Anxiety and depression in people with epilepsy: The contribution of metacognitive beliefs

Metacognitive beliefs in epilepsy: What is their contribution to quality of life in the context of anxiety, depression and cognitive functioning?

BACKGROUND

Beliefs about one's own thinking process - metacognition - are thought to influence a person's susceptibility to anxiety and depression. We aimed to explore the association between metacognitive beliefs, psychological symptomatology, objective cognitive functioning and quality of life (QoL) among people with epilepsy.

METHODS

We performed a cross-sectional study including adults with epilepsy who attended an outpatient clinic. Participants provided sociodemographic data, information about their seizures and were then asked to complete the metacognitions questionnaire-30 (MCQ-30), the patient-weighted inventory on quality of life in epilepsy (QOLIE-31-P), the Neurological Disorders Depression Inventory in Epilepsy (NDDI-E), the Generalized Anxiety Disorder Scale-7 (GAD-7), and provide a self-rated assessment of cognitive functioning by rating their memory, attention and reaction speed on single-item scales from 0 to 10. They then underwent neuropsychological assessment targeting executive functioning, attention and reaction speed. The associations between metacognitive beliefs, psychological symptoms and QoL as well as self-rated and objective cognitive assessment were explored through correlation calculations. Statistically significant relationships were then used for analysis of path models with QoL as the dependent variable.

RESULTS

The PWE sample consisted of 54 PWE (32, 59.3 % female), most having focal epilepsy (38, 70.4 %) and receiving ASM polytherapy (36, 66.7 %). There were no substantial differences in metacognitive beliefs based on demographic or epilepsy-related variables (p > 0.05). Symptoms of anxiety and depression were found to mediate the association between negative metacognitive beliefs about the uncontrollability and danger of perseverative thinking and QoL. Cognitive confidence and self-rated assessment of memory, attention and reaction speed contributed to overlapping psychometric constructs with the cognitive subscale of QOLIE-31-P. Correlations between objective cognitive measures and self-rated attention, but not metacognitive domains were seen.

CONCLUSION

Metacognitive beliefs may be associated with QoL in epilepsy by exerting effect through psychological symptomatology. Based on our findings, negative metacognitive beliefs may be investigated as relevant targets for future therapies aiming to improve QoL among PWE. Self-rated cognitive ability assessment and cognitive confidence are largely independent of objective cognitive performance and overlap with the cognitive domain of QOLIE-31-P.

The value of self-reported variables in epilepsy monitoring and management. A systematic scoping review

PURPOSE

Self-reported records of seizure occurrences, seizure triggers and prodromal symptoms via paper or electronic tools are essential components of epilepsy management. Despite recent studies indicating that this information could hold important clinical value, the adoption of self-reported information in clinical practice is inconsistent and of uncertain value.

METHODS

We performed a systematic scoping review of the literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A combination of different digital libraries was used (Embase, MEDLINE, Global Health, PsycINFO). The review examined acceptability, adherence, and ability to self-report or predict seizures, along with innovative applications of self-reported data. We comprehensively outline study characteristics, key results, and identified strengths and limitations.

RESULTS

Sixty-eight full-text and two abstracts were included, where a total of 10 electronic tools were identified. Studies revealed high patient interest and acceptable adherence, particularly when tools were well-designed, and data shared with healthcare providers. While patients faced challenges in self-reporting or predicting seizures, a subgroup exhibited higher accuracy and compliance. Studies underscored the value of self-report information in identifying seizure clusters, understanding associations between self-reported seizure frequency and triggers, developing personalized seizure risk, forecasting and prediction models, and the potential benefits when integrated with wearable or implantable devices. Limitations included population selection, repeated dataset use, and the absence of gold standards for seizure counting.

CONCLUSION

Personalizing tools to collect self-report information, integrating them with wearable technologies, utilizing collected data for clinical outcomes, and merging them with electronic health records could provide a reliable resource for epilepsy monitoring and management.

The Role of Metacognition in the Prediction of Depressive and Anxiety Symptoms in Chronically Ill Patients

INTRODUCTION

Cancer, diabetes, and heart diseases are frequent causes of depression and anxiety. The study explored the metacognitive beliefs manifested by chronically ill patients and the presence of depressive or anxiety symptoms and the predictive role of metacognition in both.

METHODS

A total of 254 chronically ill patients participated in the study. The Metacognitive Questionnaire was used to measure the patients' metacognitive beliefs, whereas the Hospital Anxiety and Depression Scale was applied to evaluate their psychopathological symptoms. A correlation analysis was performed to explore the relationships between metacognition and psychopathological symptoms. Regression analyses were conducted to examine the predictive role of metacognition in anxiety and depression.

RESULTS

The Negative Beliefs about Uncontrollability and Danger scale correlated with both anxiety and depression scales, and the Cognitive Confidence scale correlated with the depression scale. Linear regression analyses indicated that metacognitive beliefs were responsible for 32.2% of the variance of anxiety symptoms among all the chronically ill. Metacognitive beliefs accounted for 48.8% of the variance in anxiety symptoms and 36.6% in depressive symptoms among diabetes patients.

CONCLUSIONS

There are specific correlations between psychopathological symptoms and metacognition among chronically ill patients. Metacognitions have a moderate role in developing and sustaining anxiety and depressive symptoms.

