Washington Psychosocial Seizure Inventory Research Articles

Quality of life research in adults with epilepsy in Japan

Quality of life (QOL) research in epilepsy is a relatively recent development, but the field has expanded rapidly over the past 10 to 15 years. This expansion has seen the development of many tools with which to measure QOL in specific psychosocial domains and treatment settings. However, to date the initial development of these tools has been in English. Tools are also necessary to assess the QOL of people with epilepsy in non—English-speaking countries. These tools can be produced in two ways: by developing original tools in the language spoken in the country of use, or by translating and validating tools originally published in English. The latter approach has the advantages of being more rapid and allowing cross-cultural comparisons. We have completed or are in the process of translating into Japanese and validating three QOL assessment tools: the Washington Psychosocial Seizure Inventory, the Side Effects and Life Satisfaction inventory, and the Quality of Life in Epilepsy questionnaire. In this article, the results of this process are reported and cross-cultural comparisons using some of these tools are made. In this way, some of the problems associated with translating and validating QOL assessment tools are illustrated, and differences and similarities in the psychosocial impact of epilepsy in different countries are highlighted.

Neuroticism in Temporal Lobe Epilepsy: Assessment and Implications for Pre‐ and Postoperative Psychosocial Adjustment and Health‐Related Quality of Life

We assessed 77 candidates for epilepsy surgery to determine the association among neuroticism (a dimension of personality characterized by chronic negative emotions and behaviors), psychosocial adjustment as measured by the Washington Psychosocial Seizure Inventory (WPSI), and health-related quality of life (HRQOL) as measured by the Epilepsy Surgery Inventory 55 (ESI-55). Minnesota Multiphasic Personality Inventory 2 (MMPI-2) Neuroticism scale scores were significantly correlated with many domains of patient -perceived psychosocial adjustment and HRQOL regardless of frequency or type of seizures. We then followed 45 of the patients who subsequently underwent epilepsy surgery to determine the influence of neuroticism on postoperative functioning. Two-way analysis of variance (ANOVA) indicated that patients with high preoperative neuroticism had significantly poorer postoperative psychosocial adjustment and HRQOL scores than patients who had low or moderate preoperative neuroticism scores. These results support the validity of the MMPI-2 as a useful measure of neuroticism. Preoperative neuroticism has an important influence on postoperative psychosocial adjustment and HRQOL that is independent of postoperative seizure outcome. Understanding the influence of personality variables, such as neuroticism, on psychosocial functioning both before and after epilepsy surgery is essential in managing intractable seizures.

The evolution of health-related quality of life assessment in epilepsy

The purpose of this article is to review the ways in which quality of life has been assessed in patients with epilepsy. It is specifically proposed that there have been three phases or types of studies examining the effects of epilepsy on cognitive, behavioural, social and physical function. The first and oldest phase was characterized by the use of traditional forms of clinical evaluation and available generic measures of cognitive, behavioural and psychosocial function to study the general effects of epilepsy, effects of epilepsy-specific clinical variables (e.g. seizure type, age at onset), and the consequences of treatment with antiepileptic medications on patients' lives. The second phase of research was characterized by the development of epilepsy-specific measures of cognitive ability, psychological status and psychosocial status, which were designed to meet the special research and clinical needs not provided by previous generic measures (e.g. Washington Psychosocial Seizure Inventory, Fear of Seizures Scale). The third and most recent phase is characterized by the use of models, techniques, and measures developed from the health services research field to assess formally contemporary definitions of health-related quality of life (HRQOL) (e.g. ESI-55, QOLIE-89, Seizure Severity Scale) and develop models of the effects of epilepsy on HRQOL. Thus, concern regarding the impact and consequences of epilepsy is not a new development, but has evolved over the years, resulting in new models and methods of assessment of disease impact on well-being and functional status.

Washington Psychosocial Seizure Inventory: a multiinstitutional study in Japan.

No reports of the Washington Psychosocial Seizure Inventory (WPSI) have yet been presented from Asian countries in detail. We performed a multiinstitutional study of this test in 652 Japanese subjects. The mean value of the Lie Scale was high, and only one third of our subjects were under the limit of the original criterion; this has been the biggest obstacle to use of the validity scales of this test in Japan. The profile form of the clinical scales was very similar to those reported from other countries. According to the relation between clinical characteristics and the WPSI scales, seizure frequency showed the strongest influence. In a comparison of whole subjects, mean scores of the clinical scales in Japan remained at an intermediate value or lower. This result was obviously distorted by the high score of the Lie Scale. When comparison was restricted to cases with valid Lie Scale scores, the values of five clinical scales showed high levels. Therefore, Japanese patients among developed countries apparently showed relatively severe levels of problems. We conclude that the WPSI could be a useful examination in Japan to determine reliably the various psychosocial problems of epileptic persons, but use of the Lie Scale according to the original criterion is not practical. Modifications of the limitation may be needed.

