Social cognitive impairment in people with epilepsy

Abstract

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.