Experience sampling methodology study of anxiety and depression in adolescents with epilepsy: The role of metacognitive beliefs and perseverative thinking

Emotional distress is common in young people with epilepsy (YPwE). According to the Self-Regulatory Executive Function (S-REF) model, maladaptive metacognitive beliefs and perseverative thinking are fundamental in the development and maintenance of emotional distress. As emotional distress and perseverative thinking can highly fluctuate over short intervals in YPwE, it is important to account for this variability when testing the utility of psychological models. Experience sampling methodology (ESM) was therefore used to explore the momentary relationship between metacognitive beliefs, perseverative thinking, and emotional distress in YPwE. Eighteen participants diagnosed with epilepsy (aged 12-17 years) completed the 10-day ESM period. Participants were prompted to complete the ESM assessment five times daily. The ESM assessment assessed participant's momentary levels of metacognitive beliefs, perseverative thinking (i.e., worry and rumination), and emotional distress (i.e., anxiety and depression). A series of multilevel regression analyses indicated that metacognitive beliefs were significantly positively associated with worry, rumination, anxiety and depression. After controlling for worry and rumination, respectively, metacognitive beliefs did not account for additional variance in anxiety or depression. Findings provide preliminary support for the utility of the S-REF model for emotional distress in YPwE. Metacognitive therapy, which is underpinned by the S-REF model, may be an appropriate intervention for emotional distress in YPwE. Future studies should assess the mediational relationship between metacognitive beliefs, perseverative thinking, and emotional distress using time-lagged models.

Psychosocial factors associated with anxiety and depression in adolescents with epilepsy: A systematic review

Anxiety and depression are common in adolescents with epilepsy. Identifying psychosocial risk factors for anxiety and depression is essential for adolescents with epilepsy to receive appropriate support. This systematic review synthesised findings of studies examining the relationship between psychosocial factors and anxiety and/or depression in adolescents with epilepsy. Outcomes were anxiety, depression, and mixed anxiety & depression. Six electronic databases were searched for studies which: used cross-sectional or prospective designs; quantitatively evaluated the relationship between psychosocial factors and anxiety and/or depression; presented results for adolescents with epilepsy aged 9-18 years; and used validated measures of anxiety and/or depression. Psychosocial factors were categorised as intrapersonal, interpersonal, or parent-specific factors. Sixteen studies (23 articles) were included. All but one were cross-sectional. Regarding intrapersonal factors, alternative mental health difficulties were consistently positively associated with all three outcomes. Negative attitude towards epilepsy, lower seizure self-efficacy, lower self-esteem and stigma were consistently positively associated with depression. Interpersonal factors (i.e., lower family functioning assessed from an adolescent's perspective) and parent-specific factors (i.e., parental stigma, stress, anxiety and psychopathology) were positively associated with at least one outcome. Adolescent epilepsy management should exceed assessment of biological/biomedical factors and incorporate assessment of psychosocial risk factors. Prospective studies examining the interplay between biological/biomedical factors and the psychosocial factors underpinning anxiety and depression in adolescents with epilepsy are needed.

Rehabilitation of cognition and psychosocial well-being - a better life with epilepsy (ReCaP-ABLE): a protocol for a randomized waitlist-controlled trial

Despite advances in the understanding of cognitive dysfunction among people with epilepsy (PWE), evidence for cognitive rehabilitation in epilepsy (CoRE) remains scarce. We present the protocol of a randomized waitlist-controlled trial (ClinicalTrials.gov ID NCT05934786) of a psychological-behavioral intervention aiming to ameliorate quality of life as well as cognitive functioning in a mixed PWE sample. The study is set at Vilnius University Hospital Santaros Klinikos and will offer adult PWE six individual and two group sessions led by a certified psychologist and directed toward improving memory, attention, self-regulation, mood and quality of life. The trial is expected to address major gaps in the literature by providing novel evidence on the effectiveness of CoRE in patients with genetic generalized epilepsies, the importance of epilepsy-specific factors for the response to CoRE, the impact of CoRE on long-term memory as well as its maintenance effects.

Anxiety, depression, and psychosocial adjustment in people with epilepsy

Objective

Effect of psychological disorders on social functioning in people with epilepsy (PWE) is not extensively reported. We evaluate psychosocial functioning in PWE attending an outpatient clinic and aim to understand the differences in psychosocial functioning between anxiety, depression, and coexisting anxiety and depression in PWE.

Materials and Methods

A prospective evaluation of psychosocial functioning of 324 consecutive adult PWE attending outpatient epilepsy clinic was done using self-reported Washington Psychosocial Seizure Inventory. The study population was divided in four groups - without psychological disorders, anxiety, depression, and both anxiety and depression.

Results

The mean age of study population was 25.90 ± 6.22 years. Anxiety was noted in 73 (22.5%), depression in 60 (18.5%), and both anxiety and depression were seen in 70 (21.6%) and the rest had normal psychosocial function. There were no significant differences across all the four sub-groups for sociodemographics. Psychosocial functioning did not differ significantly between PWE with normal psychosocial function and PWE with anxiety alone. However, psychosocial functioning scores were worse in PWE with depression and PWE with both anxiety and depression when compared to PWE with normal psychosocial function.

