Психологические и поведенческие особенности больных с фармакорезистентной эпилепсией

Abstract

INTRODUCTION: Pharmacoresistant epilepsy (PRE) is diagnosed in 30% of all patients with epilepsy, causing disorders in psychological and social well-being, as well as the development of intrapersonal conflicts and psychological defense mechanisms. The psychotraumatic role of the epilepsy diagnosis is deepened by restrictions in the daily and professional activities of patients. AIM: To analyze the psychological and behavioral characteristics of patients with PRE compared with patients with successfully controlled seizures. MATERIALS AND METHODS: We studied 60 patients diagnosed with epilepsy aged 20 to 75 years, who were divided to 2 groups: 30 patients with pharmacoresistant epilepsy and 30 patients with successfully controlled seizures. The following psychometric methods were used in the study: Eysenck's test; Strelau test; Freiburg Multivariate Personality Inventory (FPI); Toronto alexithymic scale; T. Bant's scale of manipulative attitude; test ‘Tendency to self-destruction’; test of intrapersonal conflicts by V. Lauterbach; questionnaire ‘Types of behavior in conflict’ by K. Thomas – R. Kilman. Statistical differences between the groups were assessed using non-parametric statistics; differences were considered significant at p < 0.05. RESULTS: The patients with PRE showed a higher level of anxiety and alexithymia, a lower level of spontaneous and reactive aggression and tranquility compared to the patients of the control group. Patients with PRE show a higher tendency to manipulative behavior and a lower tendency to self-destructive behavior than patients with successful seizure control. The spectrum of intrapersonal conflicts in patients with PRE is represented by an imbalance between the needs for dominance, achievements, independence and passive avoidance, submission, unrealized opportunities. In interpersonal conflicts, these patients are prone to avoidant behavior, while patients in the control group demonstrate the flexibility of behavior using all possible behavioral strategies. In general, patients with PRE have psychological and behavioral characteristics typical of patients with epilepsy, but expressed to a greater extent. However, in patients with PRE, we found a lower level of aggression and a lower tendency to self-destructive behavior than in patients with successfully controlled seizures, which can be explained by the compensating impact of persistent seizures on high aggressiveness, as well as a behavioral strategy that manifests itself in low compliance with a simultaneous tendency to manipulative behavior when interacting with a doctor. CONCLUSION: The conducted study revealed psychological and behavioral features of patients with PRE, causing significant psychological and social maladaptation requiring correction by medical professionals and psychologists. The research of the psychological characteristics of patients with epilepsy seems promising to us for optimizing an individual treatment strategy.