Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2003 Nov;74(11):1485–1492. doi: 10.1136/jnnp.74.11.1485

Psychopathology in people with epilepsy and intellectual disability; an investigation of potential explanatory variables

C Espie 1, J Watkins 1, L Curtice 1, A Espie 1, R Duncan 1, J Ryan 1, M Brodie 1, K Mantala 1, M Sterrick 1
PMCID: PMC1738251  PMID: 14617702

Abstract

Objectives:There are few studies on epilepsy and psychopathology in people with intellectual disability (mental retardation) despite epilepsy prevalence rates that are thirty times higher than in the general population. The aims of this study, therefore, were to identify reliable, epilepsy-specific predictors of psychiatric and behavioural disorder in these patients, and to investigate reliable predictors of carer stress.

Methods:A database of 685 patients was compiled, from which 250 were randomly selected. Structured interviews were completed on 186 of these 250 patients (74%) (108 men, 78 women; mean age (SD) 35.5 (10.1)) comprising descriptive, clinical and functional components, and validated measures of psychopathology for which comparative data were available. Logistic and linear regression methods were used to identify predictors.

Results:One-third of patients with epilepsy and intellectual disability met criteria for possible psychiatric disorder, particularly affective/neurotic disorder; twice the comparison rates for intellectual disability alone. Behavioural problem levels, however, were lower than population norms. Regression models explaining modest amounts of variance (R2⩽24%) suggested certain seizure phenomena (greater seizure severity, more seizures in past month, lesser tendency to loss of consciousness during seizures) as particular risk factors for psychiatric disorder. General disability factors such as level of intellectual, sensory or motor disability and side effects of medication, however, contributed more to explaining behavioural problems. Around half of the family carers reported significant stress, and one-third exhibited clinically significant anxiety symptoms. Younger carers were more stressed, and side effects from patients' medication also contributed to carer stress.

Conclusions:Although epilepsy in itself may be a risk factor for psychopathology in a minority of people with intellectual disability, some epilepsy-specific factors may predict psychiatric disorder. Behavioural problems need to be considered separately from psychiatric disorder because general factors, more closely associated with disability, are stronger predictors of their occurrence.