Aura phenomena and psychopathology: a pilot investigation.

We investigated a possible relation between aura phenomena and psychopathology in patients with seizure disorders. Twenty-one patients with a variety of seizure types (90% with generalized seizures, 72% with complex partial seizures, CPS) were studied. Aura phenomena were evaluated with the Silberman-Post Psychosensory Phenomena Scale; psychopathology was assessed with the Schedule for Affective Disorders and Schizophrenia-Lifetime Version (SADS-L), the Minnesota Multiple Personality Inventory (MMPI), and the Washington Psychosocial Seizure Inventory (WPSI). Psychosensory symptoms occurring in the absence of frank seizures, but not those occurring with seizures, were related to increased psychopathology (primarily mood and anxiety related) and greater time in psychiatric treatment. Psychosensory symptoms may reflect ongoing neurophysiologic dysfunction related to epilepsy and may therefore be a useful subject for further study.

The application of WPSI to epilepsy patients.

Eighty-five epilepsy patients were questioned using the Washington Psychosocial Seizure Inventory (WPSI). It was confirmed that uncontrollable epilepsy patients had more severe psychosocial problems than other patients. WPSI was also useful in clinical work.

Therapeutic recreation programmes for children with epilepsy

Amongst children with epilepsy, research has shown that most have a negative self-concept and consequently a low level of self-esteem. This elusive concept of the self is constantly being assessed and reassessed by each child throughout the process of social development. Early literature has suggested that children with disabilities, especially chronic medical or biological disabilities, typified by epilepsy and diabetes, are more susceptible to the development of psychopathology and negative self-concepts. This paper reports that intervention in the form of therapeutic recreation programmes can help rectify this problem of negative self-concept and low self-esteem in children with epilepsy. The Piers-Harris Self Concept Scale, a Self Report Inventory on six dimensions of self-concept, was assessed both pre- and post-therapeutic recreational intervention to show significant improvement in the child's self-concept and acceptance of their epilepsy. Educational components within the programme have demonstrated significant learning and increased treatment compliance--particularly with long-term medications. The Adolescent Psychosocial Seizure Inventory, an adolescent version of the Washington Psycho-Social Seizure Inventory (WPSI), both of which have been validated as a reliable clinical assessment for use in Australia, has provided further evidence to suggest that improvements occur in children's self-concept as a consequence of therapeutic recreation, however use of this protocol appears limited to adolescents over the age of 13 years.

A clinical study of hypergraphia in epilepsy.

Fifteen patients with epilepsy and hypergraphia were compared with 32 patients with epilepsy but without hypergraphia. The number of previous psychiatric episodes, the number of Washington Psychosocial Seizure Inventory (WPSI) items indicating emotional maladjustment, and the number of CT scan abnormalities were significantly greater in the hypergraphic patients than in the non-hypergraphic patients. Cognitive performance, EEG laterality and the scores of WPSI items related to the psychological stress of seizures did not differ significantly between the two groups. Hypergraphia reflects changes in emotional responsiveness secondary to organic temporal lobe lesions.

Psychosocial consequences of postoperative seizure relief.

To address the question of whether complete seizure relief has a positive effect on psychosocial functioning in patients with temporal lobe epilepsy, a follow-up study was conducted at the Montreal Neurological Institute. The approach was one of "before-after" study, with focus on the successfully operated patients, those in whom complete seizure relief was obtained. The Washington Psychosocial Seizure Inventory, specifically developed and validated for use with epilepsy patients, was used for psychosocial assessments. Of 30 surgically treated patients screened for the study, 15 gained complete relief from seizures. At 1-year postoperative follow-up, they showed reductions in their problems scores on all but one of eight psychosocial scales; the average reduction ranged from 24% in Vocational Adjustment to 60% in Adjustment to Seizures. In the areas of Emotional Adjustment and Interpersonal Adjustment reductions were 37 and 48%, respectively. Among the component items, improvement was greatest in ability to concentrate and make decisions, confidence in interpersonal skills, ability to express personal opinions, and perception by others. No appreciable changes occurred in the 15 patients who did not gain complete relief of seizures; indeed, on six of the eight scales they showed a modest increase in their problem scores. This study provides evidence that complete relief from seizures leads to appreciable improvements in psychosocial well-being, manifest as early as 1-year postoperatively, in young adult patients.

Psychosocial evaluation of adults with epilepsy in Chile.

The Washington Psychosocial Seizure Inventory (WPSI) was used to assess psychosocial functioning of 116 epileptic outpatients being treated in an epilepsy program at a public health service (PHS). Disturbances in several areas of psychosocial adjustment were noted. Although the distribution was similar to those previously reported using the WPSI, the severity of the observed disturbances was greater. Peak-score scales were Financial Status, Emotional and Interpersonal Adjustment, and Overall Psychosocial Functioning. Rehabilitation measures in epilepsy could play a substantial role in prevention and treatment of psychosocial disorders.

Preoperative psychological adjustment and surgical outcome are determinants of psychosocial status after anterior temporal lobectomy.

This investigation evaluated the role of preoperative psychological adjustment, degree of postoperative seizure reduction, and other relevant variables (age, education, IQ, age at onset of epilepsy, laterality of resection) in determining emotional/psychosocial outcome following anterior temporal lobectomy. Ninety seven patients with complex partial seizures of temporal lobe origin were administered the Minnesota Multiphasic Personality Inventory (MMPI), Washington Psychosocial Seizure Inventory (WPSI), and the General Health Questionnaire (GHQ) both before and six to eight months after anterior temporal lobectomy. The data were subjected to a nonparametric rank sum technique (O'Brien's procedure) which combined the test scores to form a single outcome index (TOTAL PSYCHOSOCIAL OUTCOME) that was analysed by multiple regression procedures. Results indicated that the most powerful predictors of patients' overall postoperative psychosocial outcome were: 1) The adequacy of their preoperative psychosocial adjustment, and 2) A totally seizure-free outcome. Additional analyses were carried out separately on the MMPI, WPSI, and GHQ to determine whether findings varied as a function of the specific outcome measure. These results were related to the larger literature concerned with the psychological outcome of anterior temporal lobectomy.

An Objective Method for the Assessment of Psychosocial Problems in Adolescents with Epilepsy

Psychosocial problems in adolescents with epilepsy have been of concern for many years, but have been difficult to assess. This article presents the multicenter development of the Adolescent Psychosocial Seizure Inventory (APSI), an empirically based self-report test patterned after the Washington Psychosocial Seizure Inventory, which is used to evaluate psychosocial problems in adults. After pilot work, 120 adolescents with epilepsy from five centers in North America took the APSI and were interviewed by professionals with respect to adequacy of adjustment in eight psychosocial areas. At least one parent or guardian was also interviewed. Interrater reliability of professional ratings in each area was established. Using an item-by-item, empirically based technique, eight psychosocial scales were developed as well as three validity scales. Reliability of the scales was established by both internal consistency and test-retest procedures. Results for each adolescent are presented in profile form. These results give a visual display of the types and extent of problems that likely would be identified in a detailed professional assessment. It is anticipated that the APSI will be of value in a variety of treatment and research contexts.

Sepulveda Epilepsy Education: The Efficacy of a Psychoeducational Treatment Program in Treating Medical and Psychosocial Aspects of Epilepsy

The present study evaluated the efficacy of the Sepulveda Epilepsy Education program (SEE), using a controlled outcome design. SEE is a 2-day psychoeducational treatment program designed to provide medical education and psychosocial therapy. Thirty-eight outpatients, matched according to seizure type and frequency, were randomly assigned to treatment (n = 20) or waiting-list control (n = 18) groups. The major outcome measures used were a 50-item true-false test specifically designed to evaluate the SEE program, the Washington Psychosocial Seizure Inventory, the Beck Depression Inventory, Lubin's Depression Adjective Checklist, the State-Trait Anxiety Inventory, the Acceptance of Disability Scale, and Sherer's Self-Efficacy Scale. Significant differences between the two groups were found on the three major subscales of the 50-item true-false test. The treatment group demonstrated a significant increase in overall understanding of epilepsy, a significant decrease in fear of seizures, and a significant decrease in hazardous medical self-management practices. In addition, an objective measure of blood levels of antiepileptic drugs (AEDs) showed the treatment group to have a significant increase in medication compliance.

Long-term effects of severe penetrating head injury on psychosocial adjustment.

The long-term effects of severe penetrating head injury on adjustment levels were studied. Forty-one World War II veterans who suffered penetrating injury to the brain were interviewed 40 years after their initial injury using the Washington Psycho-Social Seizure Inventory (WPSI). The results support a comparable behavioral impact of right and left hemispheric lesions. Similarly, no significant relations were found between anterior and posterior locus of damage and psychosocial difficulties, although the results pertaining to the right-anterior group could be interpreted as suggestive of much greater maladjustment in all life dimensions assessed by the WPSI. Findings are discussed in terms of theoretical positions on hemispheric specialization and long-term expectancies that hold implications for planning rehabilitation programs for such patients.

