Differences in self-schema content among 16 clinical depressives, 16 nondepressed psychiatric control patients, and 16 normal nondepressives (women between the ages of 18 and 65) were investigated by having subjects make structural (Small letters?), semantic (Means same as a given word?), and self-referent (Describes you?) ratings on depressed-and nondepressed-content personal adjectives. These ratings were then followed immediately by an incidental recall period in which subjects recalled as many of the adjectives as possible. In accord with predictions generated from a self-as-schema model, adjective recall was greater overall for the self-referent rating task, relative to the structural and semantic tasks. Furthermore, consistent with the content-specificity component of this self-schema model, both normal and nondepressed psychiatric controls displayed superior recall only for self-referenced, nondepressed-content adjectives. Also consistent with the content-specificity component of this model, clinical depressives displayed significantly enhanced recall only for depressed-content adjectives rated under the self-referent task. In combination with rating time findings, these results offer empirical support for Beck's proposal that an efficient negative self-schema exists, specific to the disorder of depression.

The present research investigated the extent to which mild depressives and normals differed in their self-referent processing of personal information. In Experiment 1, these subjects made two types of ratings on depressed (e.g., bleak, dismal) and nondepressed (e.g., loyal, organized) content personal adjectives. Half of the adjectives in each content category were rated for a semantic attribute (Does this word have a specific meaning or relate to a specific situation?), whereas half were rated for degree of self-reference (Does this word describe you?). These ratings were followed immediately by an incidental recall task, in which subjects recalled as many of the adjectives as possible. Consistent with predictions generated from a content-specific self-schema model, normals displayed superior recall for self-referenced nondepressed content adjectives, when compared to recall for self-referenced depressed content adjectives and recall for semantic ratings (both depressed and nondepressed content). In contrast, mild depressives exhibited enhanced self-referent recall for both types of content, when compared to their recall for semantic adjectives. This finding suggested that mild depressives utilize a self-schema which incorporates both depressed and nondepressed content. Experiment 2 explored this suggestion further by substituting an other-referent rating task (Does this word describe Pierre Trudeau?) for the semantic judgment used in Experiment 1. Again, consistent with a content-specific self-schema model, normals displayed superior recall only for self-referenced nondepressed adjectives. Mild depressives, however, showed enhanced self-referent recall, relative to other-referent recall, only for depressed content adjectives. For nondepressed content, mild depressives did not distinguish between the self- and other-referent conditions. This finding hinted that the nondepressed component of the mild depressive's self-schema may operate at a somewhat reduced effectiveness, but only when required to differentiate between self and others.

Background: Health related quality of life (HRQOL) is increasingly recognised as an important outcome in epilepsy. However, interpretation of HRQOL data is difficult because there is no agreement on what constitutes a clinically important change in the scores of the various instruments. Objectives: To determine the minimum clinically important change, and small, medium, and large changes, in broadly used epilepsy specific and generic HRQOL instruments. Methods: Patients with difficult to control focal epilepsy (n = 136) completed the QOLIE-89, QOLIE-31, SF-36, and HUI-III questionnaires twice, six months apart. Patient centred estimates of minimum important change, and of small, medium, and large change, were assessed on self administered 15 point global rating scales. Using regression analysis, the change in each HRQOL instrument that corresponded to the various categories of change determined by patients was obtained. The results were validated in a subgroup of patients tested at baseline and at nine months. Results: The minimum important change was 10.1 for QOLIE-89, 11.8 for QOLIE-31, 4.6 for SF-36 MCS, 3.0 for SF-36 physical composite score, and 0.15 for HUI-III. All instruments differentiated between no change and minimum important change with precision, and QOLIE-89 and QOLIE-31 also distinguished accurately between minimum important change and medium or large change. Baseline HRQOL scores and the type of treatment (surgical or medical) had no impact on any of the estimates, and the results were replicated in the validation sample. Conclusions: These estimates of minimum important change, and small, medium, and large changes, in four HRQOL instruments in patients with epilepsy are robust and can distinguish accurately among different levels of change. The estimates allow for categorisation of patients into various levels of change in HRQOL, and will be of use in assessing the effect of interventions in individual patients.

We conducted a prospective study over 24 months to compare health-related quality of life in surgically and medically treated patients with intractable temporal lobe epilepsy. Seizure frequency and health-related quality of life were assessed in 81 patients before and 6, 12, and 24 months after treatment. Using the Epilepsy Surgery Inventory 55 (ESI-55), we compared (1) different seizure outcome groups and (2) temporal lobectomy with continuing medical management. Follow-up was satisfactory in 72 patients (89%), 51 treated with temporal lobectomy and 21 with no surgery. Pretreatment seizures and health-related quality of life were comparable in the two groups. Seizure outcome was significantly better at 6, 12, and 24 months after surgery. At 24 months, seizure-free patients and those with at least a 90% reduction in seizure frequency reported significant improvements in health-related quality of life (on 5 of 10 subscales and overall Epilepsy Surgery Inventory 55 scale). Deterioration in quality of life occurred with less than 90% seizure reduction. Only one Epilepsy Surgery Inventory 55 subscale at 6 months and two subscales at 12 months showed a significant difference. Patients with good seizure outcome experience improved health-related quality of life after treatment. Since temporal lobectomy results in considerably better seizure control than continued medical management, the findings support surgery as the preferred treatment, although changes in health-related quality of life may not be evident until the second postoperative year.

Summary:Purpose: Controversy exists about the relation of societal knowledge and attitudes regarding epilepsy. We conducted a survey to examine knowledge and attitudes, to note gender and occupational influences, and to examine the effect of an informational brochure.Methods: We administered a standardized questionnaire that noted demographics and examined knowledge and attitudes regarding epilepsy and persons with epilepsy, respectively, to a wide variety of Canadian college students. In a separate class we gave every other student a brochure regarding epilepsy and then administered the questionnaire to both the naïve and brochure-exposed students.Results: Knowledge was patchy and weakest for the approximate prevalence of epilepsy in the population, hereditary epilepsy and several other etiologies, recognition of nonconvulsive seizures as a type of epilepsy, and knowledge of antiepileptic drug-induced teratogenicity. In contrast, attitudes were more uniformly favorable. However, 11 and 14%, respectively, showed negative bias against persons with epilepsy having children and equal opportunity for occupational employment. Women were slightly but significantly more tolerant than men. The brochure-exposed group showed better knowledge but equivalent attitudes compared with the naïve group.Conclusions: Results compare favorably with surveys in other countries. Although knowledge was patchy, it could be easily improved on with an educational brochure. Attitudes were positive but show some discrepancies from knowledge and a gender effect.