HAWASSA UNIVERSITY COLLEGE OF MEDICINE AND OTHER

HEALTH SCIENCES SCHOOL OF NURSING DEPARTMENT OF

PSYCHIATRY NURSING

PREVALENCE AND ASSOCIATED FACTORS OF PSYCHOSIS AMONG

EPILEPSY PATIENTS AT HAWASSA UNIVERSITY COMPREHENSIVE
SPECIALIZED HOSPITAL AND ADARE GENERAL HOSPITAL 2020 G.C

RESEARCH RESULT TO BE SUBMITTED TO HAWASSA UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCE DEPARTMENT OF
PSYCHIATRIC NURSING

BY: - SEIFESLASSIE WENDWESEN AWULACHEW

MELAT ASSEFA

MENGISTU ADDISU

MUBAREK MOHAMMED

TEFERA ADDIS ASEME

DECEMBER, 2020

HAWASSA

ETHIOPIA

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 HAWASSA UNIVERSITY COLLEGE OF MEDICINE

AND OTHER HEALTH SCEINCE SCHOOL OF NURSING

DEPARTMENT OF PSYCHIATRY NURSING

PREVALENCE AND ASSOCIATED FACTORES OF PSYCHOSIS AMONG

EPILEPSY PATIENTS ATTENDING OUPATIENT DEPARTEMNT AT
HAWASSA UNIVERSITY COMPREHENSIVE SPECIALIZED HOSPITAL AND
ADARE GENERAL HOSPITAL 2020 G.C

INVESTIGATORS

1. SEIFESLASSIE WENDWESEN AWULACHEW

2. MELAT ASSEFA TFERI
3. MENGISTU ADDISU LEGESSE
4. MUBAREK MOHAMMED ALI
5. TEFERA ADDIS ASSEME

ADVISORS

1. YACOB ABRAHAM
2. FIKRU TADESSE

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ACKNOWLEDGMENT
First, we would like to thank our almighty GOD for letting us to have all our achievements; next
we would like to acknowledge Hawassa University College of medicine and health science
department of psychiatry for offering us permission to do our research program, which is
educative and golden opportunity for developing our ability, and for giving us a written consent
letter to take information about our study area.

Thirdly, we would like to express our deepest and heart full appreciation to our Advisors
Ins.Yacob Abraham and Ins. Fikru Taddese for their unreserved efforts to guide and supervise us
throughout developing this study proposal.

Finally we would like to express our great thank to Hawassa University College of health and
medical science librarians who support us in giving some available materials for guidance

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APPROVAL SHEET
This is to certify the research under the title assessment of “The prevalence and
associated factors of psychosis among epileptic patients attending Hawassa
University Comprehensive Specialized Hospital and Adare General Hospital” was
undertaken and the report compilation was led by Hawassa university 4 th year
regular psychiatry students in December 2020 G.C

Documents used during the write up are already considered, and are acknowledged
by standard matching in text citation and reference list.

Name of advisor Date Signature

1. _________________ ______________ _______________

2. _________________ ______________ _______________

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Contents
ACKNOWLEDGMENT..................................................................................................................I

APPROVAL SHEET......................................................................................................................II

LIST OF TABLES........................................................................................................................VI

LIST OF FIGURES.......................................................................................................................VI

ACRONYM/ABBREVIATION..................................................................................................VII

ABSTRACT................................................................................................................................VIII

CHAPTER ONE- INTRODUCTION.............................................................................................1

1.1 Background............................................................................................................................1

1.2 Statement of the problem.......................................................................................................3

1.3 Significant of the study..........................................................................................................5

CHAPTER TWO- OBJECTIVE OF THE STUDY........................................................................6

2.1 General objective...................................................................................................................6

2.2 Specific objective...................................................................................................................6

CHAPTER THREE- LITRATURE REVIEW................................................................................7

3.1 The prevalence of psychosis among epilepsy patients internationally..................................7

3.2 Sociodemographic factors associated with psychosis among epilepsy patients..................10

3.3 Clinical and other factors associated with psychosis among epilepsy patients...................13

CHAPTER FOUR-METHODS AND MATERIALS...................................................................17

4.1 Study Design and Period.....................................................................................................17

4.2 Study Area...........................................................................................................................17

4.3 Source and Study Population...............................................................................................17

4.3.1 Source population.........................................................................................................17

4.3.2 Study Population...........................................................................................................17

4.3.3 Study Unit.....................................................................................................................17

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 4.4 Inclusion and Exclusion Criteria.........................................................................................17

4.4.1 Inclusion Criteria..........................................................................................................17

4.4.2 Exclusion Criteria.........................................................................................................18

4.5 Sample Size Determination and Sampling Technique........................................................18

4.5.1 Sample Size Determination..........................................................................................18

4.5.2 Sampling Technique.....................................................................................................19

4.6 Study Variable.....................................................................................................................19

4.6.1 Dependent Variable......................................................................................................19

4.6.2 Independent Variable....................................................................................................19

4.7 Data Collection Procedures.................................................................................................20

4.7.1 Data Collection.............................................................................................................20

4.7.2 Data Collection Instrument...........................................................................................20

4.8 Data Quality Control............................................................................................................21

4.8.1 Data processing and Analysis.......................................................................................22

4.8.2 Operational Definition..................................................................................................22

4.8.3 Ethical Considerations..................................................................................................23

4.9 Limitation of the Study........................................................................................................23

CHAPTER FIVE –RESULTS.......................................................................................................24

5.1 Sociodemographic Characteristics of the study participants...............................................24

5.2 Clinical Characteristics and other factors of the study participants....................................26

5.3 Prevalence of psychosis among epilepsy patients...............................................................28

5.4 Associated factors of psychosis among epilepsy patients...................................................28

CHAPTER-SIX DISCUSSION....................................................................................................31

CHAPTER SEVEN-CONCLUSION AND RECOMENDATION...............................................33

7.1 Conclusion...........................................................................................................................33

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 7.2 Recommendation.................................................................................................................33

ANNEXES.....................................................................................................................................39

Annex -1 Declaration.................................................................................................................39

Annex-2 Information Sheet and Consent Form.........................................................................40

Annex -3 English Version of the Questionnaire........................................................................41

Annex-4 Amharic Version of The questionnaire.......................................................................48

