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Title: The relationship between subjective and objective cognitive functioning in epilepsy and the role of psychological distress
Author: Mottahedin-Fardo, L.
ISNI:       0000 0004 7428 4210
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2017
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Epilepsy is the fourth most common neurological condition globally (World Health Organisation, 2006) affecting approximately 1 in 103 people (Joint Epilepsy Council, 2005). It is a diverse term, encompassing over forty types of epilepsies, many types of seizure and varies significantly as to its cause and responsiveness to treatment (Berg et al., 2010). Typically, it is a chronic condition characterised by repeated seizures, which can be focal, affecting a specific part of the brain such as the frontal lobes, or general, in which most or all of the brain is affected. Although the cause of epilepsy is neurological, understanding further the psychological, behavioural and social effects of epilepsy is an important area of research, due to the significant impact these can have upon the lives of people with epilepsy (PWE) (Suurmeijer, Reuvekamp, Aldenkamp, 2001). Many PWE demonstrate cognitive difficulties in areas such as executive functioning, attention, learning and memory (van Rijckevorsel, 2006). The high prevalence of cognitive difficulties in this population and frequent reporting of cognitive deficits from PWE suggest that this area warrants further investigation (Loring & Meador, 2012). There has been increased debate about a potential discrepancy between the cognitive abilities some PWE perceive themselves to have and their cognitive ability when assessed using neuropsychological tests (Banos et al., 2004). It is purported that psychological distress may have some role to play in this discrepancy (Liik, Vahter, Gross-Paju & Haldre, 2009). Depression and anxiety, which are experienced more frequently by people with epilepsy (Sherman, 2009), have been associated with susceptibility to higher levels of perseverative thinking (a type of repetitive negative thinking often seen transdiagnostically in anxiety and depression) (Ehring & Watkins, 2009), and reduced attentional control (the ability to direct concentration and focus, often impaired in PWE) (Derryberry & Reed, 2002). This thesis seeks to establish the extent of the relationship between subjective and objective measures of cognitive functioning in PWE and the potential role of anxiety and depression. It then examines the role of attentional control and repetitive negative thinking; psychological mechanisms potentially affecting the relationship between objective and subjective measures of cognitive functioning. Chapter 1 of this thesis systematically reviews the literature to determine the relationship between PWE's self-reports of their cognitive abilities and the results of attention and executive functioning assessments, deemed 'objective' measures. It also seeks to describe the extent to which psychological distress is associated with either of these variables. The systematic review demonstrates that most studies found no significant relationship between objective and subjective measures. It was not possible to draw conclusions regarding whether PWE tended to over- or under-estimate their abilities from the results of the studies. What was apparent, however, was that psychological distress was consistently associated with participants' self-reported cognitive abilities. Chapter 2 presents a cross-sectional study with PWE that draws upon the findings and implications of the review and develops them. This empirical study finds a correlation between objective and self-reported cognitive functioning in participants with a diagnosis of epilepsy, which would not have been expected from the systematic review. When examining this further, psychological distress and repetitive negative thinking are both found to be statistically significant moderators of the relationship between objective and self-reported cognitive functioning. Attentional control, although correlated with psychological distress, does not moderate the relationship between objective and subjective measures of cognitive functioning.
Supervisor: Noble, A. ; O'Carroll, P. ; Moore, P. Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral