Search

Objectives Serious mental illness is disproportionately common in people with epilepsy and contributes to complications and mortality. Few care approaches specifically target individuals who have epilepsy and severe mental illness. We used an iterative process to refine an existing intervention and tested the novel intervention, T argeted Self-Management for Ep i lepsy and Me ntal Illness (TIME) in individuals with epilepsy and comorbid mental illness (E-MI). Methods The TIME intervention was developed with input from a community advisory board and then tested for feasibility, acceptability, and preliminary efficacy in people with E-MI, using a 16-week prospective, randomized controlled design comparing TIME (N = 22) vs. treatment as usual (TAU, N = 22). Primary outcome was change in depressive symptoms, assessed by the Montgomery Asberg Depression Rating Scale (MADRS). Secondary assessments included global psychiatric symptom severity, seizure frequency, sleep patterns, quality of life, stigma, social support, and self-efficacy. Results There were 44 individuals enrolled, mean age 48.25 (SD = 11.82) with 25 (56.8%) African-Americans. The majority (N = 31, 70.5%) were unemployed, and most (N = 41, 95.5%) had annual income < U.S. $25,000. With respect to study retention, there were 36 individuals (18 in TIME, 18 in TAU) assessed at 12 weeks and 35 individuals (19 in TIME, 16 in TAU) assessed at 16 weeks. There was a significant effect for MADRS (p = 0.036; effect size of 0.70), with lower MADRS at 16 weeks in TIME, while TAU MADRS did not change. Differences between most secondary measures were not statistically significant. Significance The TIME intervention engages individuals to actively participate in self-management and can reduce depression in E-MI. Given the high morbidity and mortality associated with epilepsy complicated by serious mental illness, additional research is needed to better identify how TIME might be implemented in routine care settings. [ABSTRACT FROM AUTHOR]

Objective This systematized literature review identified reports describing epilepsy misconceptions in the developed Western countries and research interventions focused on reducing these misconceptions. Materials and methods English language publications from January 2004 to January 2015 that described original research conducted in Europe, North/Central/South America, or Australia on misconceptions about epilepsy among the general public were used for this review. Results Eighty-one publications were selected. Most studies were conducted in the Americas (N = 30) and Europe (N = 31). Misconceptions and attitudes about epilepsy were assessed among clinical providers (N = 9), family members of people with epilepsy (PWE) (N = 5), teachers (N = 11), students (N = 22), and the general public (N = 25). Most studies used structured questionnaires, sometimes adding open-ended questions. Misconceptions reflected socially exclusionary attitudes directed at PWE, ignorance about treatment, and overgeneralizations that are stigmatizing when applied to all PWE. Misconceptions were more prevalent in those with less education, lower socioeconomic status, and no exposure to PWE. There were only 12 intervention studies. While intervention studies were generally effective in improving attitudes, many were targeted to healthcare and education settings, were time-intensive, and impractical for broad general population implementation. None incorporated newer technology-based strategies regarding effective health communication approaches. Conclusions Types of epilepsy misconceptions were similar in reports published over the last decade, although most referred to misconceptions that have already been previously described. Existing questionnaires may fail to identify more subtle forms of current misconceptions and negative attitudes. Few interventional studies specifically target epilepsy stigma. Practical and broad scalable approaches to destigmatize epilepsy may help reduce misconceptions. [ABSTRACT FROM AUTHOR]

Objective Epilepsy is a chronic neurological condition that significantly increases risk of injury and premature death. Rates of mental illness are also disproportionately high in those with epilepsy, which can be attributed in part to the stress and stigma associated with epilepsy. Psychiatric conditions generally complicate the management of epilepsy, and understanding how psychiatric comorbidity affects use of crisis-based health resources could inform care approaches that help improve epilepsy care. To better understand effects of psychiatric comorbidity on epilepsy burden, we conducted a 5-year retrospective analysis of data from a large safety-net healthcare network and compared the occurrence of negative health events (NHEs), defined as emergency department (ED) visits and hospitalizations, among individuals with epilepsy and mental illness (E–MI) vs. those with epilepsy alone (E). Methods Electronic health record (EHR) data from a large Midwestern U.S. safety-net healthcare system were queried to identify a study population of adults ≥ 18 years with a diagnosis of epilepsy, with or without mental illness. We assessed demographic and clinical characteristics for each of the 5 years and compared NHEs between subgroups with E–MI vs. E. An additional analysis focused on those individuals who remained in the healthcare system over the entire 5-year study time frame (January, 2010 to December, 2014). Annual and cumulative NHE counts and hospital length of stay for individuals with E–MI and E were assessed, as were hospital discharge diagnoses. Results The number (approximately 2000) and demographic characteristics of individuals with epilepsy who received care each year of the study period was relatively consistent. In 2014, mean age of individuals with epilepsy was 48 (range: 18–95), 48.2% were women, 51.5% were White, 37.9% were African-American, and 8.6% were Hispanic. In 2014, there were 1616 (78.6%) individuals in the subgroup with E and 439 (21.4%) in the subgroup with E–MI. Most clinical and demographic variables between the subgroups with E–MI and E were similar, except that individuals with E–MI were less likely to be employed or commercially insured. Overall, NHEs were common, with over 1/4 (27.5%) of all individuals with epilepsy having an ED visit during the year, 13.7% having hospitalization, and 34.2% having either an ED visit or hospitalization. Individuals with E–MI had significantly more NHEs compared to individuals with epilepsy only, as evidenced by higher rates of any NHE (p < .001), ED visits (p < .001), and hospitalizations (p < .001). The cumulative differential in ED and hospital use between subgroups with E–MI and E was substantial over a 5-year time period. While most NHEs were directly related to seizures for the overall group, substance-use complications appeared as a top reason for hospitalization only in the group with E–MI. Conclusions Individuals with E–MI made up just over 20% of all people with epilepsy in a safety-net system and had higher rates of NHEs than those without mental illness. Better and earlier identification of individuals with E–MI, assistance with self-management including helping individuals to optimize ambulatory care settings as opposed to the ED, and treatment for substance use disorders could eventually reduce NHEs in this vulnerable subgroup of individuals with epilepsy. [ABSTRACT FROM AUTHOR]