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LIST OF TABLES
Table 1: Sociodemographic Characteristics of the study participants at HUCSH and Adare
General Hospital 2020...................................................................................................................24
Table 2: Clinical and other associated factors of the study participants at HUCSH and Adare
General Hospital 2020...................................................................................................................27
Table 3: Factors associated with psychosis among epilepsy patents (Bivariate and Multivariate
analysis) at HUCSH and Adare General Hospital 2020, n=208....................................................29

LIST OF FIGURES
Figure 1: Conceptual framework psychosis of epilepsy................................................................16
Figure 2: Employement status of the study participants at HUCSH and Adare General Hospital
2020...............................................................................................................................................25
Figure 3: Ethnicity distribution at HUCSH and Adare General Hospital 2020............................26

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ACRONYM/ABBREVIATION
AED…………………………Antiepileptic Drugs

SPSS…………………………Statistical Package For Social Sciences

DSM-5………………………..Diagnosis and Statistical Manual of Mental Disorders

PSQ…………………………..Psychosis Screening Questionnaire

G.C………………………….. Gregorian calendar

HUCSH………………………Hawassa University Comprehensive and Specialized Hospital

SD…………………………….Standard Deviation

IIP…………………………….Interictal Psychosis

USA…………………………..United States of America

UK……………………………United Kingdom

MMAS……………………….Morisky Medication Adherence Scale

KSSE…………………………Kilifi Stigma Scale of Epilepsyy

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ABSTRACT
Introduction -: Epilepsy one of the most common neurological disorders that has high
propensity to be accompanied by several mental disorders and among those mental disorders
psychosis is one of them. The occurrence of psychosis among epilepsy patients causes them to
face social and psychological incapacity. Psychosis is one of the most extreme and intense
mental disorder which causes the person to lose traces of reality. Delusions and hallucinations
are core symptoms of psychoses. The link that occurs between epilepsy and psychosis has been
recognized since ancient times.

Objective- To assess the prevalence and associated factors psychosis among epilepsy patients
at Hawassa Comprehensive Specialized Hospital and Adare General Hospital 2020 G.C

Method-Institutional based cross sectional study was conducted from November 9 to December
11 2020 G.C, on patients with Epilepsy at Hawassa public Hospitals. Single population
proportion formula was used to calculate sample size and the final sample size was 208.
Systematic random sampling method was used to select participants. PSQ was used to assess
Psychosis among epilepsy patients. Data was entered in to and cleaned by Epi-data and was be
exported to SPSS-26 for further analysis. Descriptive statistics was used to describe the data; OR
and 95% CI was used to measure the association. P-value of less than 0.05 was be used to see the
statistically significance of the association.

Results: The majority of participants were female 113(54.32%), majorities were primary school
students (25.5%, Majority of them had perceived stigma, the majority of diagnosis was tonic
clonic (86.1%), and majority has family history.

Conclusion: The prevalence of psychosis among epileptic patients was 41.8% and the factors
associated are Medication inadherence, Family History, Seizure type and Duration of illness.

Recommendation: Regular screening for the past and current comorbid psychiatric disorders
needs to be incorporated into the evaluation of every person with epilepsy.

Key words: Epilepsy, Psychosis, Delusion, Hallucination

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CHAPTER ONE- INTRODUCTION

1.1 Background
Epilepsy is a neurological disorder which is typically characterized by the occurrence of
frequently repeated seizures without any external intrusion.(Disease et al., 2020) It is manifested
by seizures featuring with classic motor convulsion or consists instead complex abnormalities of
behavior and subjective experience as well as loss of consciousness. It is basically categorized as
focal and generalized depending on the area of the brain at which the seizure is initiated as well
as on the manifestations of the seizure disorder.

Epilepsy is one of the most common and serious brain disorders in the world that affects at least
65 million people worldwide. Epilepsy can be associated with profound physical, psychological
and social consequences and its impact on a person’s quality of life is quit severe. Epilepsy has
been a worldwide public health problem having a global prevalence of approximately 8 per
thousand. The majority of epilepsy patients 90% live in developing countries where it remains a
major public health problem. Moreover epilepsy patients are more likely to develop comorbid
mental illness compared to the general population. (Deresse and Shaweno, 2016)

The relationship between epilepsy and psychiatric disorders has been known for some time, but
in the last two decades there were several studies about the issue. The prevalence of psychiatric
comorbidities among epilepsy patients was found to be between 20 to 40%. There are several
psychiatric disorders that are comorbid with epilepsy and among these Depression, Anxiety and
Psychosis are few of them.(Bragatti et al., 2011)

Psychosis is one section of psychiatric disorder classification which is usually manifested by

impaired reality testing. It is a combination of symptoms ranging from positive symptoms
thought disorder, delusions and hallucinations to negative symptoms lack of volition and social
withdrawal with loss of sense of reality. Furthermore the sole diagnosis of psychosis is known to
be accompanied by severe psychosocial impairment.(Maguire, Singh and Marson, 2018)

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Today, the DSM-5 specifies the diagnosis of psychoses in epilepsy with commonly used sub
classifications under psychotic disorder due to another medical condition. Delusion and
hallucinations are the major clinical presentation of psychosis in epilepsy patients. Bidirectional
relationships are also observed between epilepsy and psychoses in their origin (Cascella,
Schretlen and Sawa, 2009). The manifestations of psychosis in epilepsy patients can occur
different stages the seizure, ictal, interictal and post ictal. Up to 6% of individuals with epilepsy
have a co-morbid psychotic illness and that patients have an almost eight fold increased risk of
having psychosis.(Farooq and Sherin, 2015)

The coexistence of psychosis among epilepsy patients has been studied associated with the
nature of their bidirectional relationship. This might be due to the genetic vulnerability as well as
due to the neurodevelopment abnormalities that co-occur during childhood. Plenty of studies
have suggested the bidirectional relationship between epilepsy and psychosis. People with
epilepsy are at increased of developing psychosis than the general population.(Chang et al.,
2011)

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1.2 Statement of the problem
Epilepsy is one of the most common and severe neurological disorders in the world that affects at
least 65 million people worldwide. (Hasiso and Desse, 2016) Epilepsy has been considered to be
accompanied by various types of mental health conditions and among these conditions the
manifestations of psychosis is meant to be one of them. According to several studies that have
been conducted on epileptic patients, these patients are at increased propensity of developing
psychosis. This proposed predisposition for psychosis among epilepsy patients has opened the
door to understand about the associated factors and to improve the psychosocial functioning of
these people that the problem might have caused.(Irwin et al., 2014)

However the existence of psychosis among epilepsy patients has been associated with severe
physical, social and economical impairments than any other psychiatric manifestations. Despite
having such severe functional impairment on epilepsy patients, psychosis still remains the most
understudied disorder among epilepsy patients. It is easy to remember that the sole diagnosis of
epilepsy causes people to suffer from various aspects of social life as well as other
multidisciplinary areas, as a result the comorbid diagnosis of psychosis among epilepsy patients
not only affects the social, physical, economical aspects of their life, but also the course and
prognosis of their illness. Consequently, this results in deterioration, discrimination and rejection
in all aspects of their life among the community. (Rehman, Kalita and Baruah, 2017)

Studies that are conducted on epilepsy patients concerning their psychiatric comorbidity revealed
the prevalence and the predictive variables responsible for the occurrence of psychosis and other
psychiatric comorbidities as well. The prevalence of the problem among the epilepsy patients
hasn’t received that much attention relative to the other psychiatric comorbidities despite having
the most severe functional impairment relative to other psychiatric comorbidities.

According to a study conducted in United Kingdom, the presentation of psychosis accounts to 2-

7% which is associated with poor educational attainment and neurological disturbance across the
dominant hemisphere causes language related skills such as reading and spelling which could
disrupt educational progress among these patients. (Gaitatzis and Jw, 2004)

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A study conducted in Netherlands among epilepsy patients revealed that the existence of
psychosis could pose unbearable psychosocial impairments towards epilepsy patients.
Furthermore the study reported that most of them had stated that they have a hard time getting
enough support from their friends as well as the community as a whole and they don’t count on
anybody except their family. In addition to that some of them stated that they feel ashamed and
embarrassed.(Feltz-cornelis, Aldenkamp and Ade, 2008)

As per to a study that was conducted in New Jersey on interictal psychosis among chronic
epilepsy patients revealed that 7.2 % of these patients had epilepsy related psychosis that is
accompanied by difficulty of social interaction and feeling inferior to others, difficulty asking
help from others and trusting other people. (Mendez et al., 1993)

A crossectional study that was conducted in India indicated most of the epilepsy clinic which
provide referral and consultation services are more likely to concentrate on the patients seizure
and course of treatment. As a result the patients are left with worsening of their psychosocial
functioning. The study reported that the attention given to the mental health status of people
living with epilepsy is substantially low.(Rani et al., 2018)

A descriptive crossectional study stated that there is a lack of data concerning the psychiatric
comorbidities among epilepsy patients. This lack of data brings about major negative
consequences, given the circumstances that the majority epilepsy care are found under Sub-
Saharan countries, where epilepsy remains a major public health problem, not only because of its
health implications but also for its social, cultural, psychological and economic effects. (Tenema
et al., 2017)

As per our knowledge there hasn’t been any study that has been performed to assess the
prevalence and associated factors of epileptic and psychosis in Ethiopia. There are studies
however that were conducted on common mental illness as a whole and no further specificity on
psychosis. Furthermore there was also another study that was conducted concerning psychiatric
comorbidity among epilepsy patients at Adare general hospital, but then again there was no study
specifically done on psychosis among epilepsy patients.(Press, 2016; Id et al., 2020)

So the aim of this study is to assess the prevalence and contributing factors of psychosis among
epilepsy patients at HUCSH and Adare general hospital.

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1.3 Significant of the study
The recognition of psychosis of epilepsy is becoming more important issue these recent decades,
due to the fact that these patients psychosocial impairment as well as impairing course of
treatment and illness. The manner that this problem is understudied causes persistent physical,
social and economical impairment. For this reason studies under epilepsy patients who suffer
from psychosis need a substantial attention and concentration. As per our knowledge studies
concerning psychosis among epilepsy patients have not been conducted in Ethiopia. This study
will investigate this problem for the first time in Ethiopia specifically at Hawassa public
Hospitals. So, this study is relevant because the prevalence and associated factors of psychosis is
not well known as well as there is no proper intervention. The findings of the current study are
significant in several ways. One important contribution of this study is that it provides new
knowledge of the perception of psychosis among people with epilepsy in Hawassa city. These
findings provide an important basis for mental health care services for epilepsy patients as well
as, mental health nursing practice and education, and future research among epilepsy patients. In
addition, the findings of this study will be helpful in introducing and expanding community
mental health services to the South region as well as providing an emphasis on the role early
detection and management of psychosis and other comorbid mental illness among epilepsy
patients

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CHAPTER TWO- OBJECTIVE OF THE STUDY

2.1 General objective

 To assess the prevalence and associated factors of psychosis among epilepsy patients
attending outpatient department of Hawassa University Comprehensive Specialized
Hospital and Adare General Hospital, Ethiopia, 2020 G.C

2.2 Specific objective

 To determine the prevalence of psychosis among epilepsy patients attending outpatient
department of Hawassa University Comprehensive Specialized Hospital and Adare
General Hospital, Ethiopia, 2020 G.C
 To identify associated factors of psychosis among epilepsy patients attending outpatient
department of Hawassa University Comprehensive Specialized Hospital and Adare
General Hospital, Ethiopia, 2020 G.C

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CHAPTER THREE- LITRATURE REVIEW

3.1 The prevalence of psychosis among epilepsy patients internationally

A systematic review and meta analysis that was conducted among 58 literatures that were all
published concerning the prevalence of psychosis in patients that were diagnosed epileptic
patients established that, the odds ratio for risk of psychosis among people with epilepsy
compared with controls was 7.8, on the other hand the pooled estimate for the prevalence of
psychosis in epilepsy patients came out to be 5.6% (95% CI: 4.8-6.4)(Clancy et al., 2014)

A case control study that was conducted in Royal Melbourne Hospital, Australia on psychotic
disorders induced by antiepileptic drugs on people with epilepsy established that 3.7 % of the
study participants had psychotic manifestations. In addition to that the study also reported that
disorganized behaviors as well as hallucinations were the predominant manifestations ((Chen et
al., 2016)

A case control study that was conducted in London, United Kingdom on post ictal psychosis
among temporal lobe epilepsy indicated that 7% of the study participants had been found
manifesting psychotic symptoms.(Cleary et al., 2013)

According to a retrospective study that was conducted in Barcelona, Spain on psychosis on

epileptic patients established that among the 105 patients that were studied 9% of them had
developed psychosis. The predominant psychotic manifestations were visual hallucinations and
paranoid delusion. (Carren et al., 2009)

According to a case control study was conducted on risk factors of psychosis among epilepsy
patients in Ireland the prevalence of psychosis was found to be ranging from 4%-7% of the
people with epilepsy’. Furthermore the study indicated that the prevalence of psychosis among
epilepsy patients was 15 times higher than the 0.4% prevalence that is found in the general
population (Irwin et al., 2014)

A prospective study that was conducted on the interictal psychosis in comparison with
schizophrenia in Japan among 619 epileptic patients indicated that 322 (6.5%) of the epilepsy
patients experienced psychosis(Tadokoro, Oshima and Kanemoto, 2007)

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 A cohort study was undertaken on psychiatry Comorbidity among temporal lobe epilepsy
patients in Brazil which included 186 study participants and revealed that 7.5% of whom
developed interictal psychosis. Furthermore the study also reported that more than half of the
study participants experienced visual hallucinations following the seizure could also last for
weeks.(Guarnieri et al., 2009)

A population based study that was conducted on psychosis on people with epilepsy in USA
established that the prevalence of psychosis among temporal lobe epilepsy patients to be 6.77%.
In addition to that the study indicated that compared to the general population patients with
epilepsy are 9 times more vulnerable than the general population. Furthermore the study also
revealed that the patients with complex partial seizure tend to have acute onset than other types
of seizures.(Kanner, 2009)

Institution based study that was done on psychosis and seizure challenges in diagnosis and
treatment in USA established that the prevalence of psychosis among patients who are diagnosed
with epilepsy is 7%. What’s more is that the study also implicated that higher amounts of
patients with complex partial seizures (31%) had experienced more negative symptoms. In
addition to that hallucinations as well as delusion of paranoia tend to occur frequently.(Roy et
al., 2014)

A case control study was conducted in Netherlands in a 3 year epidemiological survey on

psychosis in epilepsy patients and other chronic medically ill patients and the role of cerebral
pathology in the onset of psychosis among 901 epilepsy patients and 1752 chronic medical
disorders and the study revealed that epilepsy patients who had experienced psychosis were 49
(5.4%). Furthermore the study also indicated that among the epilepsy patients who experienced
psychosis the predominant psychotic manifestation was delusion paranoid type followed by
visual hallucination. (Feltz-cornelis, Aldenkamp and Ade, 2008)

Institution based study that was undertaken in India on psychiatry comorbidity among patients of
complex partial seizure demonstrated that among 117 patients 46 had a psychiatric disorder, and
among these psychiatric comorbidities 1.7 % of them had experienced psychosis (Desai et al.,
2010)

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On the basis of a cohort study that was undertaken on Neuropsychiatric Comorbidity in focal
epilepsy among 312 patients in Royal Melbourne Hospital Australia, psychiatric comorbidities
were diagnosed on 58% of the study participants. Among these psychiatric comorbidities 7.2%
of them had experienced psychosis. (Adams et al., 2008)

An observational study that was conducted in England on Interactions between seizure

frequency, psychopathology, and severity of intellectual disability in a population with epilepsy
among 175 patients 97 (55%) had developed psychiatry comorbidities. Amid these psychiatry
disorders 20 of them had experienced psychosis (11%) among the epileptic patients.(Ring et al.,
2007)

A retrospective study was undertaken in Austria on psychoses in epilepsy a comparison of

postictal and interictal psychoses on 1434 epilepsy patients to investigate the potential
association between the psychosis types. Moreover the study also stated that the prevalence of
psychosis among epilepsy patients was 5.9%. In addition to that the study indicated that 78.8 of
the epileptic patients who had experienced psychosis manifested delusion.(Hilger et al., 2016)

A cohort study was conducted in Norway on psychiatric comorbidity and use of psychotropic
drugs in 167 epilepsy patients for a year and the study established that 25.7% of them had
developed psychiatry disorder; consequently among these psychiatric disorder 1.2% of them had
experienced psychosis.(Oj and Ko, 2010)

A crossectional study was conducted on prevalence of psychiatric comorbidities among 166

epilepsy patients in Brazil and the study established that 106 (63.9%) of the epilepsy patients had
experienced psychosis. Furthermore the study also stated that 8.4% of them had psychosis. In
addition to that the study reported that predominant manifestations was disorganized behavior
and hallucination.(Bragatti et al., 2011)

A case control study was conducted in United Kingdom on psychosis of epilepsy among 1008
epileptic patients and among these study participants 4.6% of them had psychosis. Moreover the
study also revealed that most of the epilepsy patients diagnosed with psychosis were chronically
ill with epilepsy. In addition to that the most common psychotic manifestations were delusions of
grandiose and religious type.(Elst et al., 2002)

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According to a crossectional study that was performed to assess the prevalence of psychiatric
disorders among epilepsy patients in tertiary level care hospital in Mexico, the prevalence of
psychosis was found to be 8.33%.(Article, 2017)

A case control study was performed to assess the prevalence of psychiatric disorders among 106
epilepsy patients in Brazil and the study revealed that psychiatry disorders were found among 65
(61.3%) patients. In addition to that the prevalence of psychosis among these psychiatric
comorbidities was found to be 44.6%. On the other hand the mean age of onset for epilepsy was
19 years. And the subsequent occurrence of psychosis was 35 years of age after the diagnosis of
epilepsy. (Maria et al., 2007)

A cohort study was conducted on the prevalence of psychiatric comorbidities among 98

Caucasian epilepsy patients in southern Brazil for 2 years. According to the study 54.1% of the
epilepsy patients had experienced at least one psychiatric disorder and the prevalence of
psychosis was found to be 6.1%. On the other hand the study also reported that epileptic patients
are prone to comorbidities with psychiatric disorders, as for psychosis epilepsy patients are three
times more likely to experience psychosis than the general population (2.1%) (Bragatti et al.,
2010)

A crossectional study was undertaken on determining treatment levels of comorbid psychiatric

conditions among 397 epilepsy patients’ local clinics in Lusaka, Zambia. The study revealed that
of all the 397 study participants’ psychosis was commonly diagnosed among epilepsy patients
(50%). Moreover the study also stated that only 1.8% of the epilepsy patients who were suffering
from psychosis received appropriate treatment.(Venevivi, Mbewe and Paul, 2016)

A descriptive crossectional study was performed in Kenya to assess the prevalence of psychiatric
comorbidities among 160 epilepsy patients. The study reported that psychiatric comorbidities
among epilepsy patients were 79.2%. As for the prevalence of psychosis, 5.6% of epilepsy was
found to be experiencing psychosis.(Gloria, 2019)

3.2 Sociodemographic factors associated with psychosis among epilepsy patients

According to a case control study that was conducted on psychotic disorders induced by
antiepileptic drugs on people with epilepsy both inpatient and outpatient in Australia, female
gender and early age of onset epilepsy were significantly associated with the existence of

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psychosis among epilepsy patients. Moreover 76.9% of the epilepsy patients who were
diagnosed with psychosis were female. Furthermore the study indicated the median age of onset
of epilepsy was found to be 18.5 years.(IQR 9-31) among those who had psychosis.(Chen et al.,
2016)

A cohort study that was conducted on interictal psychotic episode among epilepsy patients in
Japan among 155 patients reported that there is an association between early age of onset of
epilepsy and the experience of psychosis. 58% of those who had psychosis were diagnosed with
epilepsy between12-18 years of age. In addition to that the also indicated that the age of onset of
psychosis to be 30.9 years with SD 10.5. Furthermore the study also stated the interval between
onset of epilepsy and that of the IIP episode to be mean 18.3 years with SD 9.0. In addition to
that the study indicated that epilepsy patients who had developed psychosis at early age tend to
last longer duration with illness.(Adachi et al., 2012)

A population based cohort study was performed on risk factors of schizophrenia like psychosis
among epilepsy patients in Denmark and the study indicated that 1.5% of the study participants
had developed psychosis. Consequently, these epilepsy patients were found to have had risk
factors for their experience of psychosis, and among these risk factors was early onset of
epilepsy. Furthermore the study stated that increased duration, mean 12 years of epilepsy illness
was associated with increased risk of developing psychosis. However, the incident(Article,
2017)ce of psychosis among the epileptic patients was the same for both sexes. (Qin et al., 2005)

According to a population based retrospective cohort study that was conducted on psychiatric
disorders after epilepsy diagnosis in Taiwan for 6 years, various psychiatric disorders were
diagnosed in those study periods. One of the psychiatry disorders identified was psychosis with
a1.5% prevalence. Furthermore the study reported that the development of psychosis was
associated with high unemployment rate ( 43%) as well as low socioeconomic status.(Chang et
al., 2013)

According to a cohort study that was conducted in Australia on neuropsychiatric comorbidity

among 312 epilepsy patients, the occurrence of psychosis among this patients was found to be
7.2. The study further explained the occurrence of psychosis was associated with unemployment
and low socioeconomic status. Among those who had experienced psychosis 52% of them were

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unemployed. In addition to that the study also stated that 61% of those who had developed
psychosis were never married.(Adams et al., 2008)

A case control study in Netherlands examined the prevalence of psychosis among epilepsy
patients and found out that psychosis was in 5.4% of the epileptic patients. The study further
illustrated that among those who were diagnosed psychosis 53% of them were unemployed. In
that manner the study also indicated that 37% of those who had experienced were never married.
In addition to that the patients diagnosed with psychosis mean age was 41 years, range 19—77,
and 25 were male, 24 female. There was no significant difference among sexes of epileptic
psychosis(Feltz-cornelis, Aldenkamp and Ade, 2008).

A case control study that was performed to assess the risk factors of psychosis among epilepsy
patients in Japan between 132 epilepsy patients who were diagnosed with psychosis and 2773
other non-psychotic epilepsy patients, revealed that early onset of epilepsy was one of the risk
factors for the existence of psychosis among epilepsy patients. As per the study indicated there
was significant association between early age of onset of epilepsy (10 year old or younger) and
psychosis. Furthermore the study revealed that there was no significant association between sex
of the study participants and the emergence of psychosis.(Kanemoto, Tsuji and Kawasaki, 2001)

A case control study was used to assess the predictive variables of psychosis among epilepsy
patients in Japan; the study was conducted between 246 epilepsy patients who had psychosis and
658 epilepsy patients with no psychosis. Among the factors investigated were sex and age of
onset of epilepsy. According to the study there was a significant association between ages at
onset of epilepsy and the existence of psychosis among epilepsy patients. Despite the fact that
there was association between age of onset and psychosis, an association could not be attained
between sex of the participants and the diagnosis of psychosis.(Adachi et al., 2000)

According to a cohort study that was used to assess psychiatric disorders among epilepsy patients
in India, the study revealed that epilepsy patients with lower educational status were found to be
vulnerable to the experience of psychosis. On the other hand female gender was also
significantly associated with the diagnosis common mental illnesses including psychosis among
epilepsy patients.(Desai et al., 2010)

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A case control study that was performed in Japan on psychosis and epilepsy to assess the
associated factors of psychosis, in both postictal and interictal. Apparently the study reached
with a conclusion that age at onset of epilepsy patients who had psychosis was 12.8 years and
age at onset of psychosis was 25 years.(Adachi et al., 2002)

A study conducted in Brazil on psychiatric disorders among epilepsy patients to assess the
prevalence and the risk factors responsible for the existence of psychiatric disorders revealed that
35.6% of epilepsy patients that had high rates of unemployment had experienced psychosis. As
for the reports of the study people with longer duration of epilepsy had the higher tendency of
experiencing psychosis and subjected to unemployment. (Sousa-pereira, David and Portela,
2010)

As for a crossectional study performed to assess treatment levels of psychiatric comorbidities

among epilepsy patients in Zambia, the study described people with epilepsy who had been
diagnosed with epilepsy are susceptible to stigma and causes them not to fit into the community.
In addition to that the study indicated epilepsy patients with psychosis tend to have reduced
productivity compared to the general population. In addition to that the epilepsy patients with
psychosis had low economic status compared to those without psychosis.(Venevivi, Mbewe and
Paul, 2016)

A descriptive crossectional study in Kenya on psychiatric comorbidities among epilepsy patients

revealed that gender and educational level were significantly associated with the existence of
psychosis among epilepsy patients. The study further illustrated that 60% of individuals with
psychosis and other psychiatric comorbidities were male study participants Furthermore the
study also indicated that high rate of unemployment is significantly associated with the existence
of psychosis and other psychiatric comorbidities.(Gloria, 2019)

3.3 Clinical and other factors associated with psychosis among epilepsy patients
A cohort study was conducted in Brazil to assess the prevalence of psychosis among epilepsy
patients revealed that 33.3% of them had family history of psychosis. In addition to that the study
also stated that epilepsy patients who had psychosis tend to be diagnosed with focal seizures,
such complex partial seizures.(Bragatti et al., 2010)

13 | P a g e
According to a case control study to assess the predictive variables of psychosis among epilepsy
patients, the study indicated a significant difference in family history of psychosis, age at onset
of epilepsy and type of epilepsy between patients with interictal psychosis and those without it.
The study reported that epilepsy patients with family history were 40 times highly vulnerable to
psychosis than those without family history. On the other hand the study stated that patients with
earlier age onset of epilepsy had experienced psychosis than patients with late onset. According
to the study this would explain the biological etiology of psychosis among epilepsy patients.
Moreover the study insisted that patients with complex partial seizure had two times higher
diagnosis of epilepsy compared to those without complex partial seizure (Adachi et al., 2000)

A case control study that was performed to study psychosis among epilepsy patients in
Netherlands revealed that comorbid chronic medical illnesses as well as types of seizures were
significantly linked with the existence of psychosis among epilepsy patients. Among those
patients who had psychosis 20% of them had AIDS who showed delusional manifestation of
paranoid type. On the other hand other individuals who had psychosis also had comorbid
hyperthyroidism that also manifested delusions as well as hallucinations. Apparently the type of
seizure had an effect on the occurrence of psychosis. The study identified that among the
epilepsy patients who developed psychosis, 53.1% of them were of generalized tonic clonic
seizure, and 14.2% were partial complex partial seizures. The study further illustrated that 44.8%
of epilepsy patients who later had psychosis manifestations, had a family history of psychosis.
(Feltz-cornelis, Aldenkamp and Ade, 2008)

A case control study was conducted with the intension of clarifying factors that are responsible
for the diagnosis of psychosis among epilepsy patients in Japan. The study assessed factors such
as, family history of psychosis, epilepsy type, and the presence of complex partial seizures, these
were the factors that were significantly correlated with psychosis of epilepsy. Moreover the study
also stated that AEDs inadherence is also associated with the diagnosis of psychosis of epilepsy.
(Adachi et al., 2002)

According to a case control study that was undertaken in Japan to assess the potential associated
factors of interictal psychosis among patients diagnosed with epilepsy, the associated factors
responsible were AEDs inadherence, prolonged duration of epilepsy, age at onset of epilepsy and
type of epilepsy. The study reviewed records of 132 epileptic psychosis patients and compared to

14 | P a g e
it with epilepsy patients with no history of interictal psychosis. The study illustrated that 34% of
epilepsy patients who experienced psychosis, had history of AEDs inadherence. Moreover the
study reported that there was a significant association among long duration of epilepsy and early
age of onset of epilepsy.(Kanemoto, Tsuji and Kawasaki, 2001)

According to a retrospective study that was conducted in Netherlands to assess treatment of

interictal psychiatric disorder in epilepsy and chronic psychosis among epilepsy patients,
revealed issues concerning AEDs induced psychosis, which usually occurs shortly after
beginning a new AED or due to inadherence of the medications. Furthermore the study also
reported that phenytoin to cause psychosis. The study also further illustrated the predisposing
factors of psychosis to be, complex partial seizures and female sex were associated with
psychosis among epilepsy patients.(Feltz-cornelis, 2002)

According to a study that was performed in Netherlands on treatment of psychiatric disorders

among epileptic patients the study implicated the major predisposing factors responsible for the
occurrence of psychosis among epilepsy patients, the study reported lack of social support and
stigma and pressure from the community.(Feltz-cornelis, 2002)

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Demographic factors
Social factors
Age
Sex Stigma
Educational Level
Discrimination
Marital status
Social support
Occupation

Epileptic

Psychosis

Psychological factor Biological factors

Loneliness Family history

Antiepileptic drug adherence

Type of seizure

Medication Type

Duration of Treatment

Figure 1: Conceptual framework psychosis of epilepsy

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CHAPTER FOUR-METHODS AND MATERIALS

4.1 Study Design and Period

Institution based crossectional study was conducted from November 9 to December 11 2020 G.C

4.2 Study Area

The study was conducted at HUCSH & Adare general hospitals. The hospitals are located in
SNNPR, which is 273Kms far from AA, the capital city of Ethiopia. HUCSH was established in
1998 E.C and it is located around mount Tabor and it is bounded by Hawassa Lake. Currently it
contains 12 OPDs and 10 inpatients departments and provides medical service for over
18,000,000 people. The hospital has Neurology OPD every Monday and Thursday. There are
about 150 patients per month at the OPD. Adare general hospital was established in 1954 E.C it
is located around Piassa. The hospital has 11 OPDs and 10 inpatient departments and serves for
350,000 people. Among these OPDs; the one is psychiatry OPD: only 2 BSc psychiatry nurses
are giving service for psychiatric patients. Epilepsy presentations are 250 cases per month

4.3 Source and Study Population

4.3.1 Source population

All patients with epilepsy who were attending outpatient department of HUCSH and Adare
General Hospital during the study period.

4.3.2 Study Population

All sampled epilepsy patients who were attending outpatient department HUCSH and Adare
General Hospital during the study period

4.3.3 Study Unit

Individual epilepsy patients who were available at the time of data collection period and who
fulfilled inclusion criteria and gave actual data

4.4 Inclusion and Exclusion Criteria

4.4.1 Inclusion Criteria

 Patients who were diagnosed as epilepsy and who visited the outpatient units of HUCSH
and Adare general hospitals during the study period.

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  Patients who had been clinically diagnosed as epilepsy and who were in the age group 18
and above.

4.4.2 Exclusion Criteria

 Individuals who were severely ill and were unable to participate cooperatively in the
study due to his/her illness

4.5 Sample Size Determination and Sampling Technique

4.5.1 Sample Size Determination

The minimum number of sample required for the study was determined by using the formula to
estimate single population proportion, since there was no study that was conducted in Ethiopia;
so we used p-value of 0.5

2
Zα
2
n 0= 2
. P(1−P)
d

n= minimum sample size required for the study

z= standard normal* distribution with confidence interval of 95%, z=1.96

d= absolute precision or tolerable margin of error, d=0.05

p= is the anticipated population proportion, which in this case was 0.5

Considering a 95 %confidence interval and 5 % degree of precision, we would obtain a sample

size of 384.

But since the study population was lower than 10,000 during the study period. We had to use
correction form
ula in order to obtain representative sample.

n× N 384 × 400
nf = = =196
N +n 384 +400

18 | P a g e
Adding non-response rate of 10%, 196+20=216

4.5.2 Sampling Technique

Systematic random sampling technique was used to select the study participants from patients
with epilepsy who came for follow up during data collection period. We chose Patients at regular
interval called sampling interval. We calculated the sampling interval 'k' by using the formula
k=N/n where 'N 'all epileptic patients seen in HUCSH and Adare general hospital ' n' total
sample size. K=400/=1.85 so k=2

Therefore, we select one randomly and continue for every other patient.

4.6 Study Variable

4.6.1 Dependent Variable

The existence of psychosis among epilepsy patients

4.6.2 Independent Variable

 Sociodemographic factors
 Age
 Sex
 Marital status
 Educational status
 Place of residence
 Occupation
 Ethnicity
 Religion
 Clinical factors and other associated factors
 Medication type
 Duration of treatment
 Duration of illness
 Medication adherence
 Family history
 Perceived Stigma and
 Poor Social Support

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  Seizure type

4.7 Data Collection Procedures

4.7.1 Data Collection

Data was collected by fifth year regular psychiatry nursing students by utilizing interview guided
structured questionnaire that was prepared in English and translated to Amharic. Furthermore we
also documented the information we obtained from the patient profile. As for the data collection,
we managed to use several steps from distribution of questionnaires to collecting the instrument.
Prior to data collection, the understandability, reliability and validity of the instrument was
assessed. After receiving the green light from our advisors, we prepared an informed consent and
began data collection from the selected participants. Consequently after the collection was
completed, we checked for any constraints in the questionnaire that might be missed or remained
unanswered questions. Following the checking for data completion, we were ready for data entry
and analysis.

4.7.2 Data Collection Instrument.

Morisky Medication Adherence Scale-8 (MMAS-8)- The eight-item Morisky Medication
Adherence Scale (MMAS-8)is a structured self-report measure of medication-taking behavior. It
was developed from a previously validated four-item and supplemented with additional items
addressing the circumstances surrounding adherence behavior. This measure was designed to
facilitate the recognition of barriers to and behaviors associated with adherence to chronic
medications such as psychiatric drugs. The scale provides information on behaviors related to
medication use that may be unintentional (e.g., forgetfulness) or intentional (e.g., not taking
medications because of side effects). The Morisky Medication Adherence Scale (MMAS-8)
remains one of the most widely used mechanisms to assess patient adherence. Its translation and
testing on languages in addition to English would be very useful in research and in practice.
(Cuevas and Pe, 2015)

Oslo’s 3 Item Social Support Social support Scale: The OSS-3 provides a brief measure of
social functioning and it is considered to be one of the best predictors of mental health31. It
covers different fields of social support by measuring the number of people the respondent feels

20 | P a g e
close to, the interest and concern shown by others, and the ease of obtaining practical help from
others.(Abiola et al., 2013)

Psychosis Screening Questionnaire- In our study, psychosis was defined as the presence of
at least hallucinations, delusions, or severe behavioral abnormalities in a state of full
consciousness; there could be no delirium. Based on DSM-5 psychosis is an impaired
reality testing manifesting by at least one delusion, Hallucination and disorganized
behavior.

Kilifi Stigma Scale of Epilepsy (KSSE) is a culturally appropriate measure with strong
psychometric properties and could be adapted and validated for use in other settings. It can be
administered to PWE or their caregivers. The scale will help researchers assess perception of
stigma in epilepsy and measure how this changes over time. The scale also allows objective
quantification, which can be used to assess public health interventions aimed at reducing stigma.
(Mbuba et al., 2012)

4.8 Data Quality Control

To assure the quality of the data special attention was paid to ensure that the patients clearly
understand the instructions about answering the questionnaire. In addition, they were asked not
to write their name or identification on the questionnaire in order to encourage them to provide
more open and honest answers. The filled forms were collected in the same session. Pre-test was
conducted to know the time needed to complete one questionnaire and to know whether the
questionnaire used is understandable to the study participants or not. The data collected during
the pre-test will not be included in the final analysis. Again the information was checked for
completeness before and during data processing for proper collecting and recording. Finally,
multivariate analysis was run in the binary logistic regression model to control the confounding
factor.

4.8.1 Data processing and Analysis

The data was checked by the investigators for their completeness and data coded and entered to
Epi data version 3.1. Following the data entry, it was exported to Statistical Package for Social
Sciences version 26 (SPSS-26) for further analysis. Descriptive statistics was used to see
frequency, mean, standard deviation and percentages of the characteristics. Binary logistic

21 | P a g e
regression was used to the assess relationship between the independent variables with the
dependent variable and multivariate logistic regression to control the effect of possible
confounders. All variables with p-value ≤ 0.2 were taken into the multivariable model to control
for all possible confounders and finally the strength of the association was measured by odds
ratio with 95% CI and P-value less than 0.05 will be considered as statistically significant.

4.8.2 Operational Definition

Psychosis Screening Questionnaire-As per our study, psychosis was defined as the presence at
least one of hallucinations, delusions, or strange behavioral abnormalities in a state of full
consciousness and must be at least one day. We utilized Psychosis Screening Questionnaire
(PSQ)-which contains assessment of hallucination, delusion, fulfilling at least one of these in a
clear consciousness and at least one day would be experiencing psychosis.

Kilifi Stigma Scale of Epilepsy (KSSE)-It is a simple three point scoring system scored as not
at all (0), sometimes (1) and always (2).A total of score will be calculated by adding of all item
scores. A patient who score above 66th percentile of the data measured by kilifi stigma scale of
epilepsy (KSSE)

Oslo’s 3 Item Social Support Social support Scale: scoring 3-8 on Oslo 3 item social support
scale. Moderate social support: scoring 9-11 on Oslo 3 item social support scale. Strong social
support: scoring 12-14 on Oslo 3 item social support scale.

