Effects of intensive psychological intervention on treatment compliance, psychological status, and quality of life of patients with epilepsy

Abstract

BACKGROUND

Epilepsy is a nervous system disease characterized by recurrent attacks, a long disease course, and an unfavorable prognosis. It is associated with an enduring therapeutic process, and finding a cure has been difficult. Patients with epilepsy are predisposed to adverse moods, such as resistance, anxiety, nervousness, and anxiety, which compromise treatment compliance and overall efficacy.

AIM

To explored the influence of intensive psychological intervention on treatment compliance, psychological status, and quality of life (QOL) of patients with epilepsy.

METHODS

The clinical data of 105 patients with epilepsy admitted between December 2019 and July 2023 were retrospectively analyzed, including those of 50 patients who underwent routine intervention (control group) and 55 who underwent intensive psychological intervention (research group). Treatment compliance, psychological status based on the Self-Rating Anxiety Scale (SAS) and Depression Scale Self-Rating Depression Scale (SDS) scores, hope level assessed using the Herth Hope Scale (HHS), psychological resilience evaluated using the Psychological Resilience Scale, and QOL determined using the QOL in Epilepsy-31 Inventory (QOLIE-31) were comparatively analyzed.

RESULTS

Treatment compliance in the research group was 85.5%, which is significantly better than the 68.0% of the control group. No notable intergroup differences in preinterventional SAS and SDS scores were identified (P > 0.05); however, after the intervention, the SAS and SDS scores decreased significantly in the two groups, especially in the research group (P < 0.05). The two groups also exhibited no significant differences in preinterventional HHS, Connor-Davidson Resilience Scale (CD-RISC), and QOLIE-31 scores (P > 0.05). After 6 months of intervention, the research group showed evidently higher HHS, CD-RISC, tenacity, optimism, strength, and QOLIE-31 scores (P < 0.05).

CONCLUSION

Intensive psychological intervention enhances treatment compliance, psychological status, and QOL of patients with epilepsy.

Key Words: Intensive psychological intervention, Epilepsy, Treatment compliance, Psychological status, Quality of life

Core Tip: Epilepsy is a common chronic disease of the nervous system. Current treatment of epilepsy is mainly based on symptomatic treatment. Patients with poorly controlled seizures are at a higher risk of depression than those with well-controlled seizures. This study mainly explores the influence of intensive psychological intervention on the treatment compliance, psychological status, and quality of life of patients with epilepsy.

INTRODUCTION

Epilepsy is a common chronic disease of the nervous system that is characterized by a persistent predisposition for seizures, which is not caused by any direct central nervous system injury, but by the neurobiological, cognitive, psychological, and social consequences of epileptic seizures[1-3]. The prevalence of epilepsy is approximately 0.5%-1%[4], with a slightly higher incidence in men than in women, especially in the youngest and oldest age groups[5,6]. Genetic susceptibility to seizures varies, as does the distribution of some environmental risk factors, which may explain the global heterogeneity of the incidence, course, and consequences of epilepsy[7]. In addition to the recurrence of seizures, the underlying etiology and adverse effects of treatment significantly affect the patient’s quality of life (QOL) and make the disease a complex health burden[8].

The treatment of epilepsy is currently based on symptomatic treatment[9]. Most patients can achieve seizure freedom through the first two appropriate drug trials. Those who fail to achieve a satisfactory response are defined as resistant and can eventually develop refractory epilepsy[10,11]. Psychiatric disorders are relatively rare but serious complications of epilepsy[12]. Current epidemiological research has shown a 5.6% incidence of psychiatric disorders in an unselected sample of patients with epilepsy[13]. In addition, patients with poorly controlled seizures are at a higher risk of depression than those with well-controlled seizures[14]. However, anxiety is not currently of sufficient interest in patients with epilepsy, even though it is more prevalent than depression[15]. Because of the long course of epilepsy and the unpredictability of seizures, patients are prone to nervous, anxious, and other negative emotions, leading to decreased treatment compliance, which is not conducive to the outcome of the disease. In the lengthy process of antiepileptic treatment, recurrent episodes and the huge psychological pressure caused by economic burden and social discrimination will seriously affect the normal work and life of patients[16]. Furthermore, the level of self-identification of patients with epilepsy also diminishes, leading to behavioral abnormalities, such as inner pain[17]. Therefore, psychological intervention for patients with epilepsy is a crucial feature of clinical treatment. This study retrospectively analyzed the clinical data of patients with epilepsy to explore the impact of intensive psychological intervention on treatment compliance, psychological status, and QOL of these patients.