Conclusion

In the present study of PWE attending an outpatient epilepsy clinic, one-fifth of PWE had both anxiety and depression. Psychosocial functioning in PWE with anxiety was similar to otherwise healthy/normal PWE, whereas PWE with depression showed poor psychosocial functioning. Role of psychological interventions on psychosocial aspects of epilepsy should be studied extensively in future.

The effect of mindfulness and metacognition on anxiety symptoms: a case-control study

Background

Anxiety disorders (ADs) are associated with numerous psychiatric disorders; despite the efforts in psychotherapy models targeting their etiology, novel treatment strategies are still developing. We aimed to assess whether mindfulness and metacognition differ between patients with ADs and healthy controls (HCs) and whether the symptom severity of ADs is related to mindfulness and metacognition among patients. Two-hundred participants were enrolled in this study. Structured clinical interview, sociodemographic form, Five Facet Mindfulness Questionnaire-Short Form, Metacognition Questionnaire-30, and Hamilton Anxiety Rating Scale were administered. Multivariate analysis of covariance was conducted to compare the groups in terms of mindfulness and metacognition. Correlation and multiple linear regression analyses were performed to measure the association between the variables.

Results

The main finding indicates that positive beliefs about worry are associated with reduced symptom severity of ADs. Furthermore, HCs have more positive beliefs about worry and nonjudging of inner experience compared to patients with ADs, who utilize negative beliefs about uncontrollability and danger and need to control thoughts to a greater extent.

Conclusions

This study demonstrates that dysfunctional metacognitive beliefs may influence the anxiety severity of adult patients. We suggest that focusing on reducing maladaptive metacognitions may be supportive of AD improvement.

Association between Metacognitive Beliefs and COVID-19 phobia in a community population: a cross-sectional study

This study aims to investigate the relationship between metacognitive beliefs and COVID-19 phobia. The sample included 514 Turkish adults, 295 of whom are women (57,4%), and 219 are men (42,6%). Their ages ranged between 18 and 70 years (M = 32.96, SD = 10.79). COVID-19 Phobia Scale (C19P-S) and Metacognitions Questionnaire-30 (MCQ-30) were administered. Our analysis showed that women reported significantly higher COVID-19 phobia. The participants with chronic illnesses showed significantly higher COVID-19 phobia and MCQ-30 scores. It was found that C19P-S total score positively correlated with negative beliefs about worry concerning uncontrollability of thoughts, the need to control thoughts, cognitive self-consciousness, positive beliefs, cognitive confidence, and MCQ-30 total score respectively (r = .47, p < .001; r = .33, p < .001; r = .30, p < .001; r = .29, p < .001; r = .12, p < .001; r = .44, p < .001). Then, hierarchical multiple regression was conducted, and the relationships were tested via structural equation modeling. To sum up, it can be concluded that negative beliefs about worry concerning the uncontrollability of thoughts contribute to COVID-19 phobia. However, explained variance was small suggesting that there are additional factors involved. These results provided preliminary findings relating to the association between metacognitive beliefs and coronavirus phobia symptoms. Further longitudinal research is necessary to determine the causal direction of these findings.

Inappropriate Metacognitive Status Increases State Anxiety in Genetic Counseling Clients

Background

Many genetic counseling (GC) studies have focused on anxiety status because clients of GC often feel anxious during their visits. Metacognition is known to be one of the causes of having an inappropriate thinking style. In this study, we examined the relationship between anxiety and the metacognitive status of GC clients according to their characteristics.

Methods

The participants were 106 clients who attended their first GC session in our hospital from November 2018 to March 2021. The survey items were the clients’ characteristics, anxiety status at the time of the visit, and metacognitive status.

Results

High state anxiety and high trait anxiety were observed in 34.9 and 11.3% of clients, respectively. Clients who were a relative or had a family history were significantly more likely to have high state anxiety. As for metacognitive status, only negative beliefs about thoughts concerning uncontrollability and danger were associated with having an anxiety status. Furthermore, multivariate analysis showed that negative beliefs about thoughts concerning uncontrollability and danger were an independent determinant of higher state anxiety, but not being a relative or having a family history. Metacognitive status scores were significantly lower in clients than in the control group.

Conclusion

State anxiety was shown to be more dependent on negative beliefs about thoughts concerning uncontrollability and danger of GC clients than their characteristics such as being a relative or having a family history. The results of this study will contribute to the development of new GC psychosocial support measures to address the anxiety of GC clients.

Predictors of Comorbid Anxiety Symptoms After a New Diagnosis of Epilepsy: A Prospective 12-Month Follow-Up Observation

Objectives: We aimed to identify the factors contributing to comorbid anxiety symptoms over a 12-month follow-up period in Chinese adults with newly diagnosed epilepsy. Methods: Adult patients with newly diagnosed epilepsy (PWNDE) were recruited from First Hospital, Jilin University. Anxiety symptoms were assessed using the Generalized Anxiety Disorder-7 questionnaire (GAD-7; Chinese version) at 12 months. Multivariate stepwise logistic regression analysis was employed to identify the predictors for anxiety symptoms at 12 months. Results: A total of 157 PWNDE completed the study and were included in the final analysis. The percentage of participants with anxiety symptoms significantly decreased from 31.2% at baseline to 23.6% at 12 months (p = 0.027). Multivariate stepwise logistic regression analysis indicated that depressive symptoms at baseline [odds ratio (OR) 3.877 (95% confidence interval (CI) 1.683-8.933); P = 0.001] and the number of antiseizure medications (ASMs) during the follow-up period [OR 2.814 (95% CI 1.365-5.803); P = 0.005] were independent factors contributing to comorbid anxiety symptoms at 12 months. Conclusion: Depressive symptoms at baseline and the number of ASMs during the follow-up period were significant predictors of comorbid anxiety symptoms 12 months after a diagnosis of epilepsy.

Epilepsy at the intersection of disability, gender, and culture: A duoethnography

Epilepsy is a neurodevelopmental disorder that affects millions of adults and children. Several different types of seizures, ranging from generalized which affect both sides of the brain to focal seizures that are rooted in one location of the brain. In addition to the physical impact of epilepsy, there are many emotional and identity consequences of living with epilepsy. An area that is not yet explored is the impact of epilepsy on the lives of women of color. In this paper, we fill this gap by exploring the experiences of two women of color who have had epilepsy beginning in early childhood through motherhood. One of the women is Mexican-American and an early career faculty in social work. The other identifies as a Chinese immigrant doctoral student in disability studies. Together, these stories bring to the literature voices that have not been actively engaged by epilepsy research or academia. We use a duoethnographic approach in this work given that this method provides an opportunity to explore identity and intersectionality and juxtapose our narratives surrounding epilepsy. By applying disability critical race theory (DisCrit) to our narratives, we identified how fluctuating epileptic symptoms, gender, and culture, interact with the layers of our epileptic identities. Furthermore, we discuss how our experiences with epilepsy exposes the lack of accommodative efforts in both the healthcare and education systems for individuals with invisible neurodevelopmental disabilities. This duoethnography has important implications for engaging youth with epilepsy and other invisible disabilities. By showcasing our journey of "coming to terms" with epilepsy, our dialog provides insights into how to support youth in building a positive disability identity. Our experiences in academia set up a basis to discuss accommodations for students with epilepsy and other invisible disabilities.

Therapeutic Targets for the Treatment of Comorbidities Associated with Epilepsy

One of the most common neurological disorders, which occurs among 1% of the population worldwide, is epilepsy. Therapeutic failure is common with epilepsy and nearly about 30% of patients fall in this category. Seizure suppression should not be the only goal while treating epilepsy but associated comorbidities, which can further worsen the condition, should also be considered. Treatment of such comorbidities such as depression, anxiety, cognition, attention deficit hyperactivity disorder and, various other disorders which co-exist with epilepsy or are caused due to epilepsy should also be treated. Novel targets or the existing targets are needed to be explored for the dual mechanism which can suppress both the disease and the comorbidity. New therapeutic targets such as IDO, nNOS, PAR1, NF-κb are being explored for their role in epilepsy and various comorbidities. This review explores recent therapeutic targets for the treatment of comorbidities associated with epilepsy.

The Association Between Maladaptive Metacognitive Beliefs and Emotional Distress in People Living With Amyotrophic Lateral Sclerosis

OBJECTIVE

Approximately half of all people living with amyotrophic lateral sclerosis (ALS) experience persistent or recurrent emotional distress, yet little is known about the psychological processes that maintain emotional distress in this population. The self-regulatory executive functioning (S-REF) model specifies that maladaptive metacognitive beliefs and processes are central to the development and maintenance of emotional distress. This study explored whether maladaptive metacognitive beliefs are associated with emotional distress after controlling for demographic factors, time since diagnosis, and current level of physical functioning.

DESIGN

In a cross-sectional design, 75 adults with a diagnosis of ALS completed self-report questionnaires. Participants had a mean age of 60.40 years, mean duration of symptoms 63.92 months, and male:female gender ratio of 14:11.

MAIN OUTCOME MEASURES

Questionnaires assessed emotional distress (HADS, adapted for ALS), physical functioning (ALSFRS-R), repetitive negative thinking (RTQ-10), metacognitive beliefs (MCQ-30), and demographic factors.

RESULTS

Maladaptive metacognitive beliefs explained additional variance in emotional distress after controlling for age, gender, time since diagnosis, physical functioning, and repetitive negative thinking. Repetitive negative thinking partially mediated the relationships between positive and negative metacognitive beliefs and emotional distress.

CONCLUSIONS

These data support the utility of the metacognitive model in understanding emotional distress in people with ALS. Examination of the temporal relationship between maladaptive metacognitive beliefs and emotional distress in people living with ALS may help to guide the development of therapeutic approaches.

