Unidade de Pesquisa e Tratamento das Epilepsias (UNIPETE), Unifesp, São Paulo, SP, Brazil.
Unidade de Pesquisa e Tratamento das Epilepsias (UNIPETE), Unifesp, São Paulo, SP, Brazil.
Epilepsy Behav. 2020 Apr;105:106958. doi: 10.1016/j.yebeh.2020.106958. Epub 2020 Feb 22.
This article intends to verify the association of dysfunctional beliefs of personality disorders with the executive performance in people with juvenile myoclonic epilepsy (JME).
Fifty-two patients (35 women, 67.3%) with JME aged 18-50 yrs. (32.3 ± 9.7) were evaluated between May 2017 and April 2018 and compared with controls. All subjects were submitted to the Personality Beliefs Questionnaire (PBQ) (Beck & Beck, 1991; Savoia et al., 2006), Dysexecutive Questionnaire (DQ; Wilson et al., 1996; Macuglia et al., 2016), estimated intelligence quotient (IQ) using Vocabulary and Block Design tests, attention and executive functions evaluation (Controlled Oral Word Association (COWA), Digit Span, Trail Making Tests (TMT) A and B, Stroop and Wisconsin Card Sorting Test (WCST)). The inclusion criteria were as follows: diagnosis of JME (ILAE, 1989); age ≥18 yrs., schooling ≥ 11 yrs. and IQ ≥70. The inclusion criteria for the control group were the same except diagnosis of epilepsy.
Compared with controls, patients presented higher scores in PBQ for personality disorders, namely Narcissistic (z = -0.79; p < 0.001), Borderline (z = -0.58; p = 0.002), Paranoid (z = -0.43; p = 0.017), and Histrionic (z = -0.39; p = 0.041). Executive functions were impaired when compared with controls in TMT A (z = -0.97; p = 0.038), TMT B (z = -0.65; p = 0.023), and COWA (z = -0.51; p = 0.001). Patients showed higher WCST scores for Errors (z = -1.62; p ≤ 0.001), Perseverative Errors (z = -0.77; p = 0.001), Non-Perseverative Errors (z = -1.01; p = 0.001), Conceptual Level Response (z = -1.56; p ≤ 0.001), Completed Categories (z = -2.12; p = 0.002), and Failure to Maintain Context (z = -0.49; p = 0.015). Personality Beliefs Questionnaire results showed correlation with lower values in TMT A, Antisocial (r = -0.298; p = 0.032), Narcissistic (r = -0.303; p = 0.029), Schizoid (r = - 0.410; p = 0.003), Histrionic (r = -0.341; p = 0.013), Passive-aggressive (r = -0.341; p = 0.015), and Obsessive-compulsive (r = -0.319; p = 0.021); TMT B results showed a trend for Obsessive-compulsive traits (r = -0.261; p = 0.052); COWA was correlated to Dependent (r = 0.319; p = 0.021); and Digit Span to Passive-aggressive (r = 0.287; p = 0.039). On WCST, Failure to Maintain Context was correlated to Avoidant (r = 0.335; p = 0.017). The DQ was not correlated with PBQ.
People with JME presented dysfunctional beliefs of personality disorder that were correlated with executive dysfunction. These findings reinforce the need for psychological rehabilitation in these patients.
本文旨在验证人格障碍的不良信念与青少年肌阵挛性癫痫（JME）患者执行功能之间的关系。
2017 年 5 月至 2018 年 4 月期间评估了 52 名年龄在 18-50 岁之间的 JME 患者（女性 35 名，占 67.3%），并与对照组进行了比较。所有受试者均接受了人格信念问卷（PBQ）（Beck & Beck，1991；Savoia 等人，2006）、执行功能问卷（DQ；Wilson 等人，1996；Macuglia 等人，2016）、使用词汇和块设计测试估计智商、注意力和执行功能评估（受控口头联想测验（COWA）、数字跨度、连线测验 A 和 B、Stroop 和威斯康星卡片分类测验（WCST））。纳入标准如下：JME 的诊断（ILAE，1989 年）；年龄≥18 岁，受教育程度≥11 年，智商≥70。对照组的纳入标准除了诊断为癫痫外，其余与患者组相同。
与对照组相比，患者在人格障碍 PBQ 中的评分更高，即自恋型（z=-0.79；p<0.001）、边缘型（z=-0.58；p=0.002）、偏执型（z=-0.43；p=0.017）和表演型（z=-0.39；p=0.041）。与对照组相比，患者在连线测验 A（z=-0.97；p=0.038）、连线测验 B（z=-0.65；p=0.023）和 COWA（z=-0.51；p=0.001）中的执行功能受损。患者在 WCST 上的错误（z=-1.62；p≤0.001）、持续错误（z=-0.77；p=0.001）、非持续错误（z=-1.01；p=0.001）、概念水平反应（z=-1.56；p≤0.001）、完成类别（z=-2.12；p=0.002）和维持上下文失败（z=-0.49；p=0.015）的分数较高。人格信念问卷结果显示与连线测验 A（r=-0.298；p=0.032）、反社会型（r=-0.303；p=0.029）、分裂样型（r=-0.410；p=0.003）、表演型（r=-0.341；p=0.013）、被动攻击型（r=-0.341；p=0.015）和强迫型（r=-0.319；p=0.021）的低值相关；连线测验 B 结果显示强迫症特征呈趋势相关（r=-0.261；p=0.052）；COWA 与依赖型（r=0.319；p=0.021）相关；数字跨度与被动攻击型（r=0.287；p=0.039）相关。在 WCST 上，维持上下文失败与回避型（r=0.335；p=0.017）相关。DQ 与 PBQ 不相关。
JME 患者存在人格障碍的不良信念，与执行功能障碍相关。这些发现强调了这些患者需要进行心理康复。
