Epilepsy has been known since antiquity -...

METHODOLOGY

The present study was basically oriented to investigate the

psychopathology, cognitive functions and coping processes among the

patients of epilepsy. To realize the main objective, the selected patients of

epilepsy and their counterpart normals were tested with psychological tests

such as Personality Assessment Inventory (PAI), PGI Memory Scale

(PGIMS), Nahor-Benson Test (NBT), and Ways of Coping Questionnaire.

PAI was used to tap four types of variables viz. validity of responses,

presence of comorbid psychopathological symptoms, treatment

consideration, and interpersonal behavior. PGIMS, and NBT were used to

assess cognitive functions. Ways of Coping Questionnaire was used to

assess the coping processes (problem-focused and emotion-focused).

Sample

The sample used in the present study consisted of two groups of

subjects i.e. epilepsy patients (N=200) and normal subjects (N=200). Sample

of epilepsy patients was drawn from the patients who were attending to the

OPDs of psychiatry department at Lady Harding Medical College and

Hospital Delhi, Ram Manohar Lohiya Hospital, Delhi, Lok Nayak Jai

Prakash Civil Hospital, Kurukshetra, and Aggarwal Nursing Home,

Kurukshetra. For the identification of patients, the consulting psychiatrists

and physicians in respective OPDs were initially apprised of the present

research project and then were requested to cooperate and collaborate.

Consequently, the consulting doctors referred the diagnosed patients to the

investigator for the psychological testing with measures used in the present

study. The inclusion criteria for the patients were that they had all received

their diagnosis from the consulting doctors and had continuous contact with

them in follow up visits, older than 18 years, and education (minimum of

primary school completion). The diagnosis of epilepsy was based on the

clinical presentation of the symptoms and EEG testing according to ILAE,

1990. The epilepsy patients ranged in age from 18 to 40 years with mean age

of 30 years. The duration of illness in the included patients ranged from 1 to

Psychopathology, Cognitive Functions, and Coping among Epileptic Patients

131

28 years with the mean duration of 14 years. Only those patients were

included in the sample who volunteered to participate and being referred to

by the consulting doctors. The exclusion criteria were progressive

neurological disorders, head injury, mental retardation, severe psychiatric

problems, and ongoing use of any centrally acting medication or other

severe medical disorders. The clinical sample consisted of hundred male and

hundred female patients. Though epilepsy is classified in various types, yet

the present study is not confined to a particular type of epilepsy rather

included the epilepsy of any type in the sample with a view to explore the

common psychopathology, cognitive functions, and coping among patients

of epilepsy. Most of the patients were on pharmaceutical treatment married

and living in home setting with their family members i.e. spouse, sons,

daughters, and parents.

A normal group consisting of 200 subjects (100 males and 100

females) matched for age and education was drawn from the general

population residing in the areas to which the patients belonged. The normal

subjects included in the sample were also free from any psychopathological,

medical problems (ascertained on the basis of medical and psychiatric /

clinical history), and with no family history of seizures, of medication for

illness, which can confound the results.

Tests/Measures

Testing was done in a sound-attenuated, temperature-controlled room

by the investigator herself. The selection of tests was based on personal

experience and review of literature mainly suitable to epilepsy patients. If a

seizure occurred during a neuropsychological examination, testing was

suspended and the obtained data were excluded from subsequent analysis.

Following tests were used to collect the data.

(1) Personality Assessment Inventory-PAI (Leslic C. Morey, 1991)

(2) PGI-Memory Scale- PGIMS (Pershad and Verma, 1990)

(3) Nahor-Benson Test – NBT (Nahor and Benson, 1970) and

(4) Ways of Coping Questionnaire (Folkman and Lazarus, 1988)

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132

Brief description of tests is as follows:

(1) Personality Assessment Inventory (PAI)

The Personality Assessment Inventory (PAI) developed by Morey

(1991) is a self-administered objective inventory of adult personality

designed to provide information on critical clinical variables. The

Personality Assessment Inventory contains 344 items which comprise 22

non-overlapping full scales: 4 Validity Scales, 11 Clinical Scales, 5

Treatment Scales, and 2 Interpersonal Scales. Ten of the full scales contain

conceptually derived subscales designed to facilitate interpretation and

coverage of the full breadth of complex clinical constructs.

The PAI can be administered in either individual or group testing

situations. In both the situations, the testing environment should protect the

confidentiality of the respondent‟s item responses.

Respondents are to first provide demographic information on the

answer sheet and then directions are made clear to them. The importance of

answering all items should be emphasized, as well as necessity for choosing

only one response per item. Completion of the PAI takes 40-50 minutes for

most individuals. Simple definitions of words can be provided in the case

when the respondent does not understand an item. In case the respondent is

unsure about the option to mark, he is told to mark the item, which is

closest.

Scoring and Profiling

Before scoring and profiling answer sheet examined and number of

unanswered items are counted. If 18 or more items are left unanswered the

respondent is asked to review and complete the unanswered items. The items

are scored from 0 to 3 for all the 344 items. Item scores for each scale or

subscale should be calculated. Unanswered items should be marked as zero;

any scales or subscales for which 20% or more of the items have been left

unanswered should not be interpreted. Obtained raw scores are converted in

T scores that have a mean score of 50T and standard deviation of 10T.


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PAI Scales and Sub Scales

Validity Scales: Four validity scales assess the factors that could

distort the results of testing. An elevated score on any of these scales

suggest that interpretation should be made cautiously. In general, if a

respondent obtains a score that is more than two standard deviations above

the mean of the clinical sample, the profile is considered seriously distorted

and should be considered invalid.

(1) Inconsistency (ICN): The scale is comprised of 10 pairs of items; each

item pair has related content. The distribution of scores on the ICN

scale is fairly similar for both normal and clinical subjects, although

clinical subjects tend to score slightly higher (i.e. respond slightly

inconsistently) than normals. It is used to determine if the respondent is

answering consistently throughout the inventory.

(2) Infrequency (INF): The INF scale is useful in the identification of

individuals who complete the PAI in an atypical way because of random

responding, indifference, carelessness, confusion or reading difficulties.

It includes eight items that were designed to be answered similarly by

all the respondents regardless of clinical status.

(3) Negative Impression (NIM): The NIM scale contains items which

present an exaggerated unfavourable impression or represent extremely

bizarre and unlikely symptoms.

(4) Positive Impression (PIM): The contents of PIM scale items involve the

presentation of a very favourable impression or denial of relatively

minor faults.

Clinical Scales:

The clinical scales assess the clinical syndromes, the items for which

were selected on the basis of two criteria: (a) history of importance within

the nosology of mental disorders, and (b) their significance in contemporary

diagnostic practice. These scales identify the components central to the

definition of each disorder in question. Thus, the items on a clinical scale

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directly reflect the phenomenology and symptomatology of that clinical

construct. Elevated score implies that the respondent is reporting the

experience of these symptoms at a frequency and/or intensity beyond that of

most people.these eleven clinical scales can be devided into three broad

classes of disorders (a) neurotic spectrum disorders (SOM, ANX, ARD, and

DEP); (b) psychotic spectrum disorders (MAN, PAR, SCZ); and (c)

behavior or impulse control disorders (BOR, ANT, ALC, and DRG).

(1) Somatic Complaints (SOM): The SOM scale includes items that reflect

concerns about physical functioning and health matters. The item

content ranges across various somatoform presentations, extending

from repeated problems with relatively minor physical ailments (such

as paralysis). The scale is comprised of three subscales: Conversion

(SOM-C), Somatization (SOM-S), and Health Concerns (SOM-H).

(2) Anxiety (ANX): The ANX scale includes various features of anxiety

including ruminative worry, subjective feelings of apprehension and

strain, and physical signs of tension and stress. The scale is comprised

of three subscales: Cognitive (ANX-C), Affective (ANX-A), and

Physiological (ANX-P). Scores on the ARD scale may indicate more

specific forms of pathology

(3) Anxiety Related Disorders (ARD): The ARD scale measures clinical

features of three different areas of sympatomatology related to anxiety

disorders. The item content includes specific fears related to objects or

situations, encompassing phobias, obsessive-compulsive thoughts and

behaviours, and troublesome experiences related to traumatic event.

These symptoms are thus arranged into three subscales: Obsessive

Compulsive (ARD-O), Phobias (ARD-P), and Traumatic Stress (ARD-

T).

(4) Depression (DEP): The DEP scale measures clinical features common

to the syndrome of depression. The item content ranges across various

features of this syndrome, including pessimism and negative

expectations, subjective feelings of unhappiness and apathy, and


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physical signs such as low energy and changes in sleep and appetite.

The scale is comprised of three subscales reflecting three major

constellations of depressive symptomatology: Cognitive (DEP-C),

Affective (DEP-A), and Physiological (DEP-P). Particular attention

should be given to Suicidal Ideation (SUI) scale elevations when DEP

scale is markedly elevated.

(5) Mania (MAN): The MAN scale measures elements of the clinical

presentation of mania and hypomania. The item content ranges across

various features of these syndromes, including elevated mood,

expansiveness and grandiosity, heightened activity levels, irritability

and impatience. The scale is comprised of three subscales reflecting

three major aspects of mania: Activity Level (MAN-A), Grandiosity

(MAN-G), and Irritability (MAN-I).

(6) Paranoia (PAR): The PAR scale measures the characteristic

phenomenology of the paranoid individual, with respect to both

symptomatology and personality elements. The scale is comprised of

three subscales reflecting three elements of a paranoid stance:

Hypervigilance (PAR-H), Persecution (PAR-P), and Resentment (PAR-

R).

(7) Schizophernia (SCZ): The SCZ scale was designed to measure a

number of the different facets of schizophrenia, the item content

includes unusual beliefs and perceptions; poor social competence and

social anhedonia; and inefficiency and disturbances in attention,

concentration, and associational processes. Each of these elements is

assessed by one of the three subscales that comprise SCZ: Psychotic

Experience (SCZ-P), Social Detachment (SCZ-S), and Thought

Disorder (SCZ-T).

(8) Borderline Features (BOR): The BOR scale includes indicators of poor

control over emotions and anger, intense and often combative

interpersonal relationships, confusion around issues of identity and self

worth and impulsivity that often results in self-destructive behaviours.

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The scale is comprised of 4 subscales tapping the different elements of

the syndrome: Affective Instability (BOR-A), Identity Problems (BOR-

I), Negative Relationships (BOR-N), and Self Harm (BOR-S).

(9) Antisocial Features (ANT): The ANT scale provides an assessment of

personality and behavioural features relevant to the constructs of

antisocial personality and psychopathy. The item content ranges from

indicators of egocentricity, adventursomeness and poor empathy to

items addressing antisocial attitudes and behaviours. The scale is

comprised of three subscales tapping different facets of the syndrome:

Antisocial Behaviours (ANT-A), Egocentricity (ANT-E), and Stimulus

Seeking (ANT-S).

(10) Alcohol Problems (ALC): The ALC provides an assessment of

behaviours and consequences related to alcohol use, abuse, and

dependence. In general, however, a direct inquiry about alcohol use

will usually provide more accurate data than making inferences from

indirect sources.

(11) Drug Problems (DRG): The DRG scale provides an assessment of

behaviours and consequences related to drug use, abuse, and

dependence. The item content ranges from statements of total

abstinence through frequent use to severe consequences of drug use.

Treatment Consideration Scales:

These scales tend to provide indicators of potential complications in

treatment that would not necessarily be apparent from diagnostic

information. There are five such scales: two indicators of potential for harm

to self or others (AGG and SUI), two measures of the subject‟s

environmental circumstances (STR and NON), and one indicator of subject‟s

motivation for treatment (RXR).

(1) Aggression (AGG): The AGG scale provides an assessment of attitudinal

and behavioral features relevant to aggression, anger, and hostility. The

item content ranges from indicators of verbal assertiveness and poor


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anger control to violent and assaultive behaviours. The scale is

comprised of three subscales tapping different facets of aggression:

Aggressive Attitude (AGG-A), Verbal Aggression (AGG-V), and

Physical Aggression (AGG-P).

(2) Suicidal Ideation (SUI): The SUI scale provides an assessment of

thoughts and ideas related to death and suicide. The item content ranges

from hopelessness, through general and vague thoughts of dying and

suicide, to thoughts representing concrete plans for the suicidal act.

However, a direct inquiry of the type provided by the SUI items are

often effective in uncovering intentions for self-harms.

(3) Stress (STR): the STR scale measures the impact of current or recent

stresses in areas of family, health, employment, finances and other

major life areas.

(4) Non-support (NON): The NON scale provides a measure of perceived

lack of social support, tapping both the availability and quality of the

respondent‟s social relationships. The scaling of NON is such that low

scores reflect high-perceived social support, while elevations indicate a

perception of the social environment as unsupportive.

(5) Treatment Rejection (RXR): The RXR scale provides a measure of

attitudes associated with an interest in personal changes of a

psychological or emotional nature. Items tap the relative‟s willingness

to participate actively in treatment, acknowledgement of personal

problems, and the disposition to accept responsibility for problems

one‟s life.