Tinnitus and Metacognitive Beliefs-Results of a Cross-Sectional Observational Study

Recent research has highlighted the role of metacognitions as a moderator for psychological distress in patients with chronic diseases. The present study investigates the role of metacognitions and worry in the association between tinnitus distress, anxiety, and depression. A cross-sectional study was carried out with a sample of tinnitus-outpatients who completed the Tinnitus-Handicap Inventory, Beck Anxiety Inventory, Beck Depression Inventory, Metacognition Questionnaire-30, Penn-State-Worry-Questionnaire. Associations of metacognitions, worries, tinnitus distress, anxiety and depression were investigated using structural equation models (SEMs). A sample of n = 107 patients was included in the study. In the first SEM, tinnitus distress significantly predicted depression (β = 0.68, p < 0.001) and anxiety (β = 0.47, p < 0.001). In the second model, worries and meta-cognitions were added as moderators. The explained variance substantially increased for depression (46 to 53%) and anxiety (22 to 35%) and the association of tinnitus distress with depression (β = 0.57, p < 0.001) and anxiety was weakened (β = 0.32, p < 0.001). Negative beliefs significantly predicted worries (β = 0.51, p < 0.001) and explained 41% of its variance. A good model fit for the final model was found (comparative fit index (CFI) = 0.98; (Tucker Lewis index) TLI = 0.96; root mean square error of approximation (RMSEA) = 0.067). Anxiety and depression in tinnitus patients might be influenced by worries, which is mainly predicted by negative beliefs about uncontrollability and danger of worries. Thus, psychotherapeutic approaches focused on alterations of metacognitions in patients with tinnitus should be investigated in future studies.3 (List three to ten pertinent keywords specific to the article yet reasonably common within the subject discipline.)

Metacognitive beliefs and their relationship with anxiety and depression in physical illnesses: A systematic review

Anxiety and depression are common among patients with chronic physical illnesses and have a significant impact on morbidity, quality of life, and health service utilisation. Psychological treatment of anxiety and depression has small to moderate efficacy in this group and is not commonly based on a model of causal mechanisms. A novel approach to understanding and improving mental health outcomes in physical illnesses is needed. One approach may be to explore the role of metacognitive beliefs which are reliably associated with anxiety and depression in individuals with mental health difficulties. The current systematic review aimed to evaluate the contribution of metacognitive beliefs to anxiety and depression across physical illnesses. Systematic searches were conducted on Web of Science, PsychINFO, MEDLINE, Embase, and CINAHL of studies published between 1997 and January 2019. 13 eligible studies were identified that in sum comprised 2851 participants. Metacognitive beliefs were found to have reliable, moderate, positive and significant associations with anxiety and depression symptoms across a range of physical illnesses. There appeared to be commonality and some specificity in the relationships. Negative metacognitive beliefs concerned with uncontrollability and danger of worry were associated with both anxiety and depression across all physical illnesses assessed, whilst more specific associations emerged for individual medical conditions where positive beliefs about worry, cognitive confidence and cognitive self-consciousness were unique correlates. Negative metacognitive beliefs of uncontrollability and danger significantly and positively predicted symptoms of anxiety and depression after controlling for factors including age, gender, disease factors and cognition (illness perceptions and intolerance of uncertainty). The results suggest that the metacognitive model of psychological disorder is applicable to psychological symptoms of anxiety and depression across a range of chronic medical conditions, implying that metacognitive therapy might be helpful in improving outcomes in multiple morbidities that involve poor mental and medical health.

Vitexin Possesses Anticonvulsant and Anxiolytic-Like Effects in Murine Animal Models

Different types of epilepsy and forms of pathological anxiety have been described as significant neurological disorders that may exist as comorbidities. Some of those disorders share the association of affected limbic areas/neuropathological triggers as well as the use of drugs for their clinical management. The aim of this work was to investigate the anticonvulsant and anxiolytic properties of the vitexin (apigenin-8-C-glucoside), since this compound is a flavonoid usually found as one of the major constituents in several medicinal plants claimed as anxiolytics and/or anticonvulsants. This investigation was performed by the use of a series of classical murine animal models of chemically induced-seizures and of anxiety-related tests (open-field, elevated plus-maze, and light-dark box tests). Here, we show that the systemic administration of vitexin (1.25; 2.5 and 5 mg/kg; i.p.) exhibited selective protection against chemically-induced seizures. Vitexin did not block seizures evoked by glutamate receptors agonists (NMDA and kainic acid), and it did not interfere with the latencies for these seizures. Conversely, the same treatments protected the animals in a dose-dependent manner against the seizures evoked by the Gabaergic antagonists picrotoxin and PTZ and rise the latency time for the first seizure on non-protected animals. The higher dose of vitexin protected 100% of animals against the tonic-clonic seizures triggered by GABA antagonists. The results from open-field, elevated plus-maze, and light-dark box tests indicated the anxiolytic properties of vitexin at similar range of doses described for the anticonvulsant action screening. Furthermore, these results pointed that vitexin did not cause sedation or locomotor impairment on animals. The selective action of vitexin against picrotoxin and PTZ may reinforce the hypothesis by which this compound acts mainly by the modulation of GABAergic neurotransmission and/or related pathways. This could be useful to explain the dual activity of vitexin as anticonvulsant and anxiolytic, and highlight the pharmacological interest on this promising flavonoid.

The effect of an emotional intelligence component program on happiness in patients with epilepsy

Emotional intelligence is a psychological component that may affect happiness level in patients with epilepsy. Given the high prevalence of depression in patients with epilepsy, as well as the limitations of studies in this regard in Iran, the aim of this study was to investigate the effect of an emotional intelligence component program on happiness in patients with epilepsy.

