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Randomized Controlled Trial
. 2016 Nov;64(Pt A):152-159.
doi: 10.1016/j.yebeh.2016.08.012. Epub 2016 Oct 12.

Targeted Self-Management of Epilepsy and Mental Illness for individuals with epilepsy and psychiatric comorbidity

Martha Sajatovic  1 , Curtis Tatsuoka  2 , Elisabeth Welter  3 , Adam T Perzynski  4 , Kari Colon-Zimmermann  3 , Jamie R Van Doren  3 , Ashley Bukach  3 , Mary Ellen Lawless  4 , Eleanor R Ryan  5 , Katherine Sturniolo  6 , Samden Lhatoo  2
Affiliations
Randomized Controlled Trial

Targeted Self-Management of Epilepsy and Mental Illness for individuals with epilepsy and psychiatric comorbidity

Martha Sajatovic et al. Epilepsy Behav. 2016 Nov.

Abstract

Objectives: Serious mental illness is disproportionately common in people with epilepsy and contributes to complications and mortality. Few care approaches specifically target individuals who have epilepsy and severe mental illness. We used an iterative process to refine an existing intervention and tested the novel intervention, Targeted Self-Management for Epilepsy and Mental Illness (TIME) in individuals with epilepsy and comorbid mental illness (E-MI).

Methods: The TIME intervention was developed with input from a community advisory board and then tested for feasibility, acceptability, and preliminary efficacy in people with E-MI, using a 16-week prospective, randomized controlled design comparing TIME (N=22) vs. treatment as usual (TAU, N=22). Primary outcome was change in depressive symptoms, assessed by the Montgomery Asberg Depression Rating Scale (MADRS). Secondary assessments included global psychiatric symptom severity, seizure frequency, sleep patterns, quality of life, stigma, social support, and self-efficacy.

Results: There were 44 individuals enrolled, mean age 48.25 (SD=11.82) with 25 (56.8%) African-Americans. The majority (N=31, 70.5%) were unemployed, and most (N=41, 95.5%) had annual income <U.S. $25,000. With respect to study retention, there were 36 individuals (18 in TIME, 18 in TAU) assessed at 12weeks and 35 individuals (19 in TIME, 16 in TAU) assessed at 16weeks. There was a significant effect for MADRS (p=0.036; effect size of 0.70), with lower MADRS at 16weeks in TIME, while TAU MADRS did not change. Differences between most secondary measures were not statistically significant.

Significance: The TIME intervention engages individuals to actively participate in self-management and can reduce depression in E-MI. Given the high morbidity and mortality associated with epilepsy complicated by serious mental illness, additional research is needed to better identify how TIME might be implemented in routine care settings.

Keywords: Bipolar disorder; Comorbidity; Depression; Epilepsy; Mental illness; Schizophrenia; Seizures.

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Figures

Figure 1:
Figure 1:
CONSORT Diagram illustrating TIME and TAU enrollment and participation
Figure 2:
Figure 2:
Change in Montgomery Asberg Depression Rating Scale (MADRS) over time among individuals with epilepsy and comorbid mental illness receiving TIME vs. Treatment as usual (TAU)*
See this image and copyright information in PMC

Comment in

References

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