Interpersonal Scales:

These scales provide an assessment of interpersonal style of subjects

along two dimensions: (a) a warmly affiliative vs cold rejecting axes; and

(b) dominating controlling vs a weakly submissive style. These axes provide

a useful way of conceptualizing many different mental disorders, and

persons at the extreme of these may present with variety of mental disorders.

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(1) Dominance (DOM): The DOM scale provides a measure of the extent to

which a person is controlling, submissive, or autonomous in

interpersonal relationships. Item content involves being independent

from others, outspoken and assertive, and directive and managerial in

relationships. The scale is bipolar i.e both high and low scores have

interpretive significance.

(2) Warmth (WRM): The WRM scale provides a measure of the extent to

which a person is empathic, engaging, or rejecting and mistrustful in

interpersonal relationships. Item content involves being sociable,

sympathetic, affectionate and patient with others. The scale is bipolar,

both high and low scores have interpretive significance.

Reliability:

The reliability of a test refers to the consistency of the measurement

provided by the test. The reliability of the PAI has been examined interms of

both internal consistency and test retest stability. The internal consistency

alphas for the PAI full scales on census ranges from .445 to .81; on college

sample ranges from .26 to .82; and on clinical sample from .23 to .86. The

mean inter-item correlations of PAI full scales on different samples i.e.

general population, college students and clinical groups. The correlation

coefficients for general population ranges from .08 to .22, for college

students from .04 to .21 and for clinical group .03 to .29. Inter item

consistency for census ranges from .51 to .81; for college students from .57

to .85 and for clinical group from .55 to .88. The test -retest reliability has

been established in terms of temporal stability on different occasions on two

samples of normal subjects. The first sample consisted of 75 community

dwelling adults on two occasions with 24 days gap. The second sample

consisted of 80 college students tested on two occasions with the gap of 28

days. The test-retest reliability correlations of the 22 full scales of PAI range

in community sample from .29 to .94; in college sample from .32 to .90; and

in combined sample from .31 to .92.

Validity:

The validation of measures of clinical constructs is a process that


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requires the accumulation of data concerning convergent and discriminant

validity correlates. For validation of various clinical scales of PAI were

categorized in six groups: (a) validity scales, (b) clinical scales relevant to

neurotic disorders, (c) clinical scales relevant to psychotic disorders, (d)

clinical scales related to behaviour disorders, (e) treatment consideration

scales, and (f) interpersonal scales. The external correlates wi thin these six

subgroups have been examined to determine the convergent and discriminant

validity.

Several different instruments were used in the examination of

external correlates of different PAI scales. Some of these instruments were

used for a specific purpose. The PAI scale includes the domain and facet

scales of the NEO Personality Inventory (NEO-PI; Costa and McCrae,

1985), the MMPI clinical scales (Hathaway and McKinley, 1967), content

scales (Wiggins, 1966), and personality disorder scales (Morey, Waugh and

Blashfield, 1985), and the eight octant scores of the Interpersonal Adjective

Scale-Revised (IAS-R; Wiggins, Trapnell and Phillips, 1988). Each of these

instruments is widely used in personality and psychopathology research and

can serve as useful referents for the validation and interpretation of the PAI.

The NEO-PI provides an assessment of the “Big Five” dimensions of

personality that emerge from a number of different factor analytic studies of

normal personality. The MMPI is a popular clinical and research tool for the

assessment of mental disorder; containing three validity scales and ten

clinical scales. MMPI can also be used to score the 13 Wiggins content

scales (Wiggins, 1966) and 11 MMPI personality disorder scales (Morey,

Waugh and Blashfield, 1985). These scales have the advantage of superior

internal consistency and greater relevancy to contemporary diagnostic

practice as compared to the traditional MMPI scales.

PAI Short Form

The PAI short form may be used in that rare instances in which the

need for an abbreviate version of the PAI may arise. In general, there should

be little need for such an application: most subjects can typically finish the

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test in 40-50 minutes and even severely disturbed patients can complete the

full inventory with little difficulty. The use of short forms is usually not

encouraged as these are invariably less reliable than full versions of the

same scales. However, in certain instances there is a need for information on

abbreviated versions. For example, an uncooperative patient may refuse to

finish the PAI after completing the first half of items, or such a patient may

completer the latter half of items randomly. In some research or screening

applications, or perhaps with some patients, certain constraints may limit the

feasibility of administering the complete inventory. In any of these instances

the ability to portrait full PAI scores from available information would be

useful. The PAI was designed to maximize the utility of information

gathered in the first part of the test. The ordering of PAI items allows a

sampling of item content on nearly all scales and subscales within the first

160 items. The items with the greatest item scale correlations for each scale

or subscale are presented first; this ordering yields information that is

maximally discriminating even though relatively few items are completed.

This procedure also yields a short form that has optimal stability and

internal consistency characteristics.

The PAI short form thus consists of the first 160 items. From these

items, estimate of scores for 20 and 22 full scales can be obtained. Scores

for the ICN and STR full scales cannot be obtained from the short form, and

none of the PAI subsequently can be scored. T scores for the short form are

referenced against means and standard deviations from the census matched

sample for the first 160 items, this short-form standardization approach is

generally superior to peroration formulas or regression estimates (Telligan

and Birggs, 1967). The short form should not be used if more than 8 of the

first 160 items were unanswered. The median internal consistency

(coefficient alpha) for the 20 scorable scales is .76, whereas the median

tests-retest reliability is .91. Further supporting the conclusion that the short

form scores privies a reliable score that is reasonable approximation of what


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would be obtained from an administration of the full instrument.

Therefore, the first 160 items of the PAI can be used to provide a

reasonable estimate of a subject‟s performance on 20 of the 22 full scales of

the PAI.

(2) PGI Memory Scale

The PGI-memory scale is one of the tests of PGI Battery of Brain

Dysfunction (PGI-BBD) developed by Pershad and Verma (1990) combining

the two approaches of neuropsychological assessment (a) multifactorial; and

(b) unitary. The multifactorial approach is based on the neurological facts

that brain has differential functions and different structures of brain are

responsible for different functions where as the unitary approach is based on

the notion of functional unitary of the brain. Different parts of the brain

have adaptability, equipotentiality, compensatory functions, and are

governed by the mass action rather than localization. Multifactorial

assessment is based on the assumption of functional autonomy of structures

(localization) and carried out by comprehensive batteries such as Halstead -

Reitan Neuropsychological Battery, Luria-Nebraska Neuropsychological

Battery. On the other hand, unitary assessment of brain pathology is based

on the assumption of functional unity of the brain as a whole (mass action

and equipotentiality) and is done by psychological tests of unitary functions

such as tests of intelligence, memory, perceptual-moter functions etc.

Review related to both approaches indicates that none of these two is

satisfactory and both are having limitations but both are useful. So, in view

of the prevailing philosophy that none of the two methods/approachs of

assessment of brain dysfunctions is completely satisfactory, the present

battery was developed to provide a psychometric profile which can

differentiate patients of organic brain dysfunction from those having no

organic pathology, to validate the psychometric profile and assess its

sensitivity and utility. Hence, based on the research and clinical experience,

PGI-Battery of Brain Dysfunctions (PGI-BBD) included the tests such as

PGI Memory Scale (PGIMS), Performance Tests of Intelligence, Verbal

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Adult Intelligence Scale, Nahor-Benson Test, and Bender Visual-Motor

Gestalt Test to collaborate both the multifactorial assessment and unitary

approaches of neuron-psychologial assessment.

PGI-Memory Scale initially developed by Prashad (1977; Pershad &

Wig, 1988) was included in PGI Battery of Brain Dysfunction (Pershad and

Verma, 1990). It is based on the conceptualization of memory as the ability

to retain and reproduce impressions once learned intentionally. It includes

both the verbal and non-verbal measures to index memories on the basis of

experimental evidence; and remote, recent and immediate memories on the

basis of clinical evidences. It includes ten subtests standardized on adult

subjects in the age range of 20-45 years. Its test-retest reliability over the

period of one week ranges from .69 to .85 for ten subtests and .90 for the

total test (test-retest and split-half).

For the validity, correlations with Boston Memory Scale and

Wechsler Memory Scale were found to be .71 and .85 respectively. Agewise

elderly subjects obtained significantly lower scores than the younger

subjects. Cases suffering from organic brain pathology and functional

psychoses score significantly less than normals and neurotics. It has high

correlation with education and low with IQ. It has satisfactory cross -validty

and provides quartile norms and a profile. Scores of subjects suffering from

organic pathology, functional psychoses and neuroses fall in the lowest 2nd

and middle quartiles respectively. Separate norms are available for three

educational levels i.e 0 to 5th

, 6th

to 9th

, and above 10th

years of schooling

(Pershad & Wig, 1988).

The test has been widely used in the assessment of cognitive

functions in drug abusers, yoga practitioners, depressives, psychotics,

neurotics, and suffering from brain dysfunctions. It is equally valid for both

sexes‟ literate and illiterate subjects. Thus, it is adaptable to both research

and clinical settings.

The test material contains items for 10 subtests i.e Remote Memory,

Recent Memory, Mental Balance, Attention-Concentration, Delayed Recall,


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Immediate Recall, Verbal Retention for Similar Pairs, Verbal Retention for

Dissimilar Pairs, Visual Retention and Recognition. The ten subtests are as

under-

Remote Memory- There are six items in this subtest and each correct

answer is to be scored one. Thus maximum score would be six. Out of the

items at 3a, 3b, and 3c, only one item is to be enquired. Reliability of the

answer is checked from the attendant. Any discrepancy in the answer may be

settled or marked wrong.

Recent Memory- It consists of five items. Answer can be verified

from the attendant. Any discrepancy in the answer may be settled or marked

wrong. Each correct answer is to be scored one. Thus maximum score would

be five.

Mental Balance- It consists of three items. First item is alphabet that

are scored 3 if all correct within 15 seconds, scored 2 if all correct beyond

15 seconds, scored 1 irrespective of time required with one error/omission

and scored 0 if more than one error/omission. Second item is counting

backward (20-1) and the scoring will be the same as in i tem 1. Third item is

counting backward by 3‟s subtraction. The score is 3 if all correct within 30

seconds, scored 2 if all correct beyond 30 seconds, scored 1 irrespective of

time required with one error/omission and scored 0 if more than one

error/omission. Thus maximum score would be nine.

Attention Concentration- It consists of digits which are to be read

by the tester and immediately subject need to repeat it either in same order

or reverse order as he/she is instructed. Digits need to be read out at one

digit per second. The number of digits is counted separately for both digit

backward and digit forward. For DF number of digits in longest series and

for DB digits in longest series of any of the two sets correctly reproduced in

reverse order, is scored. The maximum score for DF and DB would be

8+8=16.

Delayed Recall- There is lists of five names each of common objects.

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The name of the common objects is read from the list 1 and then asked the

subject to recall the name of common objects after expiry of one minute post

presentation period. In the same manner the second list is also administered.

Each ticked word is counted in two lists and one point for each score. The

maximum score would be 5+5=10.

Immediate Recall- There are three sentence of increasing leanth, first

sentence has three clauses, second has four clauses and thired has 5 clauses.

Immediately after presentation, subject is said to recall. Each correctly

recalled clause is scored one and the maximum score would be 3+4+5=12.

Verbal Retention for Similar Pairs- In this sub test there are five

noun-noun pairs. Second noun is to be asked after reading first noun to the

subject. One mark for each correction of the associated word of the pair is to

be given. The total maximum score on this subtest is 5.

Verbal Retention for Dissimilar Pairs- In this subtest there are five

noun-objective pairs are given and three trials are given. In each trial

stimulus is presented in random order as written against each pair. One mark

for each correct reproduction and the maximum score on this sub test is

5+5+5=15

Visual Retention- In this subtest there are five cards and each cards

is presented for 15 seconds. After 30 second subject is asked to draw the

same design from his/her memory. Each figures correctly reproduced from

card 1 to 3 are scored 2each and card 4 is scored 3 and card 5 is scored 4.

Recognition- In this subtest there are two cards of similar size. One

for having pictures of 10 common objects and second having pictures of 20

common objects for recognition. Each object correctly identified and named

is given a score of one. An object correctly identified but either not named

or wrongly named or showing inability to name is to be given a score of ½.

To minimize the effect of guessing numbers of wrongly identified objects

are to be counted and deducted from the number of correctly identified

objects. Range of score in this subtest will be 0 to 10.


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(3) Nahor-Benson Test

Nahor-Benson (1970) developed a quick and simple screening test for

organic brain pathology. It consists of 8 cards, of which 5 cards contain a

design each and three cards contain the instruction to be followed. Five

designs are based on developmental pattern. One learns to draw simple

drawing early in life and then drawing with depth perception. Cards IV and

V represent coping designs with depth perception. It is assumed that

whenever organic brain dysfunction occurs, it will show regression in ability

and behavior following Ribots law i.e. the things learned later in life will

start diminishing earlier.

In general, drawing tests measure functioning of the right hemisphere

that is too related with parieto-occipital lobe. Parietal lobe function includes

spatial relationship and occipital includes visual perceptual acuity.

