A Psychosomatic Approach to Quality of Life in Patients with Epilepsy

Yıl 2021, , 36 - 44, 30.01.2021

Ayse Terzi Atar , Şakir Gıca , Yasemin Kurtulmuş , Hüseyin Güleç

https://doi.org/10.21673/anadoluklin.778315

Öz

Aim: The aim of this study was to evaluate psychosocial functionality in patients with epilepsy using the Diagnostic Criteria for Psychosomatic Research (DCPR) classification system that aims to identify patients with clinically significant and relatively weighted psychological factors and to compare it with the Diagnostic and Statistical Manual of Mental Disorders (DSM). In addition, it was aimed to validate the DCPR system by investigating the effects of psychosomatic diagnoses on the quality of life in the disease process.

Materials and Methods: One hundred consecutive patients with epilepsy who were referred to the Epilepsy special branch outpatient clinic were included in the study. The control group consisted of 53 healthy volunteers. All participants underwent structured DCPR and SCID-I interviews and were investigated using the Short Form-36 (SF-36) and a Sociodemographic Data Form.

Results: Eighty-seven percent of the patients met the diagnostic criteria with the DCPR system while 82% of the patients met the diagnostic criteria with DSM (χ2(1, N =100) = 4.539, p = 0.04). Examination of the effect of diagnostic systems on SF-36 scores in patients with epilepsy with the hierarchical regression model showed that diagnoses in the DCPR system predicted most of the SF-36 subscale scores better.

Conclusion: The DCPR system could detect psychological distress at a higher rate than DSM in patients with epilepsy. Syndromes in the DCPR classification were associated with poor quality of life in the patients. The DCPR classification is therefore valid in patients with epilepsy and may have advantages in a more comprehensive evaluation of patients.

Anahtar Kelimeler

Epilepsy, psychological distress/psychosomatic, validation, diagnostic criteria for psychosomatic research classification, diagnostic and statistical manual of mental disorders classification, quality of life

Destekleyen Kurum

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Proje Numarası

None

Teşekkür

We would like to thank MD Ari B.Ç. for her important contributions during data collection.

Epilepsi Hastalarında Yaşam Kalitesine Psikosomatik Açıdan Yaklaşım

Öz

Amaç: Bu çalışmanın amacı, epilepsi hastalarında psikososyal işlevselliği; klinik olarak anlamlı ve belirgin psikolojik faktörleri olan hastaları tanımlamayı amaçlayan Psikosomatik Araştırmalar için Tanı Ölçütleri (PATÖ) sınıflandırma sistemi kullanarak değerlendirmek ve Ruhsal Bozuklukların Tanısal ve İstatistiksel El Kitabı (DSM) ile karşılaştırarak farklılıklar olup olmadığını göstermektir. Ayrıca psikosomatik tanıların hastalık sürecindeki yaşam kalitesi üzerine etkisi araştırılarak PATÖ sisteminin geçerliliğini göstermek amaçlanmıştır.

Gereç ve Yöntemler: Çalışmaya Epilepsi Özel Dal Polikliniğinden yönlendirilen ardışık yüz epilepsi hastası ve 53 sağlıklı gönüllü kontrol grubu dahil edildi. Tüm katılımcılarla yapılandırılmış PATÖ ve SCID-I görüşmeleri yapıldı. Katılımcılar Kısa Form-36 (SF-36) ve Sosyodemografik Veri Formu kullanılarak araştırıldı.

Bulgular: Hastaların %87’si DCPR sistemi ile ve hastaların % 82'si DSM ile tanı kriterlerini karşıladı (χ2(1,N=100) = 4,539, p=0,04). Epilepsili hastalarda tanı sistemlerinin SF-36 skorları üzerindeki etkisi hiyerarşik regresyon modeli ile incelendiğinde, PATÖ sistemindeki tanıların birçok SF-36 alt ölçek puanını daha iyi yorumladığı bulundu.

Sonuç: Epilepsili hastalarda, PATÖ sendromları DSM'den daha yüksek oranda psikolojik sıkıntı tespit etmiştir. PATÖ sınıflandırmasındaki sendromlar hastaların düşük yaşam kalitesi ile ilişkilendirilmiştir. PATÖ sınıflandırması epilepsili hastalarda geçerlidir ve hastaların daha kapsamlı değerlendirilmesinde avantajları olabilir.

Anahtar Kelimeler

Epilepsi, psikolojik zorlanma/psikosomatik, geçerlilik, psikosomatik araştırmalar için tanı kriterleri sınıflandırması sistemi, ruhsal bozuklukların için tanı ve istatistik el kitabı sınıflandırılması sistemi, yaşam kalitesi