METHODS

This randomized clinical trial study conducted on 70 patients with epilepsy who were randomly divided into two experimental and control groups of 35 patients. Emotional Intelligence Training Based on Bar-On Combined Model was provided in eight 90-minute sessions for eight weeks. Data were collected using a two-part questionnaire: demographic data and the Oxford Happiness Questionnaire (OHQ).

RESULTS

The mean age of the subjects was 33.3 ± 10.4 years in the intervention group and 34.4 ± 9.3 years in the control group. The independent t-test results showed no significant difference between the two groups before the intervention (p = 0.195). The Mann-Whitney test results showed a significant difference between the two groups after emotional intelligence training (p < 0.001).

CONCLUSION

Overall, the findings of this study showed that emotional intelligence training led to improvement of happiness in patients with epilepsy. According to the results of the study, it is suggested that training based on emotional intelligence components be used as an approach to improve happiness level in patients with epilepsy.

GABAA receptor β3 subunit mutation D120N causes Lennox-Gastaut syndrome in knock-in mice

The Lennox-Gastaut syndrome is a devastating early-onset epileptic encephalopathy, associated with severe behavioural abnormalities. Its pathophysiology, however, is largely unknown. A de novo mutation (c.G358A, p.D120N) in the human GABA type-A receptor β3 subunit gene (GABRB3) has been identified in a patient with Lennox-Gastaut syndrome. To determine whether the mutation causes Lennox-Gastaut syndrome in vivo in mice and to elucidate its mechanistic effects, we generated the heterozygous Gabrb3+/D120N knock-in mouse and found that it had frequent spontaneous atypical absence seizures, as well as less frequent tonic, myoclonic, atonic and generalized tonic-clonic seizures. Each of these seizure types had a unique and characteristic ictal EEG. In addition, knock-in mice displayed abnormal behaviours seen in patients with Lennox-Gastaut syndrome including impaired learning and memory, hyperactivity, impaired social interactions and increased anxiety. This Gabrb3 mutation did not alter GABA type-A receptor trafficking or expression in knock-in mice. However, cortical neurons in thalamocortical slices from knock-in mice had reduced miniature inhibitory post-synaptic current amplitude and prolonged spontaneous thalamocortical oscillations. Thus, the Gabrb3+/D120N knock-in mouse recapitulated human Lennox-Gastaut syndrome seizure types and behavioural abnormalities and was caused by impaired inhibitory GABAergic signalling in the thalamocortical loop. In addition, treatment with antiepileptic drugs and cannabinoids ameliorated atypical absence seizures in knock-in mice. This congenic knock-in mouse demonstrates that a single-point mutation in a single gene can cause development of multiple types of seizures and multiple behavioural abnormalities. The knock-in mouse will be useful for further investigation of the mechanisms of Lennox-Gastaut syndrome development and for the development of new antiepileptic drugs and treatments.

Metacognitive Therapy for Adjustment Disorder in a Patient With Newly Diagnosed Pulmonary Arterial Hypertension: A Case Report

Adjustment disorders (ADs) belong to the worldwide most diagnosed mental disorders and are particularly frequent in patients with an underlying physical illness. Pulmonary arterial hypertension (PAH) is a severe and disabling disease, which significantly impacts on quality of life and has high mortality rates. The authors here present the case of a young female who developed a severe adjustment disorder with both anxious and depressive symptoms after a diagnosis of PAH requiring intensive care treatment due to right heart failure. Psychosocial functioning was severely impaired, and physical health reduced. Following hemodynamic stabilization and the establishment of PAH treatment, the patient was admitted to the Department of Psychiatry, Social Psychiatry and Psychotherapy and received metacognitive therapy (MCT). AD with mixed anxiety and depressed mood was diagnosed according to DSM-V criteria. At the start of treatment, she reported significant mental distress, indicated by a total sum score of the Hospital Anxiety and Depression Scale (HADS) of 20 points. The 6-min walking distance was only 358 m before the patient was exhausted. She then was treated with MCT without further psychopharmacological drugs. After only four MCT sessions, she fully remitted from AD which was accompanied by an 11-point reduction in the HADS (to 9 points). MCT specific scores also improved (MCQ-30 sum score decreased from 77 to 35). Notably, physical capacity improved as well, documented by an improved walking distance (439 m; +22%). This is the first case of a patient with AD in the context of PAH treated with MCT. The case report suggests that MCT is a possible psychotherapeutic treatment option for AD in the context of a potentially life-threatening disease. The study design does not permit an attribution of outcome to MCT but it suggests MCT is a potentially viable and acceptable treatment option.

A Systematic Review of Metacognitive Beliefs in Chronic Medical Conditions

Background: Psychological functioning plays an important role in medical conditions and impacts patients' quality of life. Previously, many studies have highlighted the association of metacognition to both the development and maintenance of emotional disorders. Recently, several researchers pointed out the relevant role of dysfunctional metacognitive beliefs in the context of chronic diseases. Hence, dysfunctional metacognitive beliefs could be directly related to anxiety and depression, regardless of the medical condition's expression. The aim of this systematic review was to summarize the available evidence regarding the association of metacognition with anxiety, depression, and perceived quality of life, in the context of medical conditions, according to Wells' theory.

Methods: A systematic review based on electronic bibliographic databases (PsycINFO, PubMed, Scopus, Web of Science, and Web of Knowledge) of scientific literature was carried out. Studies involving patients evaluated in clinical settings were included in the analysis.

Results: Our findings indicated that metacognition appears to be related to anxiety, depression, and quality of life in patients with medical chronic conditions. Therefore, dysfunctional metacognitive beliefs might be a relevant factor associated with the process of adapting to illness.

Conclusions: The additional evaluation of metacognitive factors in the context of several medical chronic conditions appears valuable. Due to the rising interest in the study of metacognition, suggestions for future research have also been provided.

Cardiac Rehabilitation Patients' Accounts of Their Emotional Distress and Psychological Needs: A Qualitative Study

Background Psychological distress is prevalent among patients with cardiovascular disease and is linked to increased risk of future cardiac events. Cardiac rehabilitation (CR) is widely recommended for treating psychological distress but has been of limited benefit. This study aims to understand how distressed cardiac patients describe their emotional needs and the response of CR. Methods and Results A qualitative descriptive study was conducted with 46 patients who screened positively for anxiety and/or depression. Semi-structured interviews were held, and data were analyzed using a constant comparative approach. Patients described low mood and diverse concerns, including threat of another cardiac event, restrictions on their lives, and problems unrelated to their health. Patients described worrying constantly about these concerns, worrying about their worry, and feeling that worry was uncontrollable and harmful. Patients wanted to "get back to normal" but lacked any sense of how to achieve this and were reluctant to discuss their worries with CR staff. They hoped to recover over time, meanwhile seeking reassurance that they were responding "normally." Patients were mostly dismissive of psychological techniques used in CR. Conclusions These findings expose a conundrum. Distressed CR patients have diverse worries but do not generally want to discuss them, so they invest hopes for feeling better in time passing and reassurance. An intervention acceptable to CR patients would allow them to address diverse worries but without having to share the content of worries, would have "face validity," and would address patients' worry about worry. Metacognitive therapy is an intervention that might be suitable. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02420431.

Early endocannabinoid system activation attenuates behavioral impairments induced by initial impact but does not prevent epileptogenesis in lithium-pilocarpine status epilepticus model

Mood and anxiety disorders, as well as memory impairments, are important factors affecting quality of life in patients with epilepsy and can influence the antiepileptic therapy. Clinical studies of psychiatric comorbidities are quite complicated to design and interpret, so animal studies of behavioral impairments associated with seizures can be of use. We investigated the effect of early administration of endocannabinoid receptor agonist WIN-55,212-2 on the development of spontaneous seizures, long-term behavioral and memory impairments, and neurodegeneration in the hippocampus on the lithium-pilocarpine model of status epilepticus (SE). We also studied the role of spontaneous seizures in the development of pathologic consequences of the SE. Our results showed that behavioral impairments found in the elevated plus maze test depended mostly on the consequences of SE itself and not on the development of spontaneous seizures while hyperactivity in the open-field test and light-dark chamber was more prominent in rats with spontaneous seizures. Administration of WIN-55,212-2 decreased emotional behavior in the elevated plus maze but did not affect hyperactive behavior in the open-field test. Spatial memory impairment developed both in the presence or absence of spontaneous seizures and was not affected by administration of WIN-55,212-2. Both administration of endocannabinoid receptor agonist WIN-55,212-2 and the presence of spontaneous seizures affected SE-induced neuronal loss in the hippocampus.

Qualitative Analysis of Emotional Distress in Cardiac Patients From the Perspectives of Cognitive Behavioral and Metacognitive Theories: Why Might Cognitive Behavioral Therapy Have Limited Benefit, and Might Metacognitive Therapy Be More Effective?

Introduction: Cognitive behavioral therapy (CBT) alleviates emotional distress in mental health settings, but has only modest effects in cardiac patients. Metacognitive therapy (MCT) also alleviates depression and anxiety in mental health settings and is in its initial stages of evaluation for cardiac patients. Aim: Our objective is to compare how CBT and MCT models conceptualize cardiac patients' distress, and to explore why CBT has had limited benefit for cardiac patients and whether MCT has the potential to be more efficacious. Method: Forty-nine cardiac rehabilitation patients, who screened positively for anxiety and/or depression, provided semi-structured interviews. We analyzed transcripts qualitatively to explore the "fit" of patients' accounts of their distress with the main elements of cognitive behavioral and metacognitive theories. Four illustrative cases, representative of the diverse presentations in the broader sample, were analyzed in detail and are presented here. Results: Conceptualizing patients' distress from the perspective of CBT involved applying many distinct categories to describe specific details of patients' talk, particularly the diversity of their concerns and the multiple types of cognitive distortion. It also required distinction between realistic and unrealistic thoughts, which was difficult when thoughts were associated with the risk or consequences of cardiac events. From the perspective of MCT a single category-perseverative negative thinking-was sufficient to understand all this talk, regardless of whether it indicated realistic or unrealistic thoughts, and could also be applied to some talk that did not seem relevant from a CBT perspective. Discussion: Conceptualizing distress from the perspective of CBT presents multiple, diverse therapeutic targets, not all of which a time-limited therapy would be able to address. Given the difficulty of identifying them as unrealistic or not, thoughts about disease, death or disability may not be amenable to classic CBT techniques such as reality testing. MCT proved more parsimonious and, because it did not distinguish between realistic and unrealistic thoughts, might prove a better fit to emotional distress in cardiac patients.