Therefore disturbed performance on designs I-V will represent the extent of

lesion in the right parieto occipital region. The performance on last three

cards (VI to VII) will represent the function of left hemisphere and

transference from left to right hemisphere. Thus, the test provides

simultaneous assessment of both the hemispheric functioning.

Prashad and Verma (1978) have studied the screening capacity and

clinical utility of the test and found that cases who were diagnosed having

brain dysfunction reproduced and made the drawing more incorrect as

compared to those having no brain dysfunction. About 90% of the patients

having no brain dysfunction made errors on two or less drawings whereas

75% of patients with brain dysfunction made more than 2 errors. Age of the

patients was not found to be associated with the number of errors but

education had negative correlation. Correlations of errors with PQ and VQ

were found to be .27 and .45 respectively.

Administering requires proper rapport and then subjects are to

reproduce the drawings on a full scale white paper sheet. Scoring is made

interms of correct or incorrect. The test drawings are also scored for overall

configuration. The test has been found to be useful for clinical diagnosis and

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research on clinical groups. Dysfunction rating (ranging from 0 to 3) has

been associated with number of errors.

(4) Ways of Coping Questionnaire:

The Ways of Coping Questionnaire (Folkman & Lazarus, 1988, 1988)

has been developed to provide researches with a theoretically derived

measure that can be used to explore the relationship between stress and

adaptational outcomes. It assess thoughts and actions an individual use to

cope with stressful encounters of everyday living. It measures coping

processes, not coping dispositions or styles. The questionnaire Can be used

as a stimulus for discussion in clinical, training, and workshop settings as

well as a research tool in clinical settings in relation to types and degree of

pathology, or in measuring the effects of interventions. This questionnaire is

based on a definition of coping as the cognitive and behavioural efforts to

manage specific external and/or internal demands appraised as taxing or

exceeding the resources of the individuals.

An earlier version of ways of coping questionnaire named ways of

coping checklist which listed 67 strategies (Lazarus and Launier, 1978). The

strategies included items from the domains of defensive or palliative coping

such as avoidance, wishful thinking, intellectualization, isolation, and

suppression as well as items from the problem solving domain such as

information seeking, inhibition of action, and direct action. The items of

original ways of coping checklist classified on the basis of judgements as

being “problem-focused” or “emotion-focused” could not reflect the richness

and complexity of human coping process. Certain strategies were found

serving to be problem-focused and emotion-focused functions. Therefore,

the present 66 items version ways of coping questionnaire come into

existence by deleting or rewarding several redundant and unclear items and

adding some new items response format was also changed from „yes‟ -„no‟ to

4-point Likert‟s Scale. The subscales were empirically derived by using

factor analysis. Factor analysis revealed factors representing the eight

coping processes or ways which are as under-


147

Confrontive Coping: This describes aggressive efforts to alter the

situation and suggests some degree of hostility and risk taking.

Distancing: This describes cognitive efforts to detach oneself and to

minimize the significance of the situations.

Self –Controlling: This describes efforts to regulate one‟s feelings and

actions.

Seeking Social Support: This describes efforts to seek informational

support, tangible support, and emotional support.

Accepting Responsibility: This acknowledges one‟s own role in the

problem with a concomitant theme of trying to put things right.

Escape-Avoidance: This describes wishful thinking and behavioral

efforts to escape or avoid problems. Items on this scale contrast with those

on the distancing scale, which suggest detachment.

Planful Problem Solving: This describes deliberate problem focused

efforts to alter the situation, coupled with an analytic approach to solve the

problem.

Positive Reappraisal: This describes efforts to create positive meaning

by focusing on personal growth. It also has a religious dimension.

The ways of coping questionnaire can generally be completed in about

ten minutes although the time may vary with respondents. The items of the

questionnaire have been designed to be answered in relation to a specific

stressful encounter. Although it is a self-administered test, it can also be

used as an interview schedule.

There are two method of scoring ways of coping questionnaire, raw and

relative. Raw score describe coping efforts for each of the eight types of

coping whereas relative scores describe the proportion of effort represented

by each type of coping. Relative scores describe the contribution of each

coping scale relative to all of the scales combined and these are calculated

by technique described by Vitaliano et al., 1987. In both methods of scoring

individuals respond to each item in a 4-point Likert‟s Scale, indicating the

Methodology

148

frequency with which each strategy is used. 0 indicates “does not apply or

not used”, 1 indicates “used somewhat”, 2 indicates “ used quite a bit” and 3

indicates “used a great deal”.

