Wolf Peter, Lin Katia, Mameniškiené Rüta, Walz Roger
Danish Epilepsy Centre Filadelfia, Dianalund, Denmark.
Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, Brazil.
Front Psychol. 2020 Sep 9;11:2251. doi: 10.3389/fpsyg.2020.02251. eCollection 2020.
Many chronic diseases impair patients' quality of life and may also affect their control perceptions. This could particularly happen for patients with epilepsy whose seizures often imply loss of control as a deeply disturbing experience. In 1980, a study on learned helplessness in epilepsy found a highly significant reduction of internal general locus of control (GLOC) and an increase of chance and powerful others health-related LOC (HLOC). In consequence, LOC became a frequent target of investigations relating to depression and anxiety, quality of life, coping, compliance, and other psychosocial aspects of epilepsy. Both GLOC and HLOC were investigated, and special groups like children, elderly, mentally handicapped persons, and those with psychogenic non-epileptic seizures were addressed. Most studies attempted to relate in-group differences of LOC to other parameters. Seizure-free patients were found to have a more internal HLOC, and patients with severe epilepsies have a more external HLOC. Patients with a high external HLOC seem to have more difficulties with coping and to be more anxious. Whereas external GLOC was correlated with learned helplessness, internal GLOC was associated with high self-efficacy and better life quality. An association of external LOC with depression seemed not to be a stable co-relation as clinical improvement following epilepsy surgery dissociated the two. A hypothesis was confirmed that the ability of some patients to counteract seizures at their onset, thus preserving control, was correlated with a higher internal HLOC. Some other theoretically well-founded hypotheses were not supported. Absolute figures as reported in several papers are of limited use because the only normative data for comparison come from a local sample of 1976 from Tennessee, whereas LOC scores may differ largely dependent on cultural and societal conditions. Very few controlled studies exist, and the early finding of a generally externalized LOC in epilepsy was confirmed only in one study performed in a South Indian community known for strong stigma against epilepsy. A recent transcultural investigation conducted in Brazil and Lithuania found no differences from healthy controls and between countries. It seems worthwhile to further investigate relations of LOC with epilepsy stigma.
许多慢性病会损害患者的生活质量，也可能影响他们的控制感。对于癫痫患者来说尤其如此，他们的癫痫发作常常意味着失去控制，这是一种极其令人不安的经历。1980年，一项关于癫痫患者习得性无助的研究发现，患者的内部总体控制源（GLOC）显著降低，而机遇和他人强大控制源（HLOC）与健康相关的控制源增加。因此，控制源成为了与癫痫的抑郁、焦虑、生活质量、应对方式、依从性及其他社会心理方面相关的研究中频繁涉及的对象。研究同时考察了GLOC和HLOC，并针对儿童、老年人、智力障碍者以及患有心因性非癫痫性发作的患者等特殊群体进行了研究。大多数研究试图将控制源的组内差异与其他参数联系起来。无癫痫发作的患者被发现具有更内在的HLOC，而患有严重癫痫的患者则具有更外在的HLOC。具有较高外在HLOC的患者似乎在应对方面存在更多困难，且更容易焦虑。外在GLOC与习得性无助相关，而内在GLOC则与高自我效能感和更好的生活质量相关。外在控制源与抑郁之间的关联似乎并非稳定的相关性，因为癫痫手术后的临床改善使二者分离。一个假设得到了证实，即一些患者在癫痫发作开始时抵消发作从而保持控制的能力与更高的内在HLOC相关。其他一些理论上有充分依据的假设则未得到支持。几篇论文中报告的绝对数据用途有限，因为唯一可供比较的规范数据来自1976年田纳西州的一个本地样本，而控制源得分可能因文化和社会条件的不同而有很大差异。对照研究非常少，而且早期关于癫痫患者普遍存在外在化控制源的发现仅在一项针对一个因对癫痫有强烈污名化而闻名的南印度社区的研究中得到证实。最近在巴西和立陶宛进行的一项跨文化调查发现，癫痫患者与健康对照组之间以及两国之间没有差异。进一步研究控制源与癫痫污名之间的关系似乎是值得的。
