Mental disorders in epilepsy

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According to our data, during the first stage the development of psychopathological disorders, i.e., before the appearance of signs of dementia, as the evidence, which confirm diagnostics of the type of the course of epileptic process with the set aside exacerbation, serve an increase in the lifetime and the loading of delusional states, the appearance of hallucinatory episodes, the shortening of the remissions, which interrupt the transient (transitory and schubweise) psychoses. A sign of the unfavorable type of the course of the epileptic process at this point of disease is the sudden aggravation of the picture of psychosis due to the catatono-delusional, catatonic or polymorphous states, which include affective, hallucinatory and catatonic manifestations.

On the second stage of development of psychopathology with the appearance of clinical, verified during the investigation, pathopsychologic signs of dementia, including manifested in the form of severe ex-

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plosivity, the aggravation until relatively favorable flowing epileptic process showed an increase in the share structure of psychotic affectivedelusional syndromes, reducing the quality of remission due to residual productive psychopathological disorders. In the case of an unfavorable course of the disease at this stage in its clinical picture is dominated by catatono-delusional and hallucinatory-delusional disorder.

At the third stage of the development of the psychopathological disorders, which include the steadfast and expressed disturbances of thinking, bradyphrenia, to the cases with the set aside exacerbation of epileptic process corresponds the transformation of psychosis into the polymorphous states with the predominance of sharp affective-delusional and catatonic disorders. The unfavorable course of process is characterized here by appearance in the patients of tendency toward the systematization of dilusional ideas, the development of paranoid dementia or by predominance in the clinical picture of the complex of hallucinatory, delusional and catatono-delusional syndromes.

At the fourth stage of the development of psychopathological disorders, which is characterized by the completion of the formation of epileptic dementia (expressed mnestico-intellectual defect) and by the offensive of late remission in the psychotic symptoms, in the cases of the processes, which take place with the set aside exacerbation, is noted the decrease of the manifestation of affective and delusional disturbances. In the cases of the unfavorable flow of epileptic process this tendency is expressed to a lesser degree: in the picture of psychosis for long remain simple in structure monomorphic affective and catatonic disorders in cases with transient transient and paroxismal psychosis marked further reduction in the duration of remission.

Data of the epidemiological investigation conducted by us attest to the fact that the presence or the absence of psychotic disorders on the stages of the formation of epileptic dementia in general doesn’t have vital importance for the nature of the working of patients. In this connection it was natural to assume that the special feature of personal changes, and also the nature of negative psychopathological disorders under the conditions of regular antiepileptic therapy reduction in the sharpness of psychotic symptoms at these stages of disease in the larger measure than psychotic manifestations, refer to the level of the social-working adaptation of patients, retention or loss of their residual ability to work.

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Based on this, we thought it appropriate to consider specifically the possibility of forming in patients under the therapy of appropriate to their state social attitudes. It was thought that the prognostic significance of the fact of the presence or absence in our patients such facilities can not be determined without taking into account the quality of their lives, including the stability of their employment in conventional or specially created conditions of production, productivity at work, the possibility of establishing optimal relationships with others, including other patients in the family, in terms of employment, etc.

In recent years in the literature to questions of the quality of life with epilepsy is given much attention; however, one should recognize that by quality of life frequently is understood the totality of different concepts.

For quality of life measurement together with the frequency of seizures C. Diaz-Obregon et al. (1997) uses “simple scale” from the points, which characterize the degree of the independence of patient, including independence in the ordinary life, the independence of life in the solitude or with the family, withdrawal into the solitude or in the group, the withdrawal in the instruction or the work. S. Dykgraaf (1997) assumes that “the successful control of seizures yet does not give the guarantee of an improvement in the quality of the life of patient and his family”. With quality research of life J. Yacoby et al. (1998) use the scales for measuring the gravity of seizures, behavior and mood. Results of carried out by M.T. Ratti et al. (1997) studies of patients with “chronic epilepsy” showed the considerably lower in them level of satisfactoriness by life, in comparison with the control group.

A. Alexander et al. (1997) consider that neuropsychological data have an important significance for the social functioning and qualities of life with epilepsy. Quality of life only “to a certain extent”, in the opinion of H. Malmgren (1997), can be the index of personal, physical and psychological functioning. Nevertheless, as the author considers, for his direct measurement is necessary the precise interrogation of a person relative to what is considered a good quality of life.

On the basis of the results of the study, carried out with the use of a questionnaire due to the functional state, G. Baker et al. (1997) arrived at the conclusion about the presence of the statistically reliable differences between the groups of patients on the different criteria of the quality of life, with the exception of “social interaction” and

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“sexual relations”. In this case the authors note that their data contradict indications that the poor quality of life refers to an increase in the frequency of seizures.

A. Jacoby (1997) and D. Chadwick (1997), being oriented toward the differentiation of the quality of life in the dependence on clinical and behavioral data, note that it is improved in the cases of reaching in the patients of the reduction of paroxysms. In these cases, they have improved behavior, including the expense of its possible alternative, the emergence of the need for communication and others, as well as mood – in the form of reduced tearfulness and anxiety. Identifying “the influence of epilepsy on the physical, social and psychological functioning,” the authors found that epilepsy adversely affect the general health, self-esteem and social functioning of patients.

Finally, G. Baker, A. Jacoby et al. (1998) with a study of different scales of the quality of life in 100 patients: distress, anxieties, depressions, clinical symptoms, neurotoxicity, social activity, social support, social stigmatization, social limitations, work experience, established that with different gravity of seizures in the patients with recently diagnosed epilepsy it is possible to reveal differences as the life according to the scales of symptoms and neurotoxicity, especially when patients report about “heavy disorders”.

The given data testifies on the search for approaches to the study of the quality of life in the patients with epilepsy in the clinical, neuropsychological, behavioral, psychological and social aspects of life of the patients. Such attempts at the solution of problem are the expression of a “holistic” view on the needs of patient and justification of the poly-professional realization of therapeutic and rehabilitative processes. In the opinion of S. Davies et al. (2003), the routine monitoring of psychological regulation must become the standard component part of the multidistsiplinary package of care for children with epilepsy.

As an example of a multi-vector approach to the assessment of quality of life, you can specify the use of classifications and criteria approved by the joint decision of the Ministry of Labour and Social Development and the Ministry of Health of the Russian Federation of 29.01.1997 № 1/30.

In normative document for the conduction of medico-social examination it is proposed to use the following terms.

Health – state of complete physical, mental and social well being, not just the absence of disease or anatomical defects.

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Disturbance of health – physical, mental and social trouble, connected with the loss, anomaly, the disorder of psychological, physiological, anatomical structure and (or) function of the human organism.

The limitation of life activity – deviation from the standard of human activity as a result of the disturbance of the health, which is characterized by the limitation of the abilities to achieve self-ser- vice, movement, orientation, contact, control of its behavior, instruction and working activity.

The disablement – social insufficiency as a result of the disturbance of health with the steadfast disorder of the functions of organism, which leads to the limitation of life activity and need for social protection.

For evaluating the quality of life of the patient with epilepsy, in our opinion, most suitable are the concepts of the degree of the limitation of vital activity and degree of social insufficiency. In this respect such terms asserting in the literature of the last years, as psycho-social outcome (H.M. de Boer, 1997, and S. Jarvie, 1997), psycho-social development (S. Ehlers, 1997), the level of psycho-social regulation (A. Gramstadt et al., 1997), psycho-social incapacity (P. Moran et al., 1997), psycho-social estimation (L.A. Lathrop, 1997, and others) are of interest.

Difficulties, which appear with quality of life evaluation in epilepsy, in the opinion of D. Brock. (1998), consist in the fact that the application of the existing tools, including – the measurement of health generally and the measurement of specific disorders – is unproductive. In the philosophy of morals and politics, as in bioethics, exist, according to the evidence of the author, the completely different theories of the quality of life, not suitable, for example, to the question of how a person adapts to disability.

B. Brulde (1997, 1998) as the final goal of medicine considers assistance, in the first place, to the quality of life (quality of life is equal to the level of well being) and, in the second place, to a quantity of life (perception of life as values). All other purposes of medicine from the correction of organs to the action on the general functioning of patient are only the means of reaching this final goal. By medical means it is possible to act on the physical and mental functioning of personality, and this is explained, why as the within the framework specific medical practice we can measure not only the prosperity or the quality of life, but also the degree of the attainability “intermediate” or “working” purposes.

