针对患有癫痫和精神疾病共病的个体的癫痫与精神疾病靶向自我管理。
Targeted Self-Management of Epilepsy and Mental Illness for individuals with epilepsy and psychiatric comorbidity.
作者信息
Sajatovic Martha, Tatsuoka Curtis, Welter Elisabeth, Perzynski Adam T, Colon-Zimmermann Kari, Van Doren Jamie R, Bukach Ashley, Lawless Mary Ellen, Ryan Eleanor R, Sturniolo Katherine, Lhatoo Samden
机构信息
Department of Psychiatry and of Neurology, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Department of Neurology, Case Western Reserve University School of Medicine, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
出版信息
Epilepsy Behav. 2016 Nov;64(Pt A):152-159. doi: 10.1016/j.yebeh.2016.08.012. Epub 2016 Oct 12.
OBJECTIVES
Serious mental illness is disproportionately common in people with epilepsy and contributes to complications and mortality. Few care approaches specifically target individuals who have epilepsy and severe mental illness. We used an iterative process to refine an existing intervention and tested the novel intervention, Targeted Self-Management for Epilepsy and Mental Illness (TIME) in individuals with epilepsy and comorbid mental illness (E-MI).
METHODS
The TIME intervention was developed with input from a community advisory board and then tested for feasibility, acceptability, and preliminary efficacy in people with E-MI, using a 16-week prospective, randomized controlled design comparing TIME (N=22) vs. treatment as usual (TAU, N=22). Primary outcome was change in depressive symptoms, assessed by the Montgomery Asberg Depression Rating Scale (MADRS). Secondary assessments included global psychiatric symptom severity, seizure frequency, sleep patterns, quality of life, stigma, social support, and self-efficacy.
RESULTS
There were 44 individuals enrolled, mean age 48.25 (SD=11.82) with 25 (56.8%) African-Americans. The majority (N=31, 70.5%) were unemployed, and most (N=41, 95.5%) had annual income <U.S. $25,000. With respect to study retention, there were 36 individuals (18 in TIME, 18 in TAU) assessed at 12weeks and 35 individuals (19 in TIME, 16 in TAU) assessed at 16weeks. There was a significant effect for MADRS (p=0.036; effect size of 0.70), with lower MADRS at 16weeks in TIME, while TAU MADRS did not change. Differences between most secondary measures were not statistically significant.
SIGNIFICANCE
The TIME intervention engages individuals to actively participate in self-management and can reduce depression in E-MI. Given the high morbidity and mortality associated with epilepsy complicated by serious mental illness, additional research is needed to better identify how TIME might be implemented in routine care settings.
目的
严重精神疾病在癫痫患者中极为常见，会导致并发症和死亡。很少有护理方法专门针对患有癫痫和严重精神疾病的个体。我们采用迭代过程对现有干预措施进行完善，并在患有癫痫合并精神疾病（E-MI）的个体中测试了新型干预措施——癫痫与精神疾病针对性自我管理（TIME）。
方法
TIME干预措施是在社区咨询委员会的参与下制定的，然后采用16周前瞻性随机对照设计，比较TIME组（N=22）和常规治疗（TAU，N=22）组，在患有E-MI的人群中测试其可行性、可接受性和初步疗效。主要结局是通过蒙哥马利-阿斯伯格抑郁评定量表（MADRS）评估的抑郁症状变化。次要评估包括总体精神症状严重程度、癫痫发作频率、睡眠模式、生活质量、耻辱感、社会支持和自我效能感。
结果
共有44人入组，平均年龄48.25岁（标准差=11.82），其中25人（56.8%）为非裔美国人。大多数人（N=31，70.5%）失业，且大多数人（N=41，95.5%）年收入低于25000美元。关于研究保留率，12周时有36人（TIME组18人，TAU组18人）接受评估，16周时有35人（TIME组19人，TAU组16人）接受评估。MADRS有显著效果（p=0.036；效应大小为0.70），TIME组在16周时MADRS较低，而TAU组MADRS没有变化。大多数次要指标的差异无统计学意义。
意义
TIME干预措施促使个体积极参与自我管理，并可减轻E-MI患者的抑郁症状。鉴于癫痫合并严重精神疾病的高发病率和死亡率，需要进一步研究以更好地确定如何在常规护理环境中实施TIME。
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