Summary: Phobic and agoraphobic symptoms are common in people with epilepsy and result in poor quality of life.
Source: Wake Forest University
About 5.1 million people in the United States have a history of epilepsy, which causes recurrent seizures. According to the Epilepsy Foundation, epilepsy is the fourth most common neurological disorder.
While current research shows increased anxiety and depression in people with epilepsy, little is known about crowds and agoraphobia, an anxiety disorder that can cause fear of being in public or panic or embarrassment.
However, recent research from Heidi Munger Clary, associate professor of neurology at Wake Forest University School of Medicine, shows that phobia and agoraphobic symptoms are common in people with epilepsy and are associated with a poorer quality of life.
The study is available online Epilepsy research.
“We know that agoraphobia can lead to delays in patient care due to reluctance to go out in public,” said Munger Clary, the study’s lead researcher. “So this is an area that needs more attention in clinical practice.”
In the study, researchers conducted a cross-sectional analysis of baseline clinical data from the Neuropsychology Registry Collection Study. Researchers analyzed a diverse sample of 420 adults with epilepsy, ages 18 to 75, who underwent neuropsychological evaluations over a 14-year period at Columbia University Medical Center in New York.
“More than one-third of the participants reported significant phobic/agoraphobic symptoms,” Munger-Clary said. “We also found that phobic/agoraphobic symptoms were independently associated with poorer quality of life along with depressive symptoms, but overall anxiety symptoms were not.”
According to Munger-Clary, because phobia/agoraphobic symptoms are not routinely assessed by clinicians, the findings suggest a need for future studies to develop more comprehensive screening criteria for epilepsy-related psychiatric disorders.
“Symptoms of agoraphobia don’t go hand in hand with symptoms of general anxiety or depression,” Munger-Clary said.
“Providers may want to consider more robust symptom screening methods to identify and better assist these patients. Given other key study findings showing that people with low education and non-white race/ethnicity are more likely to have severe phobia/agoraphobic symptoms, this may be important to improve health equity.”
Financial support This work was supported in part by grants R01 NS035140, KM1 CA156709, UL1 TR001420 and 5KL2TR001421-04 from the National Institutes of Health.
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Author: Mira Wright
Source: Wake Forest University
Contact: Mira Wright – Wake Forest University
Image: The image is in the public domain.
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Preliminary study: Open Access.
“Fear of going out: Poor quality of life with phobia anxiety in a large cross-sectional adult epilepsy center sample.” by Munger Clary et al Epilepsy research
Draft
Fear of going out: Poor quality of life with phobia anxiety in a large cross-sectional adult epilepsy center sample.
Purpose
People with epilepsy (PWE) have unmet health care needs, particularly in terms of mental health. Although the current literature supports increased anxiety and depression in PWE and their contribution to poor quality of life, little is known about the presence and impact of specific phobias and agoraphobia. Our aim was to evaluate factors associated with high phobia/agoraphobic symptoms in a large, single epilepsy center sample and to assess their impact on quality of life.
Methods
In a heterogeneous sample of 420 adults with epilepsy, demographic, epileptic, and cognitive factors associated with higher phobic symptoms were assessed using multiple logistic regression. Symptoms were measured with the SCL-90R validated self-report subscale (T-score ≥ 60 considered high phobic symptom group). Multiple logistic regression modeling was used to assess the association between demographic and clinical variables with higher phobic symptoms, and multiple linear regression modeling was used to assess independent class-by-class associations with epilepsy-specific quality of life (QOLIE-89). .
Results
Low education (adjusted OR 3.38), nonwhite race/ethnicity (adjusted OR 2.34), and general anxiety symptoms (adjusted OR 1.91) were independently associated with higher phobia/agoraphobic symptoms, all p < 0.005. Phobic/agoraphobic symptoms were independently associated with poorer quality of life, as were depressive symptoms, older age, and nonwhite race/ethnicity. Generalized stress did not show a significant independent relationship with quality of life in the multivariate model.
Conclusion
In this study sample, phobic/agoraphobic symptoms were independently associated with poorer quality of life. Clinicians should consider using more global symptom screening tools because these influencing symptoms may be missed using general-anxiety-focused screening paradigms.