Cognitive-behavioural therapy does not meaningfully reduce depression in most people with epilepsy: a systematic review of clinically reliable improvement

Psychological treatment is recommended for depression and anxiety in those with epilepsy. This review used standardised criteria to evaluate, for the first time, the clinical relevance of any symptom change these treatments afford patients. Databases were searched until March 2017 for relevant trials in adults. Trial quality was assessed and trial authors asked for individual participants' pre-treatment and post-treatment distress data. Jacobson's methodology determined the proportion in the different trial arms demonstrating reliable symptom change on primary and secondary outcome measures and its direction. Search yielded 580 unique articles; only eight eligible trials were identified. Individual participant data for five trials-which included 398 (85%) of the 470 participants randomised by the trials-were received. The treatments evaluated lasted ~7 hours and all incorporated cognitive-behavioural therapy (CBT). Depression was the primary outcome in all; anxiety a secondary outcome in one. On average, post-treatment assessments occurred 12 weeks following randomisation; 2 weeks after treatment had finished. There were some limitations in how trials were conducted, but overall trial quality was 'good'. Pooled risk difference indicated likelihood of reliable improvement in depression symptoms was significantly higher for those randomised to CBT. The extent of gain was though low-the depressive symptoms of most participants (66.9%) receiving CBT were 'unchanged' and 2.7% 'reliably deteriorated'. Only 30.4% made a 'reliable improvement. This compares with 10.2% of participants in the control arms who 'reliably improved' without intervention. The effect of the treatments on secondary outcome measures, including anxiety, was also low. Existing CBT treatments appear to have limited benefit for depression symptoms in epilepsy. Almost 70% of people with epilepsy do not reliably improve following CBT. Only a limited number of trials have though been conducted in this area and there remains a need for large, well-conducted trials.

Metacognitive beliefs and illness perceptions are associated with emotional distress in people with epilepsy

PURPOSE

Emotional distress is common in people with epilepsy (PWE) for which efficacious interventions are required. Developing evidence-based treatments should be based on testable models of the psychological mechanisms maintaining psychopathology. The Self-Regulatory Executive Function (S-REF) model proposes that maladaptive metacognitive beliefs and processes are central to the development and maintenance of emotional distress. Although preliminary support exists for the role of metacognitive beliefs in emotional distress in PWE, their role has yet to be tested when controlling for the contribution made by illness perceptions.

METHODS

Four hundred and fifty-seven PWE completed an online survey, which assessed anxiety, depression, metacognitive beliefs, illness perceptions, general demographic factors, and epilepsy characteristics.

RESULTS

Hierarchical regression analyses demonstrated that metacognitive beliefs and illness perceptions were both associated with anxiety and depression when controlling for the influence of demographic variables and epilepsy characteristics. However, metacognitive beliefs accounted for more variance in anxiety and depression than illness perceptions.

CONCLUSION

Metacognitive beliefs appear to make a greater contribution to anxiety and depression in PWE than illness perceptions. Prospective studies are now needed to establish the causal role of metacognitive beliefs in both the development and persistence of emotional distress.

Kindling epileptogenesis and panic-like behavior: Their bidirectional connection and contribution to epilepsy-associated depression

Anxiety is one of the most common comorbidities of epilepsy, which has major detrimental effects on the quality of life. Generalized anxiety disorder (GAD) associated with epilepsy has been receiving most attention. However, several other forms of anxiety reportedly present in patients with epilepsy, including panic disorder (PD). In this study, using an animal model of limbic epilepsy, we examined the interplay between epilepsy and panic-like behavior (PLB). Further, considering the high degree of comorbidity between depression on the one hand, and both epilepsy and PD on the other hand, we studied whether and how the presence of PLB in animals with epilepsy would affect their performance in depression-relevant tests. Fifty-day-old male Wistar rats were subjected to repeated alternating electrical stimulations of the basolateral amygdala (BLA) to induce kindling of limbic seizures, and the dorsal periaqueductal gray (DPAG) to induce panic-like episodes. Seizure susceptibility and panic reaction threshold were examined before the first and 24h after the last stimulation. At the end of the stimulations, the rats were examined in depression-relevant tests: saccharin preference test (SPT) for anhedonia and forced swimming test (FST) for despair/hopelessness. With regard to kindling, BLA+DPAG stimulation induced more profound increase of seizure susceptibility than BLA stimulation alone (evident as the reduction of the afterdischarge threshold and the increase of the afterdischarge duration). With regard to PLB, the BLA+DPAG stimulation exacerbated the severity of panic-like episodes, as compared with the DPAG stimulation alone. Basolateral amygdala stimulation alone had no effects on panic-like reactions, and DPAG stimulation alone did not modify kindling epileptogenesis. Combined stimulation of BLA and DPAG induced depressive-like behavioral impairments. This is the first experimental study showing bidirectional, mutually exacerbating effect of epilepsy and PLB, and the precipitation of depressive-like state by the epilepsy-PLB comorbidity.