Full Text

The Full Text of this article is available as a PDF (290.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aman M. G., Singh N. N., Stewart A. W., Field C. J. The aberrant behavior checklist: a behavior rating scale for the assessment of treatment effects. Am J Ment Defic. 1985 Mar;89(5):485–491. [PubMed] [Google Scholar]
  2. Baker G. A., Jacoby A., Smith D. F., Dewey M. E., Chadwick D. W. Development of a novel scale to assess life fulfillment as part of the further refinement of a quality-of-life model for epilepsy. Epilepsia. 1994 May-Jun;35(3):591–596. doi: 10.1111/j.1528-1157.1994.tb02479.x. [DOI] [PubMed] [Google Scholar]
  3. Beran R. G., Gibson R. J. Aggressive behaviour in intellectually challenged patients with epilepsy treated with lamotrigine. Epilepsia. 1998 Mar;39(3):280–282. doi: 10.1111/j.1528-1157.1998.tb01373.x. [DOI] [PubMed] [Google Scholar]
  4. Brodie M. J., Dichter M. A. Antiepileptic drugs. N Engl J Med. 1996 Jan 18;334(3):168–175. doi: 10.1056/NEJM199601183340308. [DOI] [PubMed] [Google Scholar]
  5. Collacott R. A. Epilepsy, dementia and adaptive behaviour in Down's syndrome. J Intellect Disabil Res. 1993 Apr;37(Pt 2):153–160. doi: 10.1111/j.1365-2788.1993.tb00582.x. [DOI] [PubMed] [Google Scholar]
  6. Deb S. Electrophysiological correlates of psychopathology in individuals with mental retardation and epilepsy. J Intellect Disabil Res. 1995 Apr;39(Pt 2):129–135. doi: 10.1111/j.1365-2788.1995.tb00480.x. [DOI] [PubMed] [Google Scholar]
  7. Deb S., Hunter D. Psychopathology of people with mental handicap and epilepsy. I: Maladaptive behaviour. Br J Psychiatry. 1991 Dec;159:822-6, 833-4. doi: 10.1192/bjp.159.6.822. [DOI] [PubMed] [Google Scholar]
  8. Deb S., Hunter D. Psychopathology of people with mental handicap and epilepsy. II: Psychiatric illness. Br J Psychiatry. 1991 Dec;159:826-30, 833-4. doi: 10.1192/bjp.159.6.826. [DOI] [PubMed] [Google Scholar]
  9. Deb S., Hunter D. Psychopathology of people with mental handicap and epilepsy. III: Personality disorder. Br J Psychiatry. 1991 Dec;159:830–834. doi: 10.1192/bjp.159.6.830. [DOI] [PubMed] [Google Scholar]
  10. Espie C. A., Gillies J. B., Montgomery J. M. Antiepileptic polypharmacy, psychosocial behaviour and locus of control orientation among mentally handicapped adults living in the community. J Ment Defic Res. 1990 Aug;34(Pt 4):351–360. doi: 10.1111/j.1365-2788.1990.tb01545.x. [DOI] [PubMed] [Google Scholar]
  11. Espie C. A., Kerr M., Paul A., O'Brien G., Betts T., Clark J., Jacoby A., Baker G. Learning disability and epilepsy. 2, a review of available outcome measures and position statement on development priorities. Seizure. 1997 Oct;6(5):337–350. doi: 10.1016/s1059-1311(97)80033-7. [DOI] [PubMed] [Google Scholar]
  12. Espie C. A., Pashley A. S., Bonham K. G., Sourindhrin I., O'Donovan M. The mentally handicapped person with epilepsy: a comparative study investigating psychosocial functioning. J Ment Defic Res. 1989 Apr;33(Pt 2):123–135. doi: 10.1111/j.1365-2788.1989.tb01459.x. [DOI] [PubMed] [Google Scholar]
  13. Espie C. A., Watkins J., Duncan R., Espie A., Sterrick M., Brodie M. J., McGarvey C., Curtice L. Development and validation of the Glasgow Epilepsy Outcome Scale (GEOS): a new instrument for measuring concerns about epilepsy in people with mental retardation. Epilepsia. 2001 Aug;42(8):1043–1051. doi: 10.1046/j.1528-1157.2001.0420081043.x. [DOI] [PubMed] [Google Scholar]
  14. Ettinger A. B., Weisbrot D. M., Saracco J., Dhoon A., Kanner A., Devinsky O. Positive and negative psychotropic effects of lamotrigine in patients with epilepsy and mental retardation. Epilepsia. 1998 Aug;39(8):874–877. doi: 10.1111/j.1528-1157.1998.tb01183.x. [DOI] [PubMed] [Google Scholar]
  15. Goulden K. J., Shinnar S., Koller H., Katz M., Richardson S. A. Epilepsy in children with mental retardation: a cohort study. Epilepsia. 1991 Sep-Oct;32(5):690–697. doi: 10.1111/j.1528-1157.1991.tb04711.x. [DOI] [PubMed] [Google Scholar]
  16. Hauser W. A., Annegers J. F., Kurland L. T. Prevalence of epilepsy in Rochester, Minnesota: 1940-1980. Epilepsia. 1991 Jul-Aug;32(4):429–445. doi: 10.1111/j.1528-1157.1991.tb04675.x. [DOI] [PubMed] [Google Scholar]
  17. Kalachnik J. E., Hanzel T. E., Harder S. R., Bauernfeind J. D., Engstrom E. A. Antiepileptic drug behavioral side effects in individuals with mental retardation and the use of behavioral measurement techniques. Ment Retard. 1995 Dec;33(6):374–382. [PubMed] [Google Scholar]
  18. Larkin M. Tobacco industry giants scorched in Florida lawsuit. Lancet. 1999 Jul 17;354(9174):231–231. doi: 10.1016/S0140-6736(05)66306-4. [DOI] [PubMed] [Google Scholar]
  19. Matson J. L., Bamburg J. W., Mayville E. A., Khan I. Seizure disorders in people with intellectual disability: an analysis of differences in social functioning, adaptive functioning and maladaptive behaviours. J Intellect Disabil Res. 1999 Dec;43(Pt 6):531–539. doi: 10.1046/j.1365-2788.1999.00247.x. [DOI] [PubMed] [Google Scholar]
  20. McGrother C. W., Hauck A., Burton P. R., Raymond N. T., Thorp C. F. More and better services for people with learning disabilities. J Public Health Med. 1993 Sep;15(3):263–271. [PubMed] [Google Scholar]
  21. Moss S., Ibbotson B., Prosser H., Goldberg D., Patel P., Simpson N. Validity of the PAS-ADD for detecting psychiatric symptoms in adults with learning disability (mental retardation). Soc Psychiatry Psychiatr Epidemiol. 1997 Aug;32(6):344–354. doi: 10.1007/BF00805440. [DOI] [PubMed] [Google Scholar]
  22. Newton J. T., Sturmey P. The Aberrant Behaviour Checklist: a British replication and extension of its psychometric properties. J Ment Defic Res. 1988 Apr;32(Pt 2):87–92. doi: 10.1111/j.1365-2788.1988.tb01394.x. [DOI] [PubMed] [Google Scholar]
  23. Prasher V. P. Epilepsy and associated effects on adaptive behaviour in adults with Down syndrome. Seizure. 1995 Mar;4(1):53–56. doi: 10.1016/s1059-1311(05)80079-2. [DOI] [PubMed] [Google Scholar]
  24. Richardson S. A., Katz M., Koller H., McLaren J., Rubinstein B. Some characteristics of a population of mentally retarded young adults in a British city. A basis for estimating some service needs. J Ment Defic Res. 1979 Dec;23(4):275–285. doi: 10.1111/j.1365-2788.1979.tb00862.x. [DOI] [PubMed] [Google Scholar]
  25. Robinson B. C. Validation of a Caregiver Strain Index. J Gerontol. 1983 May;38(3):344–348. doi: 10.1093/geronj/38.3.344. [DOI] [PubMed] [Google Scholar]
  26. Sander J. W., Shorvon S. D. Epidemiology of the epilepsies. J Neurol Neurosurg Psychiatry. 1996 Nov;61(5):433–443. doi: 10.1136/jnnp.61.5.433. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Wolf P., Trimble M. R. Biological antagonism and epileptic psychosis. Br J Psychiatry. 1985 Mar;146:272–276. doi: 10.1192/bjp.146.3.272. [DOI] [PubMed] [Google Scholar]
  28. Zigmond A. S., Snaith R. P. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES