Psychological distress symptoms and illness perception in patients with epilepsy in Northwest Greece Eleftheria Siarava a, ⁎, Sofia Markoula a , Sygkliti-Henrietta Pelidou a , Athanassios P. Kyritsis a , Thomas Hyphantis b a Department of Neurology, University of Ioannina, University Hospital of Ioannina, Ioannina 45110, Greece b Department of Psychiatry, University of Ioannina, University Hospital of Ioannina, Ioannina 45110, Greece abstract article info Article history: Received 9 July 2019 Revised 25 September 2019 Accepted 6 October 2019 Available online xxxx Objective: The purpose of the present study was to compare psychological distress between patients with epi- lepsy and healthy controls and to evaluate potentially related factors to psychological distress in patients with epilepsy. Furthermore, we assessed how psychological distress and other potential factors mediate illness per- ception in patients with epilepsy in an urban area of Northwest Greece. Materials and methods: A case–control study was conducted in adult patients with epilepsy followed up at the University Hospital of Ioannina and in healthy controls. The Symptom Checklist—90 Revised (SCL-90R) for symp- toms of psychological distress and the overall psychological distress Global Severity Index (GSI) evaluation, the brief illness perception questionnaire (B-IPQ), and the Adverse Event Profile (AEP) questionnaire for the antiep- ileptic drugs (AEDs) were used. Results: Seventy patients with epilepsy and 70 controls were recruited in the study. Somatic, depression, and anx- iety symptoms and the GSI were higher in patients than in controls. In patients with epilepsy, the AEP score was significantly associated with psychological distress. Illness perception was associated with the number and the total number of administered AEDs; the AEP score; somatic, obsessive, depressive, and anxiety symptoms; and the GSI. After regression analysis, epilepsy character- istics, AEDs, and psychological distress accounted for 11.7%, 28.7%, and 5.5% of variance in BIP-Q score, respec- tively. Conclusion: Screening for psychological distress in patients with epilepsy is of high importance in clinical practice as somatic, depression, and anxiety symptoms and overall psychological distress are more severe in patients with epilepsy than in healthy controls. The symptoms of psychological distress are strongly associated with the ad- verse effects of AEDs. The epilepsy characteristics, the AEDs, and the psychological distress could determine a large part of illness perception in epilepsy, with the adverse effects of AEDs being the strongest predictor. © 2019 Elsevier Inc. All rights reserved. Keywords: Epilepsy Psychological distress Somatization Depression Anxiety Illness perception 1. Introduction Epilepsy is a frequent neurological disorder with a prevalence of 6.38 per 1000 persons [1], and approximately 5 million people have been di- agnosed as having epilepsy worldwide, according to the World Health Organization (WHO). Patients with epilepsy frequently experience symptoms of psychological distress [2]. Symptoms of psychological distress, especially depression and anxi- ety, are related to lower quality of life in epilepsy [3,4]. Illness percep- tion consisted of the cognitions and the beliefs of patients about their own illness [5] and is potentially modifiable after psychological inter- ventions [6]. Negative beliefs of illness are of high interest since they are associated with poor quality of life in patients with epilepsy [7]. The objective of the present study was to compare the severity of psychological distress in patients with epilepsy and healthy controls. In patients with epilepsy, we assessed potential interactions of psycho- logical distress with demographic factors, epilepsy characteristics, and the antiepileptic drugs (AEDs). Furthermore, we aimed to elucidate how demographics, epilepsy, AEDs, and psychological distress affect ill- ness perception in epilepsy, in an urban area of Northwest Greece. 2. Materials and methods 2.1. Participants All consequent adult patients with epilepsy followed up at the Adult Epilepsy Outpatient Clinic of the University Hospital of Ioannina (Ioan- nina, Greece) were enrolled in the study from September 2017 to April 2018. Epilepsy & Behavior 102 (2020) 106647 ⁎ Corresponding author. E-mail address: esiarav@cc.uoi.gr (E. Siarava). https://doi.org/10.1016/j.yebeh.2019.106647 1525-5050/© 2019 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh