Overview: Phobic and agoraphobic symptoms are common in people with epilepsy and result in a poorer quality of life.
Source: Wake Forest University
About 5.1 million people in the US have a history of epilepsy, which causes repeated seizures. According to the Epilepsy Foundation, epilepsy is the fourth most common neurological disorder.
While current research has shown an increase in anxiety and depression in people with epilepsy, little is known about this population and agoraphobia, an anxiety disorder associated with the fear of being in a public place or being in a situation that cause panic or embarrassment.
However, a recent study by Heidi Munger Clary, MD, MPH, an associate professor of neurology at Wake Forest University School of Medicine, shows that phobic and agoraphobic symptoms are common and associated with poor quality of life in people with epilepsy.
The study appears online in Epilepsy Research.
“We know that agoraphobia can lead to delays in patient care due to reluctance to go outside, including appointments with health care providers,” said Munger Clary, the study’s lead researcher. “So this is an area that needs more attention in clinical practice.”
In the study, researchers performed a cross-sectional analysis of baseline clinical data from a neuropsychology registry cohort study. Researchers analyzed a diverse sample of 420 adults ages 18 to 75 with epilepsy who underwent a neuropsychological evaluation at Columbia University Medical Center in New York over a 14-year period.
“More than a third of the participants reported significant phobic/agoraphobic symptoms,” said Munger Clary. “We also found that phobic/agoraphobic symptoms, along with depression symptoms, were independently associated with poor quality of life, but generalized anxiety symptoms were not.”
According to Munger Clary, because phobic/agoraphobic symptoms are not routinely assessed by clinicians, the findings may indicate a need for future studies to develop more comprehensive screeners for psychiatric comorbidities in epilepsy.
“Symptoms of agoraphobia do not completely overlap with generalized anxiety or depression symptoms that are often screened for in routine practice,” said Munger Clary.
“Providers should consider more robust symptom screening methods to identify and better help these patients. This may be important to improve health equity given other important research findings showing that people with less education and non-white race/ethnicity were more likely to have significant phobic/agoraphobic symptoms.”
financing: This work was supported in part by the National Institutes of Health under grants R01 NS035140, KM1 CA156709, UL1 TR001420, and 5KL2TR001421-04.
About this news about epilepsy research and psychology
Writer: Myra Wright
Source: Wake Forest University
Contact: Myra Wright – Wake Forest University
Image: The image is in the public domain
Original research: Open access.
“Afraid to go out: poor quality of life with phobic anxiety in a large cross-sectional adult epilepsy center sample” by Munger Clary et al. Epilepsy Research
Afraid to go out: poor quality of life with phobic anxiety in a large cross-sectional sample of adult epilepsy centers
People with epilepsy (PWE) have unmet care needs, especially in the context of mental health. Although the current literature has identified an increased incidence of anxiety and depression in PWE and their contribution to poor quality of life, little is known about the presence and impact of specific phobia and agoraphobia. Our aim was to assess factors associated with high phobic/agoraphobic symptoms in a large sample of one tertiary epilepsy center, and assess their impact on quality of life.
In a diverse sample of 420 adults with epilepsy, the cross-sectional association of demographic, epilepsy, and cognitive factors with high phobic symptoms was assessed using multiple logistic regression. Symptoms were measured by the self-report subscale validated by the SCL-90R (T-score ≥ 60 is considered group with highly phobic symptoms). Multiple logistic regression modeling was used to assess for independent association of demographic and clinical variables with the presence of strongly phobic symptoms, and multiple linear regression modeling was used to evaluate for independent cross-sectional associations with epilepsy-specific quality of life (QOLIE-89). .
Lower education (adjusted OR 3.38), nonwhite race/ethnicity (adjusted OR 2.34), and generalized anxiety symptoms (adjusted OR 1.91) were independently associated with high phobic/agoraphobic symptoms, all p < 0.005. Phobic/agoraphobic symptoms were independently associated with poor quality of life, as were depression symptoms, older age, and non-white race/ethnicity. Generalized anxiety showed no significant independent association with quality of life in the multivariable model.
In this study sample, phobic/agoraphobic symptoms were independently associated with poor quality of life. Clinicians should consider using more global symptom screening tools, with a particular focus on susceptible populations, as these impactful symptoms may be overlooked using generalized anxiety-focused screening paradigms.