MATERIALS AND METHODS

Study participants

This retrospective analysis included 105 patients with epilepsy admitted between December 2019 and July 2023. The inclusion criteria were the following: (1) Meeting the epilepsy diagnosis criteria of the International League Against Epilepsy in 2017; (2) aged 18-60 years; (3) course of epilepsy ≥ 6 months; (4) use of antiepileptic drugs ≥ 3 months; (5) no communication or hearing impairment; (6) normal comprehension and communication skills and certain reading comprehension ability; and (7) complete clinical and follow-up data. The exclusion criteria were as follows: (1) Psychogenic pseudoepileptic seizures; (2) history of epilepsy-related surgery; (3) severe mental and neurological complications; (4) diagnosis of malignant tumor(s); (5) refusal to undergo neuropsychological evaluation; and (6) incomplete clinical data.

Research methods

Patients were divided into either the control or research group based on different intervention methods documented in their records, with 50 cases in the control group and 55 cases in the research group. Patients in the control group underwent routine intervention based on the clinical treatment of the disease, i.e., safe nursing for the onset of the disease and adverse reactions, and oral explanation of disease-related knowledge. The main measures were as follows: (1) A protective belt, mouth opener, and other items were used to prevent bed falling and tongue biting, and local pressure was avoided as much as possible; and (2) valproic acid was administered to patients with generalized seizures, and antiviral therapy was strengthened for those with viral encephalitis. During seizures, phenobarbital sodium was injected intramuscularly or diazepam intravenously.

In addition to the above measures, those in the research group underwent intensive psychological intervention: (1) The patients and their families were assisted in establishing a correct understanding of the disease and reducing their psychological burden by providing health education manuals, watching videos, listening to audio presentations, holding seminars, etc.; (2) the patients were encouraged to participate in social activities more actively to help them realize their social values and improve their self-esteem; (3) doctor-patient communication was enhanced, and effective communication channels were established; medical staff patiently listened to patients’ complaints and avoided indifference and impatience so that patients felt cared for and supported; (4) the medical staff promoted communication between the patients and their families, encouraged the patients’ families to actively participate in nursing, and took good care of the patients in life; (5) the patients’ psychological state was monitored, and any psychological abnormalities were reported promptly to coordinate with the medical staff in conducting psychological counseling to manage patients’ negative emotions and enhance their confidence; (6) patient-patient communication was also encouraged to exchange self-management experience, support each other, share rehabilitation experience, and establish a relaxed and comfortable ward environment; and (7) a long-term and effective consultation platform was established, through which patients and their families can consult on treatment-related issues in or out of the hospital, while allowing doctors to regularly follow-up discharged patients’ illness and recent conditions. All patients underwent a 6-month follow-up.

Outcome measures

Determination of treatment compliance. Complete compliance: The patient can completely follow the doctor’s advice to accomplish various interventions and take the medication on time at the dosage prescribed during the treatment process. Partial compliance: The patient can partially accomplish various interventions and follow the instructions on medication time and dosage according to the doctor’s advice. Noncompliance: The patient can occasionally follow the doctor’s advice for treatment or cooperate with treatment when the condition worsens but does not understand the side effects of drugs. Compliance = complete compliance + partial compliance.

Psychological state assessment. Patients’ negative emotions before and 6 months after intervention were evaluated using Zung’s Self-Rating Anxiety Scale (SAS) and Scale Self-Rating Depression Scale (SDS), with the score in positive association with the severity of anxiety and depression.

Hope level evaluation. The hope level of patients before and 6 months after intervention was assessed using the Herth Hope Scale (HHS). The scale contains three dimensions, namely, temporality and future orientation (T), positive readiness and expectancy (P), and interconnectedness (I). Each dimension has four items that can be classified into four grades, with the possible total score ranging from 12 to 48. A higher score corresponds to a higher hope level, with 12-23, 23-35, and 35-48 points indicating low, medium, and high levels of hope, respectively.

