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 depressed-and 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 Beck's proposal that an efficient negative self-schema exists, specific to the disorder of depression.

The present research investigated the extent to which mild depressives and normals differed in their self-referent processing of personal information. In Experiment 1, these subjects made two types of ratings on depressed (e.g., bleak, dismal) and nondepressed (e.g., loyal, organized) content personal adjectives. Half of the adjectives in each content category were rated for a semantic attribute (Does this word have a specific meaning or relate to a specific situation?), whereas half were rated for degree of self-reference (Does this word describe you?). These ratings were followed immediately by an incidental recall task, in which subjects recalled as many of the adjectives as possible. Consistent with predictions generated from a content-specific self-schema model, normals displayed superior recall for self-referenced nondepressed content adjectives, when compared to recall for self-referenced depressed content adjectives and recall for semantic ratings (both depressed and nondepressed content). In contrast, mild depressives exhibited enhanced self-referent recall for both types of content, when compared to their recall for semantic adjectives. This finding suggested that mild depressives utilize a self-schema which incorporates both depressed and nondepressed content. Experiment 2 explored this suggestion further by substituting an other-referent rating task (Does this word describe Pierre Trudeau?) for the semantic judgment used in Experiment 1. Again, consistent with a content-specific self-schema model, normals displayed superior recall only for self-referenced nondepressed adjectives. Mild depressives, however, showed enhanced self-referent recall, relative to other-referent recall, only for depressed content adjectives. For nondepressed content, mild depressives did not distinguish between the self- and other-referent conditions. This finding hinted that the nondepressed component of the mild depressive's self-schema may operate at a somewhat reduced effectiveness, but only when required to differentiate between self and others.

Background: Health related quality of life (HRQOL) is increasingly recognised as an important outcome in epilepsy. However, interpretation of HRQOL data is difficult because there is no agreement on what constitutes a clinically important change in the scores of the various instruments. Objectives: To determine the minimum clinically important change, and small, medium, and large changes, in broadly used epilepsy specific and generic HRQOL instruments. Methods: Patients with difficult to control focal epilepsy (n = 136) completed the QOLIE-89, QOLIE-31, SF-36, and HUI-III questionnaires twice, six months apart. Patient centred estimates of minimum important change, and of small, medium, and large change, were assessed on self administered 15 point global rating scales. Using regression analysis, the change in each HRQOL instrument that corresponded to the various categories of change determined by patients was obtained. The results were validated in a subgroup of patients tested at baseline and at nine months. Results: The minimum important change was 10.1 for QOLIE-89, 11.8 for QOLIE-31, 4.6 for SF-36 MCS, 3.0 for SF-36 physical composite score, and 0.15 for HUI-III. All instruments differentiated between no change and minimum important change with precision, and QOLIE-89 and QOLIE-31 also distinguished accurately between minimum important change and medium or large change. Baseline HRQOL scores and the type of treatment (surgical or medical) had no impact on any of the estimates, and the results were replicated in the validation sample. Conclusions: These estimates of minimum important change, and small, medium, and large changes, in four HRQOL instruments in patients with epilepsy are robust and can distinguish accurately among different levels of change. The estimates allow for categorisation of patients into various levels of change in HRQOL, and will be of use in assessing the effect of interventions in individual patients.

We conducted a prospective study over 24 months to compare health-related quality of life in surgically and medically treated patients with intractable temporal lobe epilepsy. Seizure frequency and health-related quality of life were assessed in 81 patients before and 6, 12, and 24 months after treatment. Using the Epilepsy Surgery Inventory 55 (ESI-55), we compared (1) different seizure outcome groups and (2) temporal lobectomy with continuing medical management. Follow-up was satisfactory in 72 patients (89%), 51 treated with temporal lobectomy and 21 with no surgery. Pretreatment seizures and health-related quality of life were comparable in the two groups. Seizure outcome was significantly better at 6, 12, and 24 months after surgery. At 24 months, seizure-free patients and those with at least a 90% reduction in seizure frequency reported significant improvements in health-related quality of life (on 5 of 10 subscales and overall Epilepsy Surgery Inventory 55 scale). Deterioration in quality of life occurred with less than 90% seizure reduction. Only one Epilepsy Surgery Inventory 55 subscale at 6 months and two subscales at 12 months showed a significant difference. Patients with good seizure outcome experience improved health-related quality of life after treatment. Since temporal lobectomy results in considerably better seizure control than continued medical management, the findings support surgery as the preferred treatment, although changes in health-related quality of life may not be evident until the second postoperative year.

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.Methods: We administered a standardized questionnaire that noted demographics and examined knowledge and attitudes regarding epilepsy and persons with epilepsy, respectively, to a wide variety of Canadian college students. In a separate class we gave every other student a brochure regarding epilepsy and then administered the questionnaire to both the naïve and brochure-exposed students.Results: Knowledge was patchy and weakest for the approximate prevalence of epilepsy in the population, hereditary epilepsy and several other etiologies, recognition of nonconvulsive seizures as a type of epilepsy, and knowledge of antiepileptic drug-induced teratogenicity. In contrast, attitudes were more uniformly favorable. However, 11 and 14%, respectively, showed negative bias against persons with epilepsy having children and equal opportunity for occupational employment. Women were slightly but significantly more tolerant than men. The brochure-exposed group showed better knowledge but equivalent attitudes compared with the naïve group.Conclusions: Results compare favorably with surveys in other countries. Although knowledge was patchy, it could be easily improved on with an educational brochure. Attitudes were positive but show some discrepancies from knowledge and a gender effect.

Our results support the responsiveness of ESI-55 scales and suggest that SCL-90-R is a responsive tool for the assessment of psychologic function and distress in epilepsy. Comparatively, WPSI is relatively unresponsive to small or medium-size changes.

Objective-To provide a descriptive analysis of the prevalence and pattern of psychiatric morbidity among 300 consecutive epileptic patients refractive to treatment and admitted during a six year period for evaluation of their candidature for surgery. Methods-Patients underwent detailed observation of their seizure and standardised psychiatric assessment. Patients were considered to be refractory to treatment if they continued to manifest seizures with an average frequency of at least once every month even with polytherapy using up to three different anticonvulsants for a period of at least two years. Of the 300 patients, 231 had a temporal lobe focus, 43 had a non-temporal lobe focus, and 26 patients had a generalised and multifocal seizure onset. Results and conclusions-With the DSM-III-R criteria 142 (47-3%) patients emerged as psychiatric cases. A principal axis I diagnosis was made in 88 (29-3%), and an axis II diagnosis (personality disorder) in another 54 (18.0%) patients. The most common axis I diagnosis was anxiety disorders (10.7%). A schizophrenialike psychosis was seen in 13 (4-3%). Most patients with personality disorders showed dependent and avoidant personality traits. There was a significantly higher psychotic subscore on the present state examination in the temporal than with the non-temporal group of patients. These findings were not significant when compared with patients with a generalised and multifocal seizure disorder. There were no significant findings between the different seizure focus groups on the neurotic subscores. The findings with regard to laterality of seizure focus and the neurotic or psychotic subscores were not significant. (J Neurol Ncurosurg Psy,chiatry 1996;61:82-89)

Summary:Purpose: Other outcome measures besides seizure control must be considered when assessing the benefit of epilepsy surgery. We investigated the effect of preoperative psychosocial adjustment on postoperative depression in epilepsy patients followed up prospectively for 2 years after temporal lobectomy.Methods: The Washington Psychosocial Seizure Inventory (WPSI) evaluated psychosocial functioning; the Centre for Epidemiological Studies Depression Scale (CES-D) measured depression. Both were completed at baseline and follow-up.Results: Follow-up occurred in 39 temporal lobectomy patients at 2 years after surgery. Greatest improvement in depression scores was limited to patients with good seizure outcomes (seizure free, or marked reduction in seizure frequency), and seizure outcome was a significant predictor of postoperative depression. Despite this, preoperative scores on the emotional adjustment scale of the WPSI were most highly correlated with depression 2 years after surgery. To clarify this relation, moderated hierarchic regression suggested that good preoperative emotional adjustment (WPSI) was generally associated with less depression after surgery. Moreover, poorer preoperative adjustment combined with older age, generalized seizures, the finding of preoperative neurologic deficits, a family history of psychiatric illness, and/or a family history of seizures was related to higher depression scores 2 years after surgery.Conclusions: Depression after temporal lobectomy is dependent on a complex interaction of variables and can have a significant effect on indices of postoperative adjustment. The WPSI emotional adjustment scale may help to predict which patients are likely to be chronically depressed after surgery. Key Words: Epilepsy surgery-Depression-Emotional adj ustment-Prediction .Temporal lobectomy is an effective treatment for controlling medically intractable seizures of temporal lobe origin (1-S). The primary reasons for undergoing temporal lobectomy are to provide seizure relief and to improve quality of life (6-4, but improvements in psychosocial function may not be fully evident for several months or years after surgery (1). Postoperatively, the development, recurrence, or exacerbation of psychological problems is not uncommon, and several studies now suggest that individual differences in outcomes can be predicted by preoperative indicators of mental and physical health (9-15).Depressive symptoms are a common occurrence in the population with epilepsy and may persist despite good seizure control (16). Admissions of patients with epilepsy to psychiatric centers are often due to depression (17), and the suicide rate is higher in those with epilepsy than in the general population (1 8). Depression in epiAccepted July 2, 1999. Address correspondence and reprint requests to Dr. P. A. Deny at Department of Psychology, London Health Sciences Centre, University Campus, 339 Windermere Rd., London, Ontario, Canada. E-mail: pderry @julian.uwo.ca lepsy is most commonly an interictal phenomenon aris...