Green Becky, Norman Paul, Reuber Markus
Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom.
Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield S1 2LT, United Kingdom.
Epilepsy Behav. 2017 Jan;66:120-126. doi: 10.1016/j.yebeh.2016.10.015. Epub 2016 Dec 28.
Psychopathology levels are elevated in patients with psychogenic non-epileptic seizures (PNES) and those with epilepsy. However, patients with PNES report higher rates of trauma and neglect, poorer health-related quality of life (HRQoL), and an increased prevalence of insecure attachment. We examined to what extent attachment style and relationship quality with their main informal carer impact on levels of HRQoL, depression, and anxiety in patients with PNES versus those with epilepsy.
Consecutive patients with PNES (N=23) and epilepsy (N=72) completed questionnaires about attachment style, quality of their relationship with their main informal carer, seizure severity, HRQoL, depression, and anxiety.
Patients with PNES reported higher levels of anxiety and depression and lower HRQoL than those with epilepsy. PNES: No significant correlations were found with HRQoL but depression correlated positively with attachment avoidance, attachment anxiety, and relationship conflict. Anxiety correlated positively with attachment avoidance, attachment anxiety, and relationship conflict, and negatively with relationship depth and support. Epilepsy: HRQoL correlated negatively with seizure severity, depression, anxiety, attachment avoidance, and attachment anxiety. Depression correlated positively with attachment avoidance, attachment anxiety, and relationship conflict. Anxiety correlated positively with seizure severity, attachment avoidance, and attachment anxiety. Correlations between measures of relationship quality and anxiety were stronger in patients with PNES versus those with epilepsy (zs=2.66 to 2.97, ps<0.004). Attachment style and relationship quality explained larger amounts of variance in depression (45%) and anxiety (60%) in the patients with PNES than those with epilepsy (16% and 13%).
Levels of anxiety and depression were higher in patients with PNES than those with epilepsy. Interpersonal problems were much more closely associated with anxiety and depression in patients with PNES than those with epilepsy. The findings support the use of therapeutic interventions for PNES focusing on attachment and relationship issues.
心理性非癫痫性发作（PNES）患者和癫痫患者的精神病理学水平均有所升高。然而，PNES患者报告的创伤和忽视发生率更高，健康相关生活质量（HRQoL）较差，不安全依恋的患病率增加。我们研究了依恋风格及其与主要非正式照料者的关系质量在多大程度上影响PNES患者与癫痫患者的HRQoL、抑郁和焦虑水平。
连续纳入的PNES患者（N = 23）和癫痫患者（N = 72）完成了关于依恋风格、与主要非正式照料者关系质量、癫痫发作严重程度、HRQoL、抑郁和焦虑的问卷调查。
PNES患者报告的焦虑和抑郁水平高于癫痫患者，HRQoL低于癫痫患者。PNES：未发现与HRQoL有显著相关性，但抑郁与依恋回避、依恋焦虑和关系冲突呈正相关。焦虑与依恋回避、依恋焦虑和关系冲突呈正相关，与关系深度和支持呈负相关。癫痫：HRQoL与癫痫发作严重程度、抑郁、焦虑、依恋回避和依恋焦虑呈负相关。抑郁与依恋回避、依恋焦虑和关系冲突呈正相关。焦虑与癫痫发作严重程度、依恋回避和依恋焦虑呈正相关。与癫痫患者相比，PNES患者中关系质量指标与焦虑之间的相关性更强（z值 = 2.66至2.97，p值<0.004）。与癫痫患者相比，依恋风格和关系质量在PNES患者的抑郁（45%）和焦虑（60%）中解释的方差量更大（分别为16%和13%）。
PNES患者的焦虑和抑郁水平高于癫痫患者。与癫痫患者相比，人际关系问题在PNES患者中与焦虑和抑郁的关联更为密切。研究结果支持针对PNES采用侧重于依恋和关系问题的治疗干预措施。