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In the contemporary literature it is possible to note different examples of quality measurement of life in patients with epilepsy without the application clinical data. Among them – the satisfactory of a patient with his physical, psychological and social well-being (D. Chadwick, 1997), the confinement of patient out of the hospital (H. Collinge, 1997), “the experience of epilepsy as weaknesses” (J.A. Collings, 1998), socialization (A. Henley, 1997), decrease stigmatization (M.D. Hills, 1997, and others) or “feeling of stigmatization” (A. Jacoby et al., 1997).

D. Marinkovic et al. (1997) for quality measurement of life with epilepsy propose to use an entire complex of the indices: emotional and interpersonal regulation, the degree of self-esteem, social isolation, self-representation.

O.S. Morozova (2009) considers the quality of life with epilepsy as the complex index, which depends on a number of clinical, demographic determinants and special features of the course of disease. According to the author, in the estimation of the quality of life by patients themselves vital importance have the social indices, inseparably connected with effectiveness and transference of the therapy: employment in the working or training process, disablement, marital status, the degree of satisfactoriness by social achievements.

In the context of our work it is important to examine some “applied” aspects of the quality of the life of the patients with epilepsy. The analysis of foreign literature shows that questions of the employment of patients, their family and working adaptation are as before urgent for clinical physicians.

J. Beaussart-Defaye et al. (1997), for example, establish the sufficiently close connection between the pliability of epilepsy to therapeutic action, the working employment and the economic security of patients. S. Kochen et al. (1997) indicate the presence of the connection between the reasons for changes in the vital plans in the patients with epilepsy and the social and economic factors. According to their data, each third woman, who suffers this illness, has the high probability of unemployment. In the opinion of H. Mayer et al. (1997), status of employment with epilepsy is strictly determined by cognitive and emotional scarcity. For this reason, in the opinion of the authors, for patients with the disturbances of capability for instruction or emotional disorders is accessible only the small level of working employment. So-called favorable focal epilepsy in this respect is also sufficiently high risk. According to the data of M. Pfafflin et al. (1997),

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the percentage of employment in the population of the adult patients with epilepsy is equal to 44, which composes 2/3 from the percentage of employment in the general population. On the unemployment in the labor “the patients with epilepsy with the mental disorders with the possibility in this case to manage its daily problems of house” reports H. Matthis (1997).

A definite interest is manifested in creativity of the patients with epilepsy: poetry and drawing (M. Trimbler, 1997; H.M. Boer, 1997; J.T. Moroncy et al., 1998), literary works (M. Nikanorova and P. Temin, 1997; L. Mouzitchouk et al., 1997).

Unfortunately, in this case far from always, are conducted strictly pathographical studies, but the biographical data about various known persons communicate, as a rule, only as the confirmation of the fact that epilepsy does not always lead to the destruction of creative abilities.

Finally, a number of works is devoted to the study of the problems of the family and marriage life of patients with epilepsy.

H.M. de Boer (1997), for example, comparing the chances of the entrance into the marriage of men and women, who suffer from epilepsy, notes that if in “the countries of the third peace” the marriage for the women with epilepsy is actually impossible, and for the men a hope to marry is also small, then in the western peace despite the fact that the portion of people with epilepsy among marrying is small, the parity of genders is directly opposite. A. Georgi et al. (1997) note statistically reliably smaller, in comparison with the control group, the probability of the entrance into the marriage of women, with epilepsy, with smaller fertility, with the fact that the significant differences between the compared groups in the financial and educational aspects were not revealed. “Fear before the search for husband” notes in its patients F.C.C. Peng (1997).

D. Gigienishvili and T. Geladze (1997) report that the family situation of the surveyed by them patients with epilepsy depends on the length of the latter. In the family, to the patients with the longer duration of disease, as the authors note, often occurs negative relation, as a result of frequent neurotic disorders in them.

With a study of the signs of the stability of the social-working adaptation of patients for us seems necessary to consider the signs of the stabilization of clinical picture. In this case as one of the basic tasks of a study we considered the development of correlations between the characteristic of each individual case degree of disruptive-

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