Fear of public places is common in adults with epilepsy

Abstract: Phobic and agoraphobic symptoms are common in patients with epilepsy and result in a worse 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.

Although current research has shown an increase in anxiety and depression among people with epilepsy, little is known about this population and agoraphobia, an anxiety disorder that involves the fear of being in a public place or in a situation that could cause panic or embarrassment.

However, a recent study by Heidi Munger Clary, MD, MPH, 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 out in public, including making appointments with health care providers,” said Munger Clary, the study’s principal investigator. “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 a neuropsychological registry cohort study. Researchers analyzed a diverse sample of 420 adults aged 18 to 75 with epilepsy who underwent neuropsychological evaluation over a 14-year period at Columbia University Medical Center in New York.

“More than one-third of participants reported significant phobic/agoraphobic symptoms,” Munger Clary said. “We also found that phobic/agoraphobic symptoms, along with depressive symptoms, were independently associated with poor quality of life, but generalized anxiety symptoms were not.”

According to Munger Clary, because clinicians do not routinely assess for phobic/agoraphobic symptoms, the results may point to the need for future studies to develop more comprehensive screeners for psychiatric comorbidity in epilepsy.

“The symptoms of agoraphobia do not fully overlap with the symptoms of generalized anxiety or depression that are often screened for in routine practice,” Munger Clary said.

“Caregivers may want to consider more robust symptom screening methods to identify and better help these patients. This may be important for improving health equity, given the study’s other key findings showing that those with less education and those of non-white race/ethnicity had increased odds of 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 epilepsy and psychology research news

Author: Myra Wright
Source: Wake Forest University
Contact: Myra Wright – Wake Forest University
Picture: The image is in the public domain

Original research: Open access.
“Fear of going outside: poor quality of life with phobic anxiety in a large cross-sectional sample of an adult epilepsy center” Munger Clary et al. Epilepsy research

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Abstract

Fear of going outside: poor quality of life with phobic anxiety in a large cross-sectional sample of an adult epilepsy center

Purpose

People with epilepsy (PWE) have unmet health needs, particularly in the context of mental health. Although existing literature has established 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 severe phobic/agoraphobic symptoms in a large, single sample of a tertiary epilepsy center and to assess their impact on quality of life.

Methods

In a diverse sample of 420 adults with epilepsy, multiple logistic regression was used to assess the cross-sectional association of demographic, epileptic, and cognitive factors with pronounced phobic symptoms. Symptoms were measured by the SCL-90R validated self-report subscale (T-score ≥ 60 is considered a group of high phobia symptoms). Multiple logistic regression modeling was used to assess the independent association of demographic and clinical variables with the presence of severe phobic symptoms, and multiple linear regression modeling was used to assess independent cross-sectional associations with epilepsy-specific quality of life (QOLIE-89).

the results

Lower education (adjusted OR 3.38), non-white race/ethnicity (adjusted OR 2.34), and generalized anxiety symptoms (adjusted OR 1.91) were independently associated with severe phobic/agoraphobic symptoms, all p < 0.005 . Phobic/agoraphobic symptoms were independently associated with poor quality of life as were depressive symptoms, older age, and non-white race/ethnicity. Generalized anxiety did not show a significant independent association with quality of life in the multivariable model.

Conclusion

In this study sample, phobic/agoraphobic symptoms were independently associated with poor quality of life. Clinicians should consider using more global symptom screening instruments with particular attention to vulnerable populations, as these influential symptoms may be overlooked using screening paradigms focused on generalized anxiety.