Psychopathology and psychosocial comorbidities in epilepsy
Children with epilepsy are at increased risk for a wide range of psychopathology, 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 suggests children with epilepsy have a 3-9 times higher risk for psychopathology compared to healthy controls and children with non-CNS chronic illnesses.
Up to 50 or 60% of patients with chronic epilepsy have various mood disorders including depression and anxiety.
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.
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).
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.