Psychopathology and psychosocial outcomes

Overview

Children with epilepsy are at increased risk for a wide range of psychopathology1, poorer psychosocial outcomes, and reductions in quality of life. Factors impacting upon outcomes are multiple and include: cognitive and language deficits, family factors, stigma associated with epilepsy, and adjustment to illness.

Research findings

  • Research suggests children with epilepsy have a 3-9 times higher risk for psychopathology compared to healthy controls and children with non-CNS chronic illnesses.2
  • Up to 50 or 60% of patients with chronic epilepsy have various mood disorders including depression and anxiety. 3
  • A meta-analytic study found that attention problems, thought problems, and social problems were relatively specific to children with epilepsy in contrast to children with other chronic illnesses.4
  • While mental retardation and learning problems are reported to be strong predictors of poor psychosocial outcomes, considerable research suggests non-epilepsy related factors may also contribute to mental health problems (e.g. cognition, family functioning and parenting style, and health-related quality of life).5
  • 1. Rodeburg, R., Geert Jan Stams, MA., Meijer, A.M. (2005). Psychopathology in Children with Epilepsy: A Meta-Analysis. Journal of Paediatric Psychology, 30(6): 453-468.
  • 2. Plioplys, Dunn, & Caplan (2007). 10-year Research Update Review: psychiatric Problems in Children With Epilepsy. J. Am. Acad. Child Adolesc. Psychiatry, 46(11):1389-1402.
  • 3. Beyenburg, S. et al. (2005). Anxiety in patients with epilepsy: Systematic review and suggestions for clinical management. Epilepsy & Behaviour, 7: 161-171.
  • 4. Plioplys, Dunn, & Caplan (2007). 10-year Research Update Review: psychiatric Problems in Children With Epilepsy. J. Am. Acad. Child Adolesc. Psychiatry, 46(11):1389-1402.
  • 5. Plioplys, Dunn, & Caplan (2007). 10-year Research Update Review: psychiatric Problems in Children With Epilepsy. J. Am. Acad. Child Adolesc. Psychiatry, 46(11):1389-1402.

Signs and risk factors

Being aware of the following warning signs and risk factors will enable early intervention by way of referral for further investigation and support.

Cognitive/behavioural factors

  • Reductions in cognitive, linguistic, or academic abilities, or new behavioural problems (e.g. aggression, delinquency) are risk factors for mental health problems and reductions in quality of life.

Psychosocial factors

  • Patient and family adjustment to their diagnosis/illness, self-perception regarding well-being, self-esteem, experience of stigma, rejection by peers , signs of anxiety or depression (e.g. avoidance of social activities and withdrawal, flattened affect, negative thoughts, increased somatic complaints, snowballing worries etc.).

Family factors

  • Parental psychopathology (especially maternal depression),  sub-optimal parent-child relationships, unstable family environments, insufficient family confidence in and/or adaptation to illness, over-controlling parenting style (including limiting developmentally appropriate activities),  family stressors.