Michael E. Dewey

Positive and negative perfectionism

Abstract Previous research into perfectionism has focused on clinical populations resulting in a bias towards a negativistic, pathologically inclined conceptualization. The present study investigated the possibility of distinguishing aspects of perfectionism on the basis of perceived consequences, mirroring a behavioural distinction between positive and negative reinforcement. A 40-item questionnaire, designed to measure perfectionism defined in terms of both positive and negative outcome, was administered to 281 women; a comparison group (N = 225), an eating disordered group (N = 21), a depressed group (N = 15) and successful athletes (N = 20). A factor analysis of the results extracted three factors; negative perfectionism including both personal and social items; positive personal perfectionism; and positive social perfectionism. Limiting the number of factors to two yielded a clear distinction between positive and negative perfectionism. Group comparisons yielded significance differences; for athletes high positive perfectionism was associated with a low negative perfectionism score; for the eating disorders group a high positive perfectionism score was associated with a high negative score. When analysed in terms of personal and social items the distinguishing factors were the negative and positive components, athletes and eating disordered groups obtaining comparably high positive personal perfectionism scores and the clinical groups obtaining comparably high negative perfectionism scores.

Outcomes of Add-on Treatment with Lamotrigine in Partial Epilepsy

Summary: The need for new antiepileptic drugs (AEDs) and more sensitive methods of assessing their efficacy is well recognized. This study was designed to evaluate the efficacy and safety of lamotrigine (LTG), a potential new AED and to develop and test new outcome measures. A health‐related quality of life (HRQL) model was developed which contains previously validated measures of anxiety, depression, happiness, overall mood, self‐esteem, and mastery and a specifically designed seizure severity scale with patient‐ and caregiver‐based components. This HRQL model was used in a randomized, placebo‐controlled, double‐blind, cross‐over study of LTG in 81 patients with refractory partial seizures. Seizure frequency was the primary measure and seizure severity and the HRQL were secondary measures of efficacy. The reduction in seizure frequency with LTG, relative to placebo, was 29.7% [95% confidence interval (CI) 17.8%, 39.9%] for total seizure count, 33.4% (95% CI 14.8%, 47.9%) for complex partial seizures (CPS) and 20.3% (95% CI 0.3%, 36.2%) for secondarily generalized tonic‐clonic seizures (GTCS). However, although 41 patients elected to continue with LTG, only 11 experienced at least 50% reduction in total seizures, indicating that other factors influenced their decision. The score with LTG, relative to placebo, was significantly lower for the ictal (p = 0.017) and caregivers (p = 0.035) subscales of the seizure severity scale and significantly higher for happiness (p = 0.003) and mastery (p = 0.003). Simple correlation and multiple‐regression analyses indicate that the effects on seizure frequency, seizure severity, and psychological variables appear to be independent of each other. This study indicates that LTG is effective in reducing seizure frequency and has additional favorable effects on seizure severity, mood, and perceived internal control. Some of the scales used indicate the potential of secondary measures of efficacy to enhance the sensitivity of trials of new AEDs.

The initial development of a health-related quality of life model as an outcome measure in epilepsy

Patients with refractory epilepsy, despite no fixed physical deficit, are often socially and psychologically handicapped. Currently available outcome measures for epilepsy do not adequately address these manifestations or their influence on well-being and quality of life. A patient-based health-related quality of life (HRQL) model for epilepsy including physical, social and psychological domains was constructed. It contains previously validated measures of anxiety, depression, happiness, overall mood, self-esteem, mastery, social satisfaction and general health and a specifically designed seizure severity scale with patient- and carer-based components. The psychometric properties of this model were evaluated in the context of the trial of a potential new antiepileptic drug. All the scales, except the Social Problems Questionnaire, have acceptable internal consistency (alpha 0.69-0.85) in this patient population. Construct validity is indicated by the ability of the scales to differentiate between groups of patients predicted to have different levels of psychosocial function. Treatment effects were detected by the patient (P = 0.017) and carers (P = 0.035) subscales of the seizure severity scale, the happiness (P = 0.003) and the mastery (P = 0.003) scales. Despite obvious deficiencies preliminary analyses are encouraging. This model provides a framework for investigating the complex interaction between the physical, social and psychological manifestations of epilepsy. The model has potential as an outcome measure for use in longitudinal studies and as a measure of disability for use in cross-sectional studies designed to compare quality of life in different populations of people with epilepsy.

