Making sense of depressive symptoms associated with stroke: A Q methodological study

This thesis aimed to investigate depressive symptoms associated with stroke. Depression related to stroke is highly prevalent, not easy to diagnose, with important consequences for prognosis. Specific beliefs patients hold about their physical illness are well known to be important predictors of outcome, and there is now a growing literature on the role of beliefs about mental illness as predictors of outcome. Much less is known about how patients who have had a stroke make sense of their mood symptoms. Research indicates that including depressed patients in decisions about their care results in better outcomes; however, little is known about what treatments depressed stroke patients most prefer, and how this relates to their beliefs about their mood symptoms. Therefore, the aims of the current study were to: 1) Investigate patients' beliefs about their depressive symptoms following a stroke to find out if there are similar patterns in the way they think about them, and 2) to assess stroke patients’ preferences for treatment for their depressive symptoms and to see how this relates to their beliefs about their low mood. Q methodology was used. Twenty stroke patients were recruited who had endorsed depressive symptoms on standardized measures of mood. Patients sorted a wide range of statements about low mood associated with stroke and revealed four distinctive viewpoints: 1) depression due to external, physical factors, an emphasis on physical symptoms and social consequences; 2) highly determined with less worry, the importance of positive social support, helpful environment and a belief that depression will be over quickly; 3) past depression, internal cause, out of control and lasting a long time; 4) strong need for independence and the meaning of physical aids. Frustration, anger and worry, but not out of control. These distinct viewpoints were also associated with quite distinct preferences for treatment. Clinical implications and future research directions were discussed

Characteristics of 698 patients with dissociative seizures: a UK multicenter study

Objective We aimed to characterize the demographics of adults with dissociative (nonepileptic) seizures, placing emphasis on distribution of age at onset, male:female ratio, levels of deprivation, and dissociative seizure semiology. Methods We collected demographic and clinical data from 698 adults with dissociative seizures recruited to the screening phase of the CODES (Cognitive Behavioural Therapy vs Standardised Medical Care for Adults With Dissociative Non‐Epileptic Seizures) trial from 27 neurology/specialist epilepsy clinics in the UK. We described the cohort in terms of age, age at onset of dissociative seizures, duration of seizure disorder, level of socioeconomic deprivation, and other social and clinical demographic characteristics and their associations. Results In what is, to date, the largest study of adults with dissociative seizures, the overall modal age at dissociative seizure onset was 19 years; median age at onset was 28 years. Although 74% of the sample was female, importantly the male:female ratio varied with age at onset, with 77% of female but only 59% of male participants developing dissociative seizures by the age of 40 years. The frequency of self‐reported previous epilepsy was 27%; nearly half of these epilepsy diagnoses were retrospectively considered erroneous by clinicians. Patients with predominantly hyperkinetic dissociative seizures had a shorter disorder duration prior to diagnosis in this study than patients with hypokinetic seizures (P < .001); dissociative seizure type was not associated with gender. Predominantly hyperkinetic seizures were most commonly seen in patients with symptom onset in their late teens. Thirty percent of the sample reported taking antiepileptic drugs; this was more common in men. More than 50% of the sample lived in areas characterized by the highest levels of deprivation, and more than two‐thirds were unemployed. Significance Females with dissociative seizures were more common at all ages, whereas the proportion of males increased with age at onset. This disorder was associated with socioeconomic deprivation. Those with hypokinetic dissociative seizures may be at risk for delayed diagnosis and treatment