Psychological resilience evaluation: We used the Connor-Davidson Resilience Scale (CD-RISC) to assess patients’ psychological resilience before and 6 months after intervention. The scale consists of 25 items that fall into three dimensions: tenacity, strength, and optimism. The scale uses a five-point scoring method, with 0, 1, 2, 3, and 4 corresponding to never, rarely, sometimes, often, and always, respectively. The total score (range: 0-100) = tenacity score + strength score + optimism score. A higher score indicates better psychological resilience.

QOL of patients with epilepsy. QOL was assessed before and 6 months after the intervention using the QOL in Epilepsy-31 Inventory (QOLIE-31). QOLIE-31 exhibited good reliability and validity in Chinese adult patients with epilepsy. The scale consists of seven components: Seizure worry, overall QOL, emotional well-being, energy/fatigue, cognitive functioning, medication effects, and social functioning, each scored on a percentage scale. Scoring system: The score of each item is converted to its corresponding points (0-100), and the total score of each dimension is obtained by dividing the sum of the conversion points of the items in each dimension by the total number of items. The higher the score, the better the QOL. Finally, the total score of the seven dimensions is multiplied by the weight and then added to obtain the total QOL score.

Statistical analysis

Data analyses were performed using SPSS version 25.0, and statistical significance was set at P-value < 0.05. Measurement data are expressed as mean ± SD. Student’s t-test was used for intergroup comparisons of means and paired t-tests for intragroup comparisons before and after intervention. The rank-sum test was used to compare the ranked data. Count data are expressed as percentages, for which the chi-square test was used for comparison.

RESULTS

General information

Comparison of general data revealed no statistical intergroup differences in age, sex, course of disease, monthly frequency of attacks, and number of epileptic seizure types (P > 0.05), indicating that the two groups of patients were comparable (Table 1).

Table 1 Comparison of general information, n (%).

	Control group (n = 50)	Research group (n = 55)	χ2/t	P value
Gender
Male	24 (48.0)	29 (52.7)	0.234	0.629
Female	26 (52.0)	26 (47.3)	0.725	0.470
Age (yr)	36.65 ± 6.48	37.29 ± 6.97
Disease course (months)	18.24 ± 4.38	18.39 ± 4.33	0.451	0.653
Monthly frequency of seizure attacks (times)	6.15 ± 3.85	6.27 ± 3.91	0.469	0.640
Seizure type			0.856	0.652
Simple focal seizures	5 (10.0)	3 (5.5)
Absence seizures	16 (32.0)	20 (36.3)
Grand mal seizures	29 (58.0)	32 (58.2)

Patient compliance

The research group (85.5%) exhibited significantly higher treatment compliance than the control group (68.0%) (Table 2).

Table 2 Comparison of patient compliance, n (%).

	Control group (n = 50)	Research group (n = 55)	χ2	P value
Complete compliance	20 (40.0)	31 (56.4)	4.525	0.033
Partial compliance	14 (28.0)	16 (29.1)
Non-compliance	16 (32.0)	8 (14.5)
Compliance	34 (68.0)	47 (85.5)

Psychological states of the two patient groups

The two groups showed similar SAS and SDS scores before intervention (P > 0.05); a marked reduction was observed in SAS and SDS scores in both groups after intervention, with even lower scores in the research group (P < 0.05; Figure 1).

Figure 1 Comparison of Self-Rating Anxiety Scale and Self-Rating Depression Scale scores. A: Comparison of Self-Rating Anxiety Scale scores; B: Comparison of Self-Rating Depression Scale scores. ^aP < 0.001. SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale.

Hope level of patients in both groups

The preinterventional T, P, and I scores and overall hope level were similar between the research and control groups (P > 0.05). After the intervention, the T, P, and I scores of both groups and the overall hope level increased statistically, especially in the research group (P < 0.05; Table 3).

Table 3 Comparison of hope level.

		Control group (n = 50)	Research group (n = 55)	t	P value
Temporarily and future orientation (T)	Before intervention	7.86 ± 0.93	7.82 ± 1.12	0.198	0.843
	6 months after intervention	9.90 ± 1.39a	11.07 ± 1.51a	4.118	< 0.0001
Positive readiness and expectancy (P)	Before intervention	8.26 ± 1.31	8.49 ± 1.17	0.950	0.344
	6 months after intervention	10.50 ± 1.82a	12.80 ± 1.43a	7.234	< 0.0001
Interconnectedness (I)	Before intervention	8.56 ± 1.75	9.13 ± 1.52	1.786	0.077
	6 months after intervention	11.54 ± 2.16a	13.58 ± 1.80a	5.274	< 0.0001
Overall hope level	Before intervention	24.68 ± 2.30	25.44 ± 2.42	1.646	0.103
	6 months after intervention	31.94 ± 2.80a	37.48 ± 3.25a	9.313	< 0.0001

^aP < 0.05 vs before intervention in the same group.

Patient psychological resilience

The two groups did not differ significantly in the preinterventional total and individual dimension scores for CD-RISC (P > 0.05). Both groups showed significant increases in the total score and scores for tenacity, optimism, and strength at 6 months after intervention, with even higher scores in the research group (P < 0.05; Table 4).

Table 4 Comparison of psychological resilience level.

		Control group (n = 50)	Research group (n = 55)	t	P value
Tenacity	Before intervention	24.14 ± 4.07	24.53 ± 3.71	0.514	0.609
	6 months after intervention	33.10 ± 5.41a	36.13 ± 5.26a	2.908	0.044
Optimism	Before intervention	9.46 ± 2.58	9.75 ± 2.41	0.595	0.553
	6 months after intervention	19.02 ± 3.31a	22.15 ± 2.79a	5.255	< 0.0001
Strength	Before intervention	7.94 ± 2.41	8.60 ± 2.09	1.503	0.136
	6 months after intervention	11.00 ± 1.58a	13.60 ± 1.31a	9.210	< 0.0001
Total score	Before intervention	41.54 ± 5.93	42.87 ± 4.33	1.321	0.189
	6 months after intervention	63.12 ± 6.60a	71.87 ± 6.11a	7.054	< 0.0001

^aP < 0.05 vs before intervention in the same group.

QOLIE-31 scores

No notable intergroup differences were observed in the preinterventional total and individual dimension scores for QOLIE-31 (P > 0.05). After 6 months of intervention, the total and individual dimension scores for QOLIE-31 in both groups increase significantly, with higher scores in the research group than in the control group (P < 0.05; Table 5).

Table 5 Comparison of quality of life in Epilepsy-31 Inventory score.

		Control group (n = 50)	Research group (n = 55)	t	P value
Seizure worry	Before intervention	42.78 ± 6.21	43.15 ± 8.12	0.260	0.795
	6 months after intervention	53.10 ± 9.34a	61.82 ± 7.20a	5.385	< 0.0001
Overall quality of life	Before intervention	44.24 ± 6.32	45.78 ± 4.70	1.425	0.157
	6 months after intervention	55.66 ± 8.30a	63.45 ± 7.19a	5.152	< 0.0001
Emotional well-being	Before intervention	48.58 ± 5.41	47.64 ± 6.20	0.825	0.411
	6 months after intervention	58.34 ± 9.94a	69.20 ± 8.62a	5.995	< 0.0001
Energy/fatigue	Before intervention	50.46 ± 6.28	48.16 ± 7.86	1.646	0.103
	6 months after intervention	58.04 ± 7.13a	69.71 ± 8.36a	7.658	< 0.0001
Cognitive functioning	Before intervention	49.80 ± 3.94	51.02 ± 5.04	1.372	0.173
	6 months after intervention	59.72 ± 6.55a	70.69 ± 6.56a	7.021	< 0.0001
Medication effects	Before intervention	40.14 ± 7.72	42.22 ± 6.49	1.499	0.137
	6 months after intervention	57.50 ± 6.84a	66.18 ± 5.71a	7.081	< 0.0001
Social functioning	Before intervention	54.12 ± 6.38	53.82 ± 6.20	0.244	0.808
	6 months after intervention	63.88 ± 5.63a	71.05 ± 6.56a	5.981	< 0.0001
Total score	Before intervention	48.97 ± 2.33	49.13 ± 6.04	0.176	0.861
	6 months after intervention	59.13 ± 3.54a	68.32 ± 3.34a	14.578	< 0.0001

^aP < 0.05 vs before intervention in the same group.

