Paul A. Derry

Schematic processing and self-reference in clinical depression.

Differences in self-schema content among 16 clinical depressives, 16 nondepressed psychiatric control patients, and 16 normal nondepressives (women between the ages of 18 and 65) were investigated by having subjects make structural (Small letters?), semantic (Means same as a given word?), and self-referent (Describes you?) ratings on depressedand nondepressed-content personal adjectives. These ratings were then followed immediately by an incidental recall period in which subjects recalled as many of the adjectives as possible. In accord with predictions generated from a self-as-schema model, adjective recall was greater overall for the self-referent rating task, relative to the structural and semantic tasks. Furthermore, consistent with the content-specificity component of this self-schema model, both normal and nondepressed psychiatric controls displayed superior recall only for self-referenced, nondepressed-content adjectives. Also consistent with the content-specificity component of this model, clinical depressives displayed significantly enhanced recall only for depressed-content adjectives rated under the self-referent task. In combination with rating time findings, these results offer empirical support for Becks proposal that an efficient negative self-schema exists, specific to the disorder of depression.

Outcome Assessment in Epilepsy: Comparative Responsiveness of Quality of Life and Psychosocial Instruments

Summary: Purpose: Few data exist on the ability of instruments to detect within‐patient change over time in epilepsy, a property referred to as responsiveness. Our aim was to compare the responsiveness of three instruments [i.e., Epilepsy Surgery Inventory‐55 (ESI‐55) and Washington Psychosocial Inventory (WPSI), both epilepsy specific, and Symptom Checklist‐90–Revised (SCL‐90–R), non‐epilepsy specific].

An epilepsy questionnaire study of Knowledge and attitudes in Canadian college students

Summary:  Purpose: Controversy exists about the relation of societal knowledge and attitudes regarding epilepsy. We conducted a survey to examine knowledge and attitudes, to note gender and occupational influences, and to examine the effect of an informational brochure.

Psychosocial function following temporal lobectomy: influence of seizure control and learned helplessness

Learned helplessness is the perception that ones behaviour cannot produce a desired outcome. Individuals with intractable epilepsy who have learned that the occurrence of a seizure is beyond their control can develop such a helpless attitude with cognitive, affective and behavioral components which may generalize to many aspects of life. Post-operative testing was done on 42 patients, aged 17-60 years with I.Q. > 80 who had temporal lobectomies (25 R, 17 L) with follow-up 1-14 years (mean 5 years). In addition to seizure outcome, psychosocial adjustment was measured using the Washington Psychosocial Inventory (WPSI) and a structured interview. Three variables of learned helplessness were also assessed: internal or external locus of control, resourcefulness, and depression. Seizure outcome was: completely seizure free, 36%; > 90% improvement, 38% < 90% improvement, 26%. Overall post-operative psychosocial adjustment was good, marked improvement in lifestyle was noted by 85%, personality change for the better by 65% and improved mood by 47%. A transient mood disorder was noted by 38% in the first six months following surgery. Psychosocial adjustment was better in patients who were seizure free or had > 90% reduction in seizures compared to those with < 90% improvement. Two measures of learned helplessness, depression and lack of resourcefulness correlated with poor postoperative psychosocial adjustment. Other variables beside seizure control must be considered in determining the ultimate outcome of epilepsy surgery.

The MMPI-2 as an adjunct to the diagnosis of pseudoseizures

Although the original Minnesota multiphasic personality inventory (MMPI) showed promise in the psychometric discrimination of patients with epileptic seizures and pseudoseizures, inconsistencies and relatively low rates of accuracy have been reported. The present study evaluated the restandardized MMPI-2 for its accuracy in discriminating patients with pseudoseizures in a population with intractable epilepsy. MMPI-2 profiles for 139 consecutive adult inpatients (24 with pseudoseizures) were classified as a pseudoseizure pattern if they had (a) a T score on Scale 1 and/or 3 > or = 65, (b) Scale 1 or 3 in the 2-point high code, and (c) if 1 or 3 was not the highest scale, it was < or = 6T from the highest scale. Compared to studies using the original MMPI, it was expected the MMPI-2 would more accurately classify patients in each group. Preliminary analyses revealed pseudoseizure patients had a greater history of mental health interventions and were older when their seizure disorder began, relative to the epilepsy patients. A classification accuracy of 92% was found for pseudoseizures and 94% for epilepsy patients. For the pseudoseizure group, clinically meaningful MMPI-2 elevations followed a 3-1-2 pattern. No mean elevations above a T value of 65 were seen in the epilepsy group.

Neuroticism in Temporal Lobe Epilepsy: Assessment and Implications for Pre- and Postoperative Psychosocial Adjustment and Health-Related Quality of Life

Summary: We assessed 77 candidates for epilepsy surgery to determine the association among neuroticism (a dimension of personality characterized by chronic negative emotions and behaviors), psychosocial adjustment as measured by the Washington Psychosocial Seizure Inventory (WPSI), and health‐related quality of life (HRQOL) as measured by the Epilepsy Surgery Inventory 55 (ESI‐55). Minnesota Multiphasic Personality Inventory 2 (MMPI‐2) Neuroticism scale scores were significantly correlated with many domains of patient‐perceived psychosocial adjustment and HRQOL regardless of frequency or type of seizures. We then followed 45 of the patients who subsequently underwent epilepsy surgery to determine the influence of neuroticism on postoperative functioning. Two‐way analysis of variance (ANOVA) indicated that patients with high preoperative neuroticism had significantly poorer postoperative psychosocial adjustment and HRQOL scores than patients who had low or moderate preoperative neuroticism scores. These results support the validity of the MMPI‐2 as a useful measure of neuroticism. Preoperative neuroticism has an important influence on postoperative psychosocial adjustment and HRQOL that is independent of postoperative seizure outcome. Understanding the influence of personality variables, such as neuroticism, on psychosocial functioning both before and after epilepsy surgery is essential in managing intractable seizures.

Measuring quality of life in epilepsy surgery patients.

Treatment of chronic conditions often entails trade-offs between benefits and risks or side effects. This is of particular importance in epilepsy. Consequently, assessment of effectiveness must incorporate this trade-off as perceived by the recipient of the intervention, ie., the patient. Measurement of health related quality of life (HRQOL) aims at capturing such patient-centred effects of therapy. Conceptual aspects of HRQOL are described and issues relevant to outcomes of epilepsy surgery are addressed. Finally, practical aspects of measurement in the context of epilepsy surgery are discussed.

Causal attributions for seizures: Relation to preoperative psychological adjustment and postoperative psychosocial function in temporal lobe epilepsy

Abstract In a sample of 65 epilepsy patients who were temporal lobectomy candidates, the links between causal attributions, learned resourcefulness, and preoperative psychosocial adjustment were explored. In addition, attributions as predictors of objective 2-year postoperative psychosocial outcomes were examined prospectively. With illness severity controlled for, attribution of seizures to stress factors and low learned resourcefulness were predictive of poor psychosocial adjustment preoperatively. Taking personal responsibility for seizure occurrence (self-blame) was associated with better psychosocial adjustment. At 2 years, patients were divided into three groups: (a) postoperative seizure-free (n = 21), (b) postoperative not seizure-free (n = 19), and (c) nonoperated controls (n = 25). Seizure-free outcome status was associated with better psychosocial outcome. Of greater interest was the predictive value of preoperative attributions. As expected, attributions involving personal responsibility were predictive of postoperative full-time employment and receipt of disability benefits. The data enhance understanding of the ways in which patients with epilepsy manage the challenges they face and enhance the psychometric prediction of psychosocial behavioral outcomes after epilepsy surgery.

Subjective memory evaluation before and after temporal lobe epilepsy surgery.

Subjective memory (SM), a self-evaluation of memory, in contrast to objective memory (OM) measured by neuropsychological testing, is less well studied in patients with epilepsy. We assessed SM before and after temporal lobectomy. The Frequency of Forgetting 10 scale (FOF-10), developed to evaluate SM in dementia, was given before and one year after temporal lobectomy. Reliability and validity for use in epilepsy were first assessed. Measures of depression (CES-D) and neuroticism (PANAS) were done before and after surgery as well as complete neuropsychological assessment of OM. Correlation analysis between FOF-10 results and all the other variables was implemented. In 48 patients the FOF-10 was reliable and valid showing high internal consistency in all items (Cronbachs alpha >0.82) and high reproducibility (p<0.01). The FOF-10 also correlated with the memory assessment clinics self rating scale (MAC-S) (p<0.01). FOF-10 scores improved or were unchanged postoperatively in 28 patients (58%) and worsened in 20 (42%). The FOF-10 did not significantly correlate with memory scores from neuropsychological testing but did correlate with perceived word finding difficulty (p<0.001) and postoperative depression (p<0.05). A reduction in number of antiepileptic drugs (AEDs) after surgery distinguished those with improved postoperative SM. No correlation was found between SM and neuroticism, side of surgery or number of seizures. The FOF-10 is a brief and reliable measure of subjective memory in patients with epilepsy. Perceived memory impairment reflects more emotional state, language problems and quantity of AEDs than actual defects in memory function. These results would potentially be useful in presurgical counselling and management of memory issues after temporal lobe surgery.

Coprolalia as a manifestation of epileptic seizures

OBJECTIVE The aim of this study was to investigate the lateralizing and localizing value of ictal coprolalia and brain areas involved in its production. METHODS A retrospective search for patients manifesting ictal coprolalia was conducted in our EMU database. Continuous video-EEG recordings were reviewed, and EEG activity before and during coprolalia was analyzed using independent component analysis (ICA) technique and was compared to the seizures without coprolalia among the same patients. RESULTS Nine patients were evaluated (five women), eight with intracranial video-EEG recordings (icVEEG). Four had frontal or temporal lesions, and five had normal MRIs. Six patients showed impairment in the language functions and five in the frontal executive tasks. Two hundred six seizures were reviewed (60.7% from icVEEG). Ictal coprolalia occurred in 46.6% of them, always associated with limbic auras or automatisms. They arose from the nondominant hemisphere in five patients, dominant hemisphere in three, and independently from the right and left hippocampus-parahippocampus in one. Electroencephalographic activity always involved orbitofrontal and/or mesial temporal regions of the nondominant hemisphere when coprolalia occurred. Independent component analysis of 31 seizures in seven patients showed a higher number of independent components in the nondominant hippocampus-parahippocampus before and during coprolalia and in the dominant lateral temporal region in those seizures without coprolalia (p=0.009). Five patients underwent surgery, and all five had an ILAE class 1 outcome. SIGNIFICANCE Ictal coprolalia occurs in both males and females with temporal or orbitofrontal epilepsy and has a limited lateralizing value to the nondominant hemisphere but can be triggered by seizures from either hemisphere. It involves activation of the paralimbic temporal-orbitofrontal network.