Proje Numarası

None

Kaynakça

• Liu G, Guo H, Guo C, Zhao S, Gong D, Zhao Y. Involvement of IRE1α signaling in the hippocampus in patients with mesial temporal lobe epilepsy. Brain Res Bull. 2011;84(1):94-102.
• Strzelczyk A, Reese JP, Dodel R, Hamer HM. Cost of epilepsy: a systematic review. Pharmacoeconomics. 2008;26(6):463-76. doi: 10.2165/00019053-200826060-00002.
• Kwan P, Brodie MJ. Neuropsychological effects of epilepsy and antiepileptic drugs. Lancet. 2001;357: 216-22
• Stevens JR. Psychiatric aspects of epilepsy. J Clin Psychiatry. 1988;49(Suppl 4):49-57.
• Perez DL, Murray ED, Price BH. Depression and psychosis in neurologicial practise. In: Daroff RB, Mazziotta JC, Jankovic J, Pomray SL, editors. Bradley's Neurology in Clinical Practice. Elsevier; 2016:108-109.
• Gaitatzis A, Trimble MR, Sander JW. The psychiatric comorbidity of epilepsy. Acta Neurol Scand. 2004;110(4):207-20.
• Torta R, Keller R. Behavioral, psychotic, and anxiety disorders in epilepsy: etiology, clinical features, and therapeutic implications. Epilepsia. 1999;40(Suppl 10):2-20.
• Seo JG, Cho YW, Lee SJ, Lee JJ, Kim JE, Moon HJ, et al. Validation of the generalized anxiety disorder-7 in people with epilepsy: a MEPSY study. Epilepsy Behav. 2014;35:59-63.
• Park SP, Song HS, Hwang YH, Lee HW, Suh CK, Kwon SH. Differential effects of seizure control and affective symptoms on quality of life in people with epilepsy. Epilepsy Behav. 2010;18(4):455-9.
• Cramer JA, Blum D, Fanning K, Reed M. The impact of comorbid depression on health resource utilization in a community sample of people with epilepsy. Epilepsy Behav. 2004;5(3):337-42.
• First MB, Gibbon M. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). In M. J. Hilsenroth & D. L. Segal (Eds.), Comprehensive handbook of psychological assessment, Vol. 2. Personality assessment (p. 134–143). John Wiley & Sons Inc;2004
• Vanheule S, Desmet M, Meganck R, Inslegers R, Willemsen J, De Schryver M, et al. Reliability in psychiatric diagnosis with the DSM: old wine in new barrels. Psychother Psychosom. 2014;83(5):313-4.
• Porcelli P, Bellomo A, Quartesan R, Altamura M, Iuso S, Ciannameo I, et al. Psychosocial functioning in consultation-liaison psychiatry patients: influence of psychosomatic syndromes, psychopathology and somatization. Psychother Psychosom. 2009;78:352–358.
• Evers AWM, Gieler U, Hasenbring MI, van Middendorp H. Incorporating biopsychosocial characteristics into personalized healthcare: a clinical approach. Psychother Psychosom. 2014;83:148–57.
• Guidi J, Rafanelli C, Roncuzzi R, Sirri L, Fava GA. Assessing psychological factors affecting medical conditions: comparison between different proposals. Gen Hosp Psychiatry. 2013;35(2):141-6.
• Sonino N, Peruzzi P. A psychoneuroendocrinology service. Psychother Psychosom. 2009;78(6):346-51.
• Corapcioglu A, Aydemir O, Yildiz M, Esen A, Koroğlu E. Structured clinical interview for DSM-IV Axis I Disorders (SCID-I), clinical version. Ankara: Hekimler Yayın Birliği; 1999. [Turkish]
• Sayılgan N, Guleç H, Domaç FM. Psychosomatic diagnosis in patients with migraine and tension type headache Cukurova Med J. 2018;43(Suppl 1): 262-267. [Turkish]
• Ware JE, Sherbourne CD. The MOS 36-item short-form health status survey (SF-36). 1. Conceptual framework and item selection. Med Care. 1992;30(6):473-83.
• Koçyiğit H, Aydemir Ö, Ölmez N, Nemiş A. SF-36’nın Türkçe için güvenilirliği ve geçerliliği. İlaç ve Tedavi Derg. 1999;12:102-6.
• Marcangelo MJ, Ovsiew F. Psychiatric aspects of epilepsy. Psychiatr Clin North Am. 2007;30(4):781-802.
• Morrell MJ. RNS System in Epilepsy Study Group. Responsive cortical stimulation for the treatment of medically intractable partial epilepsy. Neurology. 2011;77(13):1295-304.
• Johnson EK, Jones JE, Seidenberg M, Hermann BP. The relative impact of anxiety, depression, and clinical seizure features on health-related quality of life in epilepsy. Epilepsia. 2004;45(5):544-50.
• Mangelli L, Bravi A, Fava GA, Ottolini F, Porcelli P, Rafanelli C, et al. Assessing somatization with various diagnostic criteria. Psychosomatics. 2009;50(1):38-41.
• Nanni MG, Caruso R, Travado L, Ventura C, Palma A, Berardi AM. Relationship of demoralization with anxiety, depression, and quality of life: A Southern European study of Italian and Portuguese cancer patients. Psychooncology. 2018;27(11):2616-2622.
• Jacoby A, Baker GA, Steen N, Buck D. The SF-36 as a health status measure for epilepsy: a psychometric assessment. Qual Life Res. 1999;8(4):351-64.
• Barry JJ, Ettinger AB, Friel P, Gilliam FG, Harden CL, Hermann B, et al. Consensus statement: the evaluation and treatment of people with epilepsy and affective disorders. Epilepsy Behav. 2008;13(supp 1):1–29.
• Cramer JA, Blum D, Reed M, Fanning K. The influence of comorbid depression on seizure severity. Epilepsia. 2003;44:1578–1584.
• Boylan LS, Flint LA, Labovitz DL, Jackson SC, Starner K, Devinsky O. Depression but not seizure frequency predicts quality of life in treatment-resistant epilepsy. Neurology. 2004;62:258–261.
• Kanner AM. Psychiatric issues in epilepsy: the complex relation of mood, anxiety disorders, and epilepsy. Epilepsy Behav. 2009;15:83–87.
• Tesio V, Ghiggia A, Di Tella M, Castelli L. Utility of the Diagnostic Criteria for Psychosomatic Research in assessing psychological disorders in fibromyalgia patients. J Affect Disord. 2019;256:219‐220. doi:10.1016/j.jad.2019.06.013.
• Sirri L, Fabbri S, Fava GA, Sonino N. New strategies in the assessment of psychological factors affecting medical conditions. J Pers Assess. 2007;89(3):216-28.