DISCUSSION

Epilepsy is a chronic nervous system disease strongly associated with genetic factors, surgery, febrile convulsions, and brain trauma[18]. Given the current lack of specific therapeutic agents, the disease is treated based on the principles of improving patient QOL and controlling disease onset. Patients with epilepsy are often affected by intermittent seizure episodes, which restrict their life and work and severely affect their psychological state, resulting in a severely reduced QOL. Therefore, psychological intervention has important implications for the prognosis of patients with epilepsy.

This study mainly investigated the influence of intensive psychological intervention on the compliance, psychological state, and QOL of patients with epilepsy. The results showed a significant decrease in SAS and SDS scores and an increase in HHS, CD-RISC, tenacity, optimism, strength, and QOLIE-31 scores in patients with epilepsy who underwent intensive psychological intervention. Therefore, intensive psychological intervention promotes the improvement of the mental state and QOL of patients with epilepsy. Recurrent seizures may affect the function of the limbic system without directly influencing the development of depression and increase patients’ susceptibility to mental disorders and social stress[19]. A bidirectional relationship has also been established between epilepsy and depression[20]. In routine nursing, patients’ psychological problems can easily be overlooked. In contrast, intensive psychological intervention is a more detailed and optimized intervention mode that further strengthens the patient’s psychological state[21]. It extends and expands the advantages of the original intervention model, extends the research on the relevant factors affecting the mental state, and implements the corresponding measures. Strengthening health education during intensive psychological nursing can help patients correctly understand the disease and reduce their psychological burden. Furthermore, intensive psychological intervention monitors the patient’s psychological adjustment and enables the development of intervention strategies that can fully meet the needs of patients, minimize external causes of psychological stress, and enhance their psychological coping ability. Cognition, as the intermediary of emotional and behavioral responses, has a fundamental influence on the occurrence and changes in emotions and behaviors[22]. Intensive psychological intervention helps patients establish correct awareness about epilepsy through scientific and rational dialogues, relieves psychological conflicts, guides patients in expressing their depression, and helps regulate their emotions, thereby improving their views and attitudes and mitigating their irrational beliefs.

Furthermore, this study found that the treatment compliance of patients with epilepsy under intensive psychological intervention was 85.5%, which was significantly better than the 68.0% compliance rate of the routine intervention group. Depression and anxiety influence treatment compliance[23]. Depression and anxiety can affect patients’ adherence to treatment for several reasons. First, the expectation of treatment response is an essential component of patients’ treatment compliance, whereas recurrent seizures can affect patients’ motivation and confidence in treatment efficacy. Anxiety itself has various presentations, such as panic attacks, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder[24], among which generalized anxiety disorder has the greatest influence on treatment compliance[25]. Moreover, the postinterventional T, P, I, and QOL scores in the research group were higher than those in the control group, indicating high acceptance of the intensive psychological intervention model among patients with epilepsy, which, consequently, improved their hope level, changed their coping styles, and increased their QOL. People with epilepsy generally have a lower QOL, especially in terms of seizure worry and medication effects. Patients generally have a strong fear of disease recurrence, which may be related to the pain caused by the seizure itself or to the fear of shame related to others witnessing such episodes, resulting in reduced compliance with medication. Intensive psychological intervention can strengthen patients’ memories of successful cases, happiness, and warmth; increase their feelings of support from society and their families and reduce their seizure worry. In addition, “happy factor” feedback intervention can enhance patients’ sense of social identity and participation and promote in them a positive attitude in receiving disease treatment, which can obviously improve their QOL.

Because of its design, this study has some limitations. The retrospective design did not allow for the randomization of the two groups of patients, which would have compromised the similarity of patients within the groups. In addition, retrospective secondary data analysis carries the risk of information bias, especially with incomplete records encountered in such studies. The sample size may also be too small to reveal differences between the two groups. Therefore, the similarity of clinical outcomes between the two groups in our investigation may be a type II error. Furthermore, the study period was too short. A well-designed, randomized, controlled trial with prospective data collection and sample size calculations is needed to confirm our findings and evaluate the relationship between long-term clinical outcomes.

CONCLUSION

In conclusion, intensive psychological intervention for patients with epilepsy can help manage positive and negative effects, enhance treatment compliance, enable patients to actively cope with disease-related problems, and increase QOL. However, given the shortcomings of this study, further studies involving more cases and a longer research period are needed.