Box 4-1EXAMPLES OF TREATMENT PROGRAMS FOR COMORBIDITIES

The following two multifaceted programs were developed and evaluated as part of the Center for Disease Control and Prevention's (CDC's) Managing Epilepsy Well (MEW) Network.

PEARLS (Program to Encourage Active, Rewarding Lives for Seniors) was originally developed to reduce minor depression in medically ill, low-income, older adults through a home-based self-management program (Ciechanowski et al., 2004). Major components of the program, which showed reduced symptoms of depression and improved health status in a randomized controlled trial, included problem solving, encouragement of social and physical activity, and communication between the psychiatrist and the patient's primary care physician about possible treatment with antidepressants (Ciechanowski et al., 2004). This program was revised for people with epilepsy through collaboration with the MEW Network (DiIorio et al., 2010). In a randomized trial, people with epilepsy were assigned either to receive eight 50-minute problem-solving sessions in the home from a trained therapist and monthly follow-up telephone calls, or to receive usual care. In the intervention group, therapists regularly reviewed progress of the sessions with a team psychiatrist who consulted with the neurologist regarding treatment related to depression. Sessions were modified to encourage people with epilepsy to be active both socially and physically, and unemployed individuals were given contact information for vocational rehabilitation. On average people with epilepsy in the intervention group had 6.2 problem-solving sessions and 2.5 follow-up telephone calls. Results are promising. The intervention group had significantly less depression severity and suicide ideation and greater emotional well-being, compared to the control group (Ciechanowski et al., 2010).

Project UPLIFT (Using Practice and Learning to Increase Favorable Thoughts), which also has the goal of reducing depression, uses a mindfulness approach and cognitive-behavioral therapy. Project UPLIFT was designed to be delivered in eight weekly sessions to small groups by telephone or the Internet (Walker et al., 2010). An initial pilot study demonstrated that people with epilepsy who received the intervention (randomly assigned to phone or Internet) had a greater decline in symptoms of depression and greater increase in knowledge and skills than the control group at 8 weeks (Thompson et al., 2010). Project UPLIFT was effective in using both the Internet and telephone methods; however, participants reported that they would have liked to have been able to participate using both methods (Walker et al., 2010).

From: 4, Health Care: Quality, Access, and Value

Cover of Epilepsy Across the Spectrum
Epilepsy Across the Spectrum: Promoting Health and Understanding.
Institute of Medicine (US) Committee on the Public Health Dimensions of the Epilepsies; England MJ, Liverman CT, Schultz AM, et al., editors.
Washington (DC): National Academies Press (US); 2012.
Copyright © 2012, National Academy of Sciences.

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