Biomedical subjects
L W Batzel
Publications and source records attributed to L W Batzel.
Resection surgery for epilepsy. Outcome and quality of life.
Psychosocial problems frequently are more difficult to manage than the seizures. Quality of life investigations are important in identifying psychosocial issues that impede the benefits of improved or complete seizure control. Three categories of quality of life assessment are discussed: professional observation and ratings, psychometric assessment, and community-based measures of adaptive ability.
The role of psychosocial and financial factors in medication noncompliance in epilepsy.
Noncompliance in the taking of medication for a chronic disorder was related to emotional adjustment, psychosocial adjustment, ability to assume responsibility in life generally, and financial factors. Of 282 adults with epilepsy, eighty were identified by physicians' ratings as definitely compliant and forty-two as noncompliant. Results showed: 1) there were no differences between compliers and noncompliers in emotional adjustment; 2) noncompliance is not related to the cost of medications or to whether or not they are free; 3) noncompliance is more likely when patients report general financial distress, regardless of actual financial status; 4) persons with regular responsibilities in life also tend to take their medication regularly; and, 5) when reported financial distress and ability to assume responsibilities are considered simultaneously, the likelihood of noncompliance is four times as great in some patient groups as in others.
Emotional and intellectual correlates of unsuccessful suicide attempts in people with epilepsy.
This study evaluated the emotional and intellectual correlates of unsuccessful suicide attempts in persons with seizure disorders. Psychosocial evaluations were completed on 198 adults with epilepsy, of whom 32 had made one or more suicide attempts. The MMPI demonstrated increased anxiety and decreased ego strength among those with histories of suicide attempts in comparison to those without such a history. Intellectual abilities as evaluated by the WAIS were slightly lower among the suicide attempters, especially on language-related tasks. Unsuccessful suicidal behavior in epilepsy is probably the product of multiple conditions and circumstances, including seizures themselves, decreased adaptive abilities, increased emotional problems, and the continual availability of agents (antiepileptic medications) with which a suicide attempt may be undertaken.
Interictal behavioral features of patients with epilepsy.
Three questions are dealt with in this paper. (1) Do patients with epilepsy differ behaviorally from normal control groups and from persons with other medical and neurological conditions with respect to emotional adjustment, and if so, in what ways? (2) Are patients with temporal lobe epilepsy different emotionally or behaviorally from patients with other types of epilepsy? (3) To what degree does underlying brain dysfunction create a substrate for abnormal and maladaptive behavior? A review of the literature reveals the following. Persons with epilepsy demonstrate more emotional and psychiatric problems than normal individuals and more difficulties than other patient groups having nonneurological disorders, but have about the same incidence of these problems as persons with other neurological disorders. Increased emotional and psychiatric problems are not found among patients with temporal lobe epilepsy in comparison to patients with other types of epilepsy, although there are some behavioral peculiarities which appear in a small proportion of these patients. There is a mild tendency for impairment on neuropsychological tests to be associated with emotional and psychiatric problems in epilepsy.
Neuropsychological and emotional correlates of marital status and ability to live independently in individuals with epilepsy.
Studies from several countries have reported that fewer people with epilepsy marry, but the reasons for this are not clear. In the present investigation, 178 adults with epilepsy were divided into married, separated/divorced, and never married groups. The never married group was subdivided into persons living in dependent versus independent settings. The groups did not differ with respect to seizure type, age at onset of seizures, and related variables. All were administered a complete battery of neuropsychological tests and the Minnesota Multiphasic Personality Inventory. On all tests of abilities, the married and the never married independent groups had the best scores, the separated/divorced group was intermediate, and the never married dependent group had by far the lowest scores. In the emotional area, however, the separated/divorced group had the poorest scores and the other groups were indistinguishable from each other. It appears that marital status is more related to emotional adjustment than to mental abilities, and that independent living skills are more related to mental abilities than to emotional adjustment.
An objective method for the assessment of psychological and social problems among epileptics.
Numerous investigators have identified psychological and social problems among epileptics and in many instances, these appear to be more debilitating than the seizures themselves. However, assessment of these problems has most frequently been done by subjective means and when objective tests have been used, they were almost always developed for and standardized on populations other than epileptics. The development of the Washington Psychosocial Seizure Inventory (WPSI) is presented in this paper. After pilot work, 127 adult epileptics were evaluated for psychosocial problems and they completed the 132-item Inventory. Professional assessment of difficulties was made with respect to family background, emotional adjustment, interpersonal adjustment, vocational adjustment, financial status, adjustment to seizures, and medical management. Finally, an assessment of overall psychosocial functioning was made. Through an item-by-item correlation technique, scales were empirically developed for each of these areas and a profile was produced which gives both the absolute and the relative extents of difficulties for each patient with respect to each area. Potential applications for the WPSI are presented.
Futher validation of the WPSI vocational scale: comparisons with other correlates of employment in epilepsy.
The present study evaluates the relationships between employment status and five types of variables: years of education, intelligence, emotional adjustment, neuropsychological impairment, and psychosocial adjustment. The latter two areas were evaluated by procedures specifically developed for work with seizure patients and include use of the Neuropsychological Battery for Epilepsy and the Washington Psychosocial Seizure Inventory. Fifty-eight patients were divided into groups based on their employment histories and classified as unemployed, underemployed, and employed. Results indicated that the two types of procedures developed specifically for work with clients having seizures demonstrated the most potent and consistent relationships with employment status. The study suggests that the use of these procedures in the evaluation of employability may be more effective than using only those variables which traditionally have been applied.
Neuropsychological abilities of children with epilepsy.
One hundred eighteen epileptic children, aged 6-15 years, underwent detailed neuropsychological testing including the Wechsler Intelligence Scale for Children-Revised and the age-appropriate Halstead-Reitan battery. Eight had classical absence seizures only, eight had classic absence seizures and generalized tonic-clonic seizures, 30 had generalized tonic-clonic seizures only, 31 had partial seizures only, 20 had partial seizures and generalized seizures, 15 had atypical absence seizures, and five had minor motor seizures. A control group of 100 children without seizures, matched to the general population for intelligence and matched to the seizure cases for age, underwent identical testing. The Wechsler full-scale intelligence quotient (FSIQ) of cases was significantly (p = 0.01) lower than that of controls and was related to seizure type. Children with minor motor or atypical absence seizures had the lowest average FSIQ (70 and 74, respectively). All seizure types were associated with below-control intelligence except classic absence only. Intelligence was also correlated with degree of seizure control. A highly significant inverse correlation between years with seizures and intelligence was found (p less than 0.0001). A rating of neuropsychological impairment, derived from all measures of brain function, was assigned to each child. Epileptic children had significantly more impairment than controls (p less than 0.0001). Children with seizures had been placed in special education or had repeated a grade in school almost twice as frequently as controls (p less than 0.001). Even though often placed in a class of younger children, their academic achievement was behind grade placement more often than in controls.(ABSTRACT TRUNCATED AT 250 WORDS)
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.