Memory complaints in epilepsy: An examination of the role of mood and illness perceptions.

The study examined the role of mood and illness perceptions in explaining the variance in the memory complaints of patients with epilepsy. METHOD: Forty-four patients from an outpatient tertiary care center and 43 volunteer controls completed a formal assessment of memory and a verbal fluency test, as well as validated self-report questionnaires on memory complaints, mood, and illness perceptions. RESULTS: In hierarchical multiple regression analyses, objective memory test performance and verbal fluency did not contribute significantly to the variance in memory complaints for either patients or controls. In patients, illness perceptions and mood were highly correlated. Illness perceptions correlated more highly with memory complaints than mood and were therefore added to the multiple regression analysis. This accounted for an additional 25% of the variance, after controlling for objective memory test performance and verbal fluency, and the model was significant (model B). In order to compare with other studies, mood was added to a second model, instead of illness perceptions. This accounted for an additional 24% of the variance, which was again significant (model C). In controls, low mood accounted for 11% of the variance in memory complaints (model C2). SUMMARY: A measure of illness perceptions was more highly correlated with the memory complaints of patients with epilepsy than with a measure of mood. In a hierarchical multiple regression model, illness perceptions accounted for 25% of the variance in memory complaints. Illness perceptions could provide useful information in a clinical investigation into the self-reported memory complaints of patients with epilepsy, alongside the assessment of mood and formal memory testing.

'Feeling sad and useless': an investigation into personal acceptance of disability and its association with depression following stroke.

OBJECTIVES: To study the association of acceptance of disability with depression following stroke and its ability to predict depression at follow-up. DESIGN: A prospective cohort mixed (quantitative and qualitative) design was used. SETTING AND SUBJECTS: Patients admitted to a stroke unit were consecutively recruited. Eighty-nine participated at one month and 81 were followed up nine months post stroke. MAIN MEASURES: Depressive disorder was assessed using a structured clinical interview. Disability and acceptance of disability were measured using self-report scales. At one month post stroke, 60 consecutive participants also participated in open-ended interviews exploring their individual concerns about having had a stroke and their responses were analysed qualitatively. RESULTS: One-third of participants were found to have depression (29/89; 33% at one month and 24/81; 30% at nine months). Non-acceptance of disability remained associated with depression after controlling for age, gender, original stroke severity and current disability at one month (odds ratio (OR) = 1.27, 95% confidence interval (CI) 1.09-1.47) and nine months (OR = 1.46, 95% CI 1.22-1.75). Also, non-acceptance of disability measured at one month independently predicted depression measured at nine months (OR = 1.19, 95% CI 1.05-1.35). The qualitative findings illustrated a self-reproachful element to non-acceptance of disability. Patients with depression often said that they 'should still' be capable and sometimes referred to themselves as 'useless'; whereas patients who were not depressed commonly reported having accepted stroke-related disability. CONCLUSIONS: These finding suggest that personal beliefs about accepting disability are associated with and predict emotional adaptation following stroke.

Fear of recurrence and beliefs about preventing recurrence in persons who have suffered a stroke.

OBJECTIVES: The aim of this study was to investigate fear of recurrent stroke and beliefs about its causes and prevention. METHODS: Eighty-nine patients participated 1 month following stroke and 81 were followed up at 9 months. Interviews addressed fears and beliefs about stroke, causes, recurrence and prevention by using closed and open-ended questions. Responses were subject to quantitative and qualitative analysis, respectively. RESULTS: Fear of recurrence was common. Profound disability was a particularly feared outcome. Participants were knowledgeable about causes. However, causal controllability ratings were low. Some reported concern about preventative strategies (e.g., difficulty stopping smoking). Many reported idiosyncratic beliefs (e.g., avoiding overexertion) or fatalistic ideas about strokes (e.g., 'nothing' can prevent them). Similar quantitative results were obtained at follow-up. CONCLUSIONS: Many patients fear stroke recurrence. They lack a sense of control over causes and have fears associated with idiosyncratic and fatalistic beliefs. There is a need to elicit and address individuals' own fears and beliefs about stroke before providing evidence-based secondary prevention recommendations.