Epilepsy is a highly prevalent neurological disorder affecting people from all walks of life. Psychosocial adjustment and psychological morbidity have been longstanding challenges for people with this clinical diagnosis. However, very little is known about the psychosocial correlates of psychological morbidity, such as anxiety and depression, among people with epilepsy in Hong Kong. Previous clinical studies suggest social cognitive impairment may contribute to the poor psychosocial integration of people with epilepsy. An important aspect of social cognition is the ability to attribute mental states to others so as to understand their behavior, desires, and intentions. This prerequisite for successful social interactions is termed mentalizing. This thesis reports two studies conducted to examine the psychosocial correlates of psychological morbidity among people with epilepsy, and their mentalizing ability with regard to the neuropsychological basis of mentalizing deficits that are specific to this neurological disorder. Study 1 examines the association of psychological morbidity with a broad array of personality traits and social skills in a sample of 54 local Chinese people with epilepsy. Participants completed the Temperament and Character Inventory (TCI), the Social Performance Survey Schedule (SPSS), and the Hospital Anxiety and Depression Scale (HADS) via semi-structured interviews. The findings showed that, independent of demographic and medical variables and perceived illness-related impact, three personality traits (harm avoidance temperament, self-directedness, and cooperation) and two subscales of interpersonal behaviors (both positive and negative social skills) are significant psychosocial predictors of adjustment among Chinese people with epilepsy. Study 2 examines the neuropsychological basis of mentalizing deficits in people with epilepsy. Thirty-nine right-handed local Chinese people with epilepsy and 38 matched healthy controls were recruited for this study. The eyes test and the faux pas test were employed to study the decoding and reasoning stages of mentalizing, respectively. The findings showed that, relative to the healthy controls, the participants with epilepsy were impaired in decoding and reasoning about the affective aspect of social materials; and at the same time, they were impaired in reasoning about the cognitive aspects of others’ mental states—that is, in inferring intentionality. Such a pattern of mentalizing deficits suggests a wider structural abnormality that may be implicated in the brains of people with epilepsy. In conclusion, epilepsy is associated with social cognitive impairment in emotion recognition and intentionality inference, involving both decoding and reasoning about the affective and cognitive aspects of others’ mental state, which may predispose people with epilepsy to maladaptive psychosocial adjustment and functioning. The significance and implications of the results are discussed. / published_or_final_version / Psychology / Doctoral / Doctor of Philosophy

published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

Ph.D. / Epilepsy is a multidimensional disorder that extends beyond the medical implications to impact nearly every aspect of the person's life, as well as the lives of the people in the surrounding environment. Intractable epilepsy has a poor prognosis with possible worsening of seizures and cognitive decline over time. Anterior temporal lobe surgery for epilepsy provides an opportunity for the alleviation of seizures; however there are potential risks, to memory in particular. Research on surgery outcome thus far has evaluated outcome from a linear paradigm and has studied impact of surgery on isolated areas of function, the results derived from this have been largely inconsistent. So far, there has been very little research that focuses on the person as a whole, and as yet there has been no integrated approach to studying surgical outcome. The aim of the current study was therefore to investigate the impact of anterior temporal lobe surgery, specifically the symptomatic and functional surgical outcomes, in an integrated and holistic manner. This was done in accordance with the paradigm of complex systems theory as a critique of the previous literature in this field, and to gain a more holistic understanding of surgical outcome. A combination of methodologies was employed in order to achieve this. The sample consisted of male (n=10) and female (n=24) patients with intractable epilepsy undergoing left-sided (n=13) and right-sided (n=21) temporal lobe surgery at the Milpark Hospital Johannesburg between the ages of 14 and 58 (mean = 39 years), over a period of seven years. A pretest-posttest design was employed to obtain quantitative data (n=34). Post surgical assessments were conducted up to seven years post surgery (mean=3.6 years). Pre and post surgery assessment included neurocognitive functioning, particularly memory and language functions, by means of the Rey Complex Figure Test, Wechsler Memory Scale-Ill, and Controlled Oral Word Association Test; as well as emotional functioning, particularly depression and anxiety, by means of the Beck Depression lnventory-11 and Beck Anxiety lnventory-11. The quantitative data was subjected to statistical analysis of the sample as a whole, as well as gender and side of surgery comparisons, and included tests of normality of distribution of the data; the paired samples t-test; the independent samples t-test; the Wilcoxon Signed Ranks test; the Mann-Whitney U test; and the Wilks' Lambda test. A semi-structured interview was also conducted (n=30) in order to obtain qualitative data on the functional (psychosocial) aspects of outcome. The interview included an assessment of postoperative seizure outcome; changes in daily activity functions; the client's report on positive and negative outcomes of surgery; quality of life changes and satisfaction with surgery. The qualitative data was analysed using the methods of open coding and axial coding. The results for neuropsychological function reflected known lateralization effects with memory showing auditory-verbal memory deficits after left-sided surgery; and visual (figural) memory deficits after right-sided surgery. Gender differences reflected known neuropsychological differences with female superiority in verbal fluency and a male advantage on visual-spatial tasks. Importantly, there was no relationship between neuropsychological deficit and decrements in daily activity functions, emotional functioning or quality of life. This indicates little impact of neuropsychological deficit post surgery and may be an indication of the effectiveness of the preoperative screening procedures. The results for emotional functioning showed a statistically significant improvement in the 'moderate/severe' depression and anxiety groups from pre to post surgery. This indicates a substantial improvement in both depression and anxiety for this severity group. The qualitative results showed that surgery rendered 74% of the sample seizure free, 15% showing worthwhile improvement, and 11% no change or worse seizures. Seizure outcome however did not determine quality of life changes, even those with some improvement or no change still reported an improvement in quality of life post surgically. The functional outcomes showed little postoperative change in daily activity functions (driving, occupational functioning and marital status) but still a reported improvement in quality of life. There were far more reports on perceived positive than negative outcomes. The most positive benefit of surgery, as reported by participants, was that of increased feelings of control, decreased helplessness, and less anxiety and worry of having seizures. The overwhelming majority of participants reported improved quality of life (90%) and satisfaction with surgery (93%).