Article Text

Download PDFPDF
Psychopathology in people with epilepsy and intellectual disability; an investigation of potential explanatory variables
  1. C A Espie1,
  2. J Watkins1,
  3. L Curtice2,
  4. A Espie3,
  5. R Duncan4,
  6. J A Ryan1,
  7. M J Brodie5,
  8. K Mantala1,
  9. M Sterrick6
  1. 1Department of Psychological Medicine, University of Glasgow, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 OXH, UK
  2. 2Nuffield Centre for Community Care Studies, University of Glasgow, UK
  3. 3Community Learning Disability Team, Old Johnstone Clinic, 1 Ludovic Square, Johnstone, UK
  4. 4West of Scotland Regional Epilepsy Service, Southern General Hospital, Glasgow G51 4TF, UK
  5. 5Epilepsy Unit, Department of Medicine and Therapeutics, Western Infirmary, Glasgow, UK
  6. 6Lothian Learning Disabilities Service, Edinburgh, UK
  1. Correspondence to:
 Professor C A Espie, University of Glasgow, Department of Psychological Medicine, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK;


Objectives:There are few studies on epilepsy and psychopathology in people with intellectual disability (mental retardation) despite epilepsy prevalence rates that are thirty times higher than in the general population. The aims of this study, therefore, were to identify reliable, epilepsy-specific predictors of psychiatric and behavioural disorder in these patients, and to investigate reliable predictors of carer stress.

Methods:A database of 685 patients was compiled, from which 250 were randomly selected. Structured interviews were completed on 186 of these 250 patients (74%) (108 men, 78 women; mean age (SD) 35.5 (10.1)) comprising descriptive, clinical and functional components, and validated measures of psychopathology for which comparative data were available. Logistic and linear regression methods were used to identify predictors.

Results:One-third of patients with epilepsy and intellectual disability met criteria for possible psychiatric disorder, particularly affective/neurotic disorder; twice the comparison rates for intellectual disability alone. Behavioural problem levels, however, were lower than population norms. Regression models explaining modest amounts of variance (R2⩽24%) suggested certain seizure phenomena (greater seizure severity, more seizures in past month, lesser tendency to loss of consciousness during seizures) as particular risk factors for psychiatric disorder. General disability factors such as level of intellectual, sensory or motor disability and side effects of medication, however, contributed more to explaining behavioural problems. Around half of the family carers reported significant stress, and one-third exhibited clinically significant anxiety symptoms. Younger carers were more stressed, and side effects from patients’ medication also contributed to carer stress.

Conclusions:Although epilepsy in itself may be a risk factor for psychopathology in a minority of people with intellectual disability, some epilepsy-specific factors may predict psychiatric disorder. Behavioural problems need to be considered separately from psychiatric disorder because general factors, more closely associated with disability, are stronger predictors of their occurrence.

  • seizures
  • mental retardation
  • psychiatric disorder
  • ABC, Aberrant Behaviour Checklist
  • AED, anti-epileptic drug
  • CSI, Caregiver Strain Index
  • ELDQOL, Epilepsy and Learning Disabilities Quality of Life scale
  • HADS, Hospital Anxiety and Depression Scale
  • PAS-ADD, Psychiatric Assessment Schedule for Adults with Developmental Disabilities
  • V-ABS, Vineland Adaptive Behaviour Scales

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interest: This study was supported by grant K/RED/4/C357 from the Chief Scientist Office, Scottish Executive Health Department

Linked Articles