Reliability:

Since the ways of coping questionnaire measures coping processes.

The traditional test-retest estimates of reliability are inappropriate, so the

reliability has been estimated interms of internal consistency. Internal

consistency (estimated with cronbach‟s coefficient alpha) estimates of

coping measures generally fall at the low end of the traditionally acceptable

range. The alpha coefficients for the eight scales are higher than the alphas

reported for most other measures of coping processes. These are .70, .61,

.70, .76, .66, .72, .68, and .79 for the eight scales Confrontive Coping,

Distancing, Self-Controlling, Seeking Social Support, Accepting

Responsibility, Escape-Avoidance, Planful Problem solving and Positive

Reappraisal respectively.

Validity:

The items on the Ways of Copying Questionnaire have face validity

since the strategies described are those that individuals have reported using

to cope with the demands of stressful situations.

Evidence of construct validity is found in the fact that the results of

the studies are consistent with the theoretical predictions, namely that (1)

coping consists of both problem-focused and emotion-focused strategies,

and (2) coping is a process. That is how people cope varies in relation to the

demands and constraints of the context and also in relation to changes in

those demands and constraints as an encounter unfolds.

Ways of Copying Questionnaire has been used as a research tool. A

number of studies in various domains i.e situational correlates of coping,

personality correlates of coping, gender and age differences in coping,

coping and adjustment, and found to be useful measure.


149

Administration and Scoring of Tests:

All the tests were administered individually in different sessions in

hospital settings as per the convenience of the patients. Before

administration of psychological tests, the detailed diagnostic information

was sought from the record as well as consulting physicians/ neurologists/

psychiatrists.

PAI was administered individually strictly according to

administrative procedure mentioned in the manual. Separate answer sheets

were provided to get the responses. PAI being a lengthy test some

intermittent rest intervals were given to facilitate the responding and to

avoid the fatigue and boring effect. Patients with low education were made

clear of the test items orally.

Similarly PGI Memory Scale was administered individually according

to prescribed instructions and administrative procedure and responses were

taken either orally or in writing from the patients. Likewise, Ways of Coping

Questionnaire was also administered individually strictly according to

procedure prescribed in the manual.

Nahor-Benson Test was also administered individually after having

established the workable rapport. All the responses (drawing the five

pictures which are shown on the cards and remaining three were drawing the

pictures as written on the cards) were taken on the blank sheet. Data were

obtained from the epileptic patients strictly realizing the inclusion criteria.

In case of normal subjects, all the four tests were administered

individually according to prescribed administrative procedures in home

setting in different sessions after established proper rapport. Data were

obtained only from those subjects who volunteered to participate after

rapport. Attempts were made to get the maximum cooperation from both the

epilepsy patients and normal subjects through proper rapport and providing

explanation to the quarries and misunderstanding/non-understanding of test

items, if any.

Methodology

150

Tests were scored in both groups of subjects by using separate keys

or scoring guides mentioned in respective manuals. PAI was scored for 20

variables (3 Validity Scales, 10 Clinical Scales, 5 Treatment Consideration

Scales, and 2 Interpersonal Scales). PGI Memory Scale was scored for 10

variables viz. Remote Memory, Recent Memory, Mental Balance, Attention

Concentration, Delayed Recall, Immediate Recall, Verbal Retention for

Similar, Verbal Retention for Dissimilar Pairs, Visual Retention, and

Recognition. NBT was scored for 1 variable i.e. Visuomotor Coordination.

Ways of Coping Questionnaire was scored for 8 variables, namely,

Confrontive Coping, Distancing, Self-Controlling, Seeking Social Support,

Accepting Responsibility, Escape-Avoidance, Planful Problem Solving and

Positive Reappraisal. Scores of Alcohol problems, a clinical scale of PAI

was not included in the analysis on technical ground i.e. zero scores were

obtained by all the female subjects (Epilepsy as well as normal).

Statistical Analysis

The obtained data from the subjects were analyzed statistically for the

under-mentioned informations:

1. Frequency Distributions, Means, Standard Deviations, Skewnesses, and

Kurtoses

2. t-ratios

3. Discriminant Function Analysis

4. Pearon‟s Product Moment Correlations

5. Principle Component Factor Analysis; and

6. Cluster Analysis.

Detailed description of analyses is reported in Chapter IV & V on

Results and Discussion.

Epilepsy has been known since antiquity -...

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