Psychologic and social adjustment to epilepsy in Rochester, Minnesota.

The psychologic and social aspects of epilepsy have rarely been assessed in community-based samples. We administered the Washington Psychosocial Seizure Inventory in 1985-1986 to 125 nonretarded adults, 18 to 59 years of age, who in 1980 had active epilepsy and resided in Rochester, Minnesota. Individuals having seizures or taking anticonvulsant medications within the past 12 months had somewhat poorer adjustment than those without recent seizures or medications, but even this more severely affected group appeared relatively well adjusted.

Economical screening for emotional disturbance in epilepsy: Anticipating Minnesota multiphasic personality inventory profile elevations by means of the Washington psychosocial seizure inventory

This study examined the ability of the Washington Psychosocial Seizure Inventory (WPSI) to identify patients with elevated (abnormal) scores on scales of the Minnesota Multiphasic Personality Inventory (MMPI). A sample of 407 adults with epilepsy who were administered both inventories was randomly divided into principal (n = 250) and cross-validation (n = 157) subsamples. Scores of 5 or more on the WPSI Emotional Adjustment Scale best identified the presence of one or more MMPI scale elevations, with 82% accuracy on cross-validation. Scores on the Emotional Adjustment Scale of 12 or more best identified the presence of two or more MMPI scale elevations, with 80% accuracy on cross-validation. High correlations were obtained between several WPSI and MMPI scales. This study suggests that the 132-item WPSI may be useful in screening for emotional disturbances in adults with epilepsy, and in determining when further emotional evaluation via clinical interview or additional testing may be warranted.

Job stability and family counseling.

The object of this study is to investigate the possible stabilizing effect of family counseling as a variable in (a) length of time spent on the job, (b) reported client satisfaction from the employer, and (c) client self-assessment through the Washington Psychosocial Seizure Inventory (WPSI). Results indicate a significant strength accomplished through family work with families in which one of the members suffers from a diagnosed seizure disorder.

Psychosocial functioning of adult epileptic and MS patients and adult normal controls on the WPSI.

The psychosocial functioning of adult epileptic outpatients (N = 68) as assessed by the Washington Psychosocial Seizure Inventory (WPSI) was compared to that of control groups of adult MS outpatients (N = 37) and normal subjects (N = 42). When all WPSI profiles were considered, the epilepsy group showed distinct difficulties in Emotional Adjustment and Adjustment to Seizures, whereas the MS group had difficulties only in Emotional Adjustment. However, the MS group had significantly higher Lie Scale scores than did normal subjects. The epilepsy group had significantly more emotional problems than normal subjects and significantly more problems adjusting to their disorder than did the MS group. However, when only valid WPSI profiles were considered, the only significant finding was that the epilepsy group (N = 44) and the MS group (N = 20) had more emotional problems than normal subjects (N = 35). The epilepsy group showed distinct difficulties in Emotional Adjustment and Adjustment to Seizures, whereas the MS group had difficulties in Emotional Adjustment, Interpersonal Adjustment, and Overall Psychosocial Functioning. Implications are discussed.

The development and standardization of a Spanish version of the Washington Psychosocial Seizure Inventory.

The Washington Psychosocial Seizure Inventory (WPSI) was translated from English into Spanish, reviewed by a bilingual panel, and then standardized on 107 Spanish-speakers and 45 bilinguals in Miami, Florida. The 152 subjects were active clients of the Epilepsy Foundation of South Florida. Subjects were assigned to one of three treatment groups: Monolingual (Spanish WPSI only), Bilingual (Spanish WPSI first), or Bilingual (English WPSI first). All three groups were given two administrations of the WPSI at least 30 days apart. Resulting data were submitted to measures of split-half reliability, test-retest reliability, and concurrent validity. The psychosocial scales were found to be internally consistent and showed stability across administrations with a marked similarity between the Spanish and English forms. The concurrent validity of the Spanish scales was established at the 0.01 level of significance or better. It was concluded that the Spanish WPSI was statistically comparable to the original English language version, thus establishing a basis for its usage in the psychological assessment of Spanish-speaking epileptics throughout the world.

Psychosocial problems in adults with epilepsy: comparison of findings from four countries.

Psychosocial problems in groups of adults with epilepsy from Canada, Finland, the German Democratic Republic, and the United States were evaluated by the Washington Psychosocial Seizure Inventory. A number of similarities in psychosocial concerns were found across the four countries. At the forefront for each group were emotional problems, followed by concerns pertaining to adjustment to the seizures themselves. Where far-reaching governmental support of a financial and vocational nature was lacking, difficulties in these areas were also noted. In all cases, few problems were found in matters pertaining to family relationships and to medical care. Hypotheses to account for differences between the groups were discussed.