suggests that the use of these procedures in the evaluation of employability may be more effective than using only those variables which traditionally have been applied.

Psychosocial Adjustment in Long-Term Survivors of Childhood Medulloblastoma and Ependymoma Treated with Craniospinal Irradiation

Improved prognosis for pediatric brain tumors has stimulated research into the quality of life of survivors. To assess cognitive function and psychosocial and family adjustment among this population, 18 long-term survivors of childhood medulloblastoma or posterior fossa ependymoma treated with surgical resection and craniospinal irradiation were interviewed and administered achievement tests and psychosocial questionnaires. A majority of parents reported significant difficulty caring for their child with a brain tumor, but no significant adverse effects upon the family. Academic achievement was significantly impaired in 12/18 subjects. Psychosocial adjustment was normal in 10/18 subjects. Although specific treatment variables (radiation dosage, chemotherapy, etc.) were not significantly related to these two outcome measures, impaired academic achievement was correlated with young age at diagnosis (p < 0.05) and impaired psychosocial adjustment was correlated with greater time since diagnosis (p < 0.05). Overall quality of life reported by these individuals appears to be acceptable but neuropsychological and psychosocial examination is clearly indicated as part of the follow-up program.

Neuropsychological and Emotional Correlates of Marital Status and Ability to Live Independently in Individuals with Epilepsy

Summary: Studies from several countries have reported that fewer people with epilepsy marry, but the reasons for this are not clear. In the present investigation, 178 adults with epilepsy were divided into married, separated/divorced, and never married groups. The never married group was subdivided into persons living in dependent versus independent settings. The groups did not differ with respect to seizure type, age at onset of seizures, and related variables. All were administered a complete battery of neuropsychological tests and the Minnesota Multiphasic Personality Inventory. On all tests of abilities, the married and the never married independent groups had the best scores, the separated/divorced group was intermediate, and the never married dependent group had by far the lowest scores. In the emotional area, however, trie separated/divorced group had the poorest scores and the other groups were indistinguishable from each other. It appears that marital status is more related to emotional adjustment than to mental abilities, and that independent living skills are more related to mental abilities than to emotional adjustment.

Emotional and intellectual correlates of unsuccessful suicide attempts in people with epilepsy

This study evaluated the emotional and intellectual correlates of unsuccessful suicide attempts in persons with seizure disorders. Psychosocial evaluations were completed on 198 adults with epilepsy, of whom 32 had made one or more suicide attempts. The MMPI demonstrated increased anxiety and decreased ego strength among those with histories of suicide attempts in comparison to those without such a history. Intellectual abilities as evaluated by the WAIS were slightly lower among the suicide attempters, especially on language-related tasks. Unsuccessful suicidal behavior in epilepsy is probably the product of multiple conditions and circumstances, including seizures themselves, decreased adaptive abilities, increased emotional problems, and the continual availability of agents (antiepileptic medications) with which a suicide attempt may be undertaken.

Millon Clinical Multiaxial Inventory Assessments of Patients Manifesting Either Psychogenic or Epileptic Seizures

Previous investigations utilizing the Minnesota Multiphasic Personality Inventory have observed personality differences between patients with epilepsy (ES) and those with psychogenic seizures (PS). This research utilized a shorter, easier-to-administer instrument, the Millon Clinical Multiaxial Inventory (MCMI), to evaluate 27 PS patients and 22 ES patients. Based on the results of EEG/video monitoring, patients were assigned to either strictly ES or strictly PS groups. PS patients scored significantly higher on MCMI Axis I scale of Anxiety, Somatoform, and Dysthymia as well as the Axis II pathological personality disorder, Borderline. Only the Axis I scales, however, showed clinically elevated base rate scores. Classification rules developed from these results correctly indentified 74% of the PS and 72% of the ES patients. These results suggest that MCMI may be a useful instrument for the evaluation of patients with PS.

Economical screening for emotional disturbance in epilepsy: Anticipating Minnesota multiphasic personality inventory profile elevations by means of the Washington psychosocial seizure inventory

Abstract This study examined the ability of the Washington Psychosocial Seizure Inventory (WPSI) to identify patients with elevated (abnormal) scores on scales of the Minnesota Multiphasic Personality Inventory (MMPI). A sample of 407 adults with epilepsy who were administered both inventories was randomly divided into principal (n = 250) and cross-validation (n = 157) subsamples. Scores of 5 or more on the WPSI Emotional Adjustment Scale best identified the presence of one or more MMPI scale elevations, with 82% accuracy on cross-validation. Scores on the Emotional Adjustment Scale of 12 or more best identified the presence of two or more MMPI scale elevations, with 80% accuracy on cross-validation. High correlations were obtained between several WPSI and MMPI scales. This study suggests that the 132-item WPSI may be useful in screening for emotional disturbances in adults with epilepsy, and in determining when further emotional evaluation via clinical interview or additional testing may be warranted.