Positive Psychosocial Variables and Outcome Variables in Persons with Epilepsy

Abstract

What does it mean to adjust to a chronic disease? The literature suggests three main conclusions: (a) a chronic disease requires adjustment across multiple life domains, (b) adjustment unfolds over time, and (c) there is marked heterogeneity across individuals in how they adjust to chronic disease. Adjustment is a process that begins at the presentation of symptoms and continues throughout the course of the illness and responds to changes in illness status (Sharp & Curran, 2006). It can be defined as a response to a change in the environment that allows an organism to become more suitably adapted to that change (Sharpe & Curran, 2006). It refers to the healthy rebalancing by patients to their new circumstances (de Ridder et al., 2008). However, for about 30% of patients, the adjustment phase is prolonged and sometimes unsuccessful (de Ridder et al., 2008). The above definition implies that adjustment occurs over time, and often refers to a desirable state or endpoint. de Ridder et al. (2008) and Stanton et al. (2007) report key elements of successful adjustment to a chronic illness: (a) the successful performance of adaptive tasks (e.g., adjustment to disability, maintained emotional balance, and preservation of healthy relationships); (b) the absence of psychological disorders; (c) the presence of low negative affect and high positive affect; (d) adequate functional (e.g., work) status; (e) and the satisfaction and wellbeing in various life domains. Several models have been proposed on how patients could achieve these outcomes, namely (de Ridder et al., 2008): the model of cognitive adaptation, which emphasises illness acceptance and perceptions of control over illness; the personality model that emphasises the role of personality factors in adjustment; and the stress and coping model that emphasises strategies used by patients to deal with adaptive tasks imposed by disease. All the models presuppose relationships between different kinds of psychosocial and behavioural variables. In other words, the adjustment process includes contextual, disease, and personal characteristics, more stable (like personality) or more elusive (more easily influenced by training or education, like stigma perception, coping, positive psychological state, adherence to treatment, social support, psychosomatic symptoms, spiritual beliefs, and life events), and their conjoint impact on outcome variables (health status perception, health related quality of life-HRQOL-, and subjective happiness). In this context, the objective of the present study is to discuss the role of psychosocial variables in adjustment to everyday life in persons with epilepsy. 3. Adjustment challenges When adjustment is unsuccessful, mental health problems/personality disorders may become (more) evident or more intense. Inversely, these situations can make adjustment more difficult. One should, nevertheless, bear in mind that what can be seen as a personality trait may, in fact, be an attempt to compensate deficits, namely, cognitive deficits (Devinsky & Najjar, 19...

Psychosocial impairments among adults with epilepsy in a neurology clinic in Nigeria

“…It has been observed that patients with psychosocial problems are more likely to have difficulties controlling their seizures (2)(3)(4). In this study, evidence was provided that supports this view as there was a significant association between increasing frequency of seizures (suggesting suboptimal seizure control) and presence of financial, physical and occupational problems.…”

“…This suggests that psychosocial maladjustment to the disorder may be a frequent phenomenon. The complex biopsychosocial dimensions of epilepsy, its unpredictable nature and course, and issues related to its treatment are factors that influence the psychosocial handicaps it engenders (1)(2)(3)(4)(5). Psychosocial adjustment is how well the affected patient responds to the various challenges posed by epilepsy.…”

“…Psychosocial adjustment is how well the affected patient responds to the various challenges posed by epilepsy. Few examples of the common psychosocial adjustment problems reported in epilepsy include: stigmatization, educational deprivations and underachievement, vocational difficulties like unemployment and underemployment, difficulty getting married, financial problems, inconveniences of treatment and follow-ups; driving restrictions; intrusiveness in valued activities and psychological distress of various kinds like fears, anxieties, anger or sadness and loss of previous future plans ( [1][2][3][4][5][6][7] Persistence of psychosocial problems may become too distressing for the patient sometimes more than the seizures themselves and when adjustment is unsuccessful other complications may emerge such as mental ill health, difficulties with seizures control and reduction in quality of life (4,8). It is therefore important to study and understand psychosocial dimensions associated with epilepsy (2,3,5).…”

“…Some of these factors include the degree of visibility of the emerging symptoms and signs, frequency of occurrence, complications that occur and the degree of unpredictability of the seizures (1)(2)(3). Seizure related consequences of psychosocial morbidity include poor compliance with medications, poor self-management attitudes and behaviors which result in more frequent fits and poorer outcome (2)(3)(4)9).…”