The development of a seizure severity scale as an outcome measure in epilepsy

In controlled trials of antiepileptic drugs (AEDs) seizure frequency is often the only variable considered. With little prospect of improving assessment of AEDs, using seizure counts as the only end-point, there is a need for the development of new outcome measures. Clinical experience indicates that seizure severity is equally important to the patient and, by preventing seizure spread, AEDs can influence seizure severity without necessarily reducing seizure frequency. A scale capable of measuring seizure severity and change of severity attributable to treatment could be a useful additional outcome measure. Such a scale should exhibit the basic properties of validity and reliability. An easily administrable 16-point scale, containing 2 subscales--perception of control and ictal/post-ictal effects--has been developed. This scale has been tested on a patient population (n = 159) representative of that seen in trials of novel AEDs. Using standardised statistical methods, the scale has been shown to be both reliable and valid.

DEVELOPMENT AND PRELIMINARY VALIDATION OF THE BODY SATISFACTION SCALE (BSS)

Abstract This paper describes the development of a simple paper-and-pencil test designed to measure satisfaction/dissatisfaction with 16 body parts. It is based on the body-cathexis scale of Secord and Jourard (1953) but takes only 2–3 minutes to complete. The factorial structure of the scale is described together with the three summative scales (“general,” “head parts” and “body parts” dissatisfaction) which are derived. The internal consistency of the scales was found to be acceptable. Significant positive correlations are also reported with the Body Shape Questionnaire (Cooper et al., 1987). The paper reports data for female comparison groups (college students, nursing students and female volunteers) and for samples of eating disorder patients and overweight subjects. The latter two groups report significantly higher body dissatisfaction than the comparison groups. Finally, it is argued that the scale is useful for work in health related fields and some current applications are briefly described.

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.

Risk factors for depression in elderly people: a prospective study

In 1982‐1983 a random sample of 1486 people aged 65 years and above was generated from general practitioner lists; 1070 were interviewed in the community using the Geriatric Mental State and a Social History questionnaire. The cohort was followed up by interview 3 years later. At year 3 the diagnostic computer program AGECAT diagnosed 44 incident cases of depression. Information from the depressed groups initial and further interviews was compared with a control group (which excluded cases of affective or organic mental illness). Univariate analysis yielded three factors that were significantly associated with the development of depression 3 years later: a lack of satisfaction with life; feelings of loneliness; and smoking. Multivariate analysis confirmed their independent effects and revealed 2 further factors attaining significance: female gender and a trigger factor, bereavement of a close figure within 6 months of the third‐year diagnosis. Some other factors traditionally associated with depression, such as poor housing, marital status and living alone, failed to attain significance as risk factors.

Measuring the impact of epilepsy: the development of a novel scale

The impact of a chronic illness is experienced not only through its physical symptoms, but also as a result of its effect on psychosocial functioning. In the case of an illness such as epilepsy, where the physical manifestations are transient, the psychosocial consequences may, with time, come to be of greater concern. We have been involved in developing a quality of life model for epilepsy. As part of the refinement of the initial model, we have devised a novel scale to measure the impact of the condition on a number of different aspects of daily life. The scale was administered to 75 patients attending an epilepsy out-patient clinic. Initial analysis of its psychometric properties is encouraging, although the inclusion of an item relating to employment reduced the scales reliability. As a result, the wording of the existing item has been amended and an additional item has been incorporated. We hope the scale will be useful in investigations of treatment for epilepsy and of its psychosocial aspects.

Development and preliminary validation of SCANS: A screening instrument for identifying individuals at risk of developing anorexia and bulimia nervosa

The development and preliminary validation of a new Self-report questionnaire for screening individuals at risk of developing an eating disorder (SCANS) is described. This instrument was derived from the functional-analytic model of anorexia nervosa, previously outlined by the first author (Slade, 1982). Forty items were created to measure five hypothesized, antecedent conditions, and this questionnaire was then administered to 722 control subjects and 40 eating disorder patients. Two principal component analyses were carried out on successive samples of control subjects (368 validation and 354 cross-validation), which yielded virtually identical solutions. Using scales empirically derived from the first component analysis, the eating disorder groups, anorexia nervosa and bulimia nervosa patients, differed significantly on all five scales from controls. Moreover, normal individuals identified as being theoretically at high risk of an eating disorder were found to score significantly higher than controls on all measures derived from the Eating Attitudes Test (EAT). Further studies and reports are planned.

Development of a Novel Scale to Assess Life Fulfilment as Part of the Further Refinement of a Quality‐of‐Life Model for Epilepsy

Summary: We have been involved in developing a health‐related quality‐of‐life model for use as an outcome measure in epilepsy. As part of the further development of this model, we have developed a measure of life fulfilment. This scale is based on methods previously described by Krupinski in 1980. The value of Krupinskis approach is the opportunity for patients to weight the numerous aspects of their quality of life and assess the discrepancy between their actual and desired circumstances. The life fulfilment scale has been shown to be reliable (α= 0.7) and valid. The scale is currently being applied to several clinical studies in epilepsy. We believe that the scale provides a valuable contribution to our health‐related quality‐of‐life model.