Morisky Medication Taking Adherence Scale: It is a structured and validated questionnaire

used to assess the medication taking behavior of individual patients. A scoring 8 on MMTAS of
is High adherence, scoring of 6-7 is intermediate adherence; and scoring of < 6 low adherence

4.8.3 Ethical Considerations

The permission was obtained from the school of nursing and the data collectors clearly explained
the aim of the study for the study participant. The information was collected after obtaining,
verbal consent from each participant and the right was given to study participants to refuse or
discontinue the participation at any time during the period of data collection. Measures were

22 | P a g e
taken to assure respect, dignity and freedom of each individuals participating in the study.
Information on the purpose and procedures of the study was explained; issue of confidentiality of
information was assured verbally to all study subjects. During the time of data collection all
personal information will be kept confidential. The privacy and respect for the patient was
secured and we had not done any activity that can harm the participant.

4.9 Limitation of the Study

 The paucity of literatures that are done in Ethiopia and other areas of Africa countries
those are compatible with the sociocultural structure of our country, which makes a
comparative analysis of the regions situation regarding this topic difficult.

23 | P a g e
CHAPTER FIVE –RESULTS

5.1 Sociodemographic Characteristics of the study participants

A total of 208 people living with epilepsy were involved with study with a response rate of 97%.
The majority of the participants were female 113 (51.9%). The mean age of the participants was
30.71 ± 7.4 years. The majority of the participants were married 99 (47.6%). Eighty six (41%) of
the individuals were secondary educated. On the other hand the majority of the participants 79
(38 %) were protestant. Out of the total participants 70 (33.7%) were Sidama by ethnicity In
addition to that out of 208 study participants 60 (28.8) were working on private business.
Moreover most of 135 (65.9%) reside in the urban area of the country.

Table 1: Sociodemographic Characteristics of the study participants at HUCSH and Adare

General Hospital 2020
No. Variable Category Frequency Percentage

1 Sex Male 95 48.1

Female 113 51.9
2 Age 18-24 45 21.6
25-34 104 50
35-44 52 25
≥45 7 3.4
3 Marital status Single 78 38.5
Married 101 47.6
Divorced 28 13.5
Widowed 1 0.5
4 Educational status Primary 53 25.5
Secondary 86 41.3
Diploma 40 19.2
First Degree 29 13.9
5 Religion Orthodox 55 26.4
Protestant 79 38
Muslim 45 21.6
Catholic 13 6.3
Other 16 7.7
6 Place of Residence Rural 73 35.1

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 135
Urban 64.9

Figure 2: Employement status of the study participants at HUCSH and Adare General
Hospital 2020

25 | P a g e
 Amhara
Orommo
Sidamma
Debub
Other

Figure 3: Ethnicity distribution at HUCSH and Adare General Hospital 2020

5.2 Clinical Characteristics and other factors of the study participants

Among the total participants of 208 epileptic patients the majority 75 (36.1%) had intermediate
social support. In addition to Furthermore our study illustrated that large amount of 117 (57.7 %)
of the epilepsy patients have perceived stigma. On the other hand we also attempted to assess the
medication adherence of these study participants. It turned out to be that the majority 82
(39.42%) had high inadherence.

Moreover almost all 179 (86.1%) of the study participants had a diagnosis of Generalized tonic
clonic diagnosis. In addition to that the majority 70 (33.7%) of the study participants were
prescribed with an AED of Sodium Valproate. The majority 184 (88.5%) of the epilepsy patient
didn’t receive any comorbid chronic medical illness. Among the study participants 10.6% of the
epileptic patients had a family history of mental illness where as 12.5% of them had family
history epilepsy. In addition to that the majority 98 (47.1%) had duration of illness of at most
five years.

26 | P a g e
Table 2: Clinical and other associated factors of the study participants at HUCSH and
Adare General Hospital 2020
No. Variable Category Frequency Percentage

1 Social support Poor support 69 33.2

Intermediate support 75 36.1
Strong support 64 30.7
2 Perceived stigma Yes 117 56.25
No 91 43.75
3 Medication Adherence Low inadherence 71 34.14
Moderate inadherence 55 26.44
High inadherence 82 39.42

4 Seizure type Tonic clonic seizure 179 86.1

Absence seizure 1 0.5
Myoclonic seizure 4 1.9
Simple partial seizure 0 0
Complex partial seizure 24 11.5
5 Medication type Valproate 70 33.7
Carbamazepine 37 17.8
Phenytoin 57 27.4
Phenobarbital 44 21.2
6 Duration of illness ≤5 years 98 47.1
6-10 years 71 34.1
≥ 11years 39 18
7 Duration of treatment ≤5 years 149 71.6
6-10 years 40 19.2
≥11 years 19 9.1
8 Family history No family history 77 37.02
Psychosis or MI 65 31.25
Epilepsy 66 31.73

27 | P a g e
5.3 Prevalence of psychosis among epilepsy patients
Overall the prevalence of psychosis among epilepsy patients was found to be 87 (41.8%).
Regarding the manifestations of psychosis the predominant manifestation was 62 (70.3%)
hallucination. The majority of epilepsy patients experienced visual hallucination as well as
auditory hallucination. Furthermore the study revealed that 28(32.2%) of them had delusions,
predominantly delusion of reference.

5.4 Associated factors of psychosis among epilepsy patients

During a logistic binary regression social support, Perceived stigma, Medication adherence, the
seizure type, family history and duration of illness have been shown to be associated with
existence of psychosis among epilepsy patients at p-value <0.2.On the other hand sex, marital
status, religion, ethnicity, educational level, job, place of residence, type of medication and
duration of illness.

From the multivariate Duration of illness 6-10years (AOR=2.34, CI 1.085, 5.064), ≥ 11years
(AOR=2.16 (1.074, 4.33); Family history, History of Psychosis or other mental illness
(AOR=2.5, CI 1.12, 5.6), Family History of epilepsy an (AOR=1.95, CI 0.94, 4.04); Seizure type
, Tonic clonic seizure (AOR=2.5 CI 1.03, 6.06); Adherence Medium (AOR=2.5, CI 1.2, 5.07),
low adherence (AOR=2.1 CI 1.003, 4.4). These were the factors significantly associated with
psychosis of epilepsy< 0.05.

Table 3: Factors associated with psychosis among epilepsy patents (Bivariate and
Multivariate analysis) at HUCSH and Adare General Hospital 2020, n=208

Variable Category Psychosis COR(95 %CI) AOR (95 p-

s %CL) valu
Yes (%) No (%) e

Age 18-24 26 (57.8%) 19 (42.2%)

25-34 43 (41.3%) 61 (58.7%) 1.94 (0.956, 3.943)
35-45 18 (34.6%) 34 (65.4 ) 2.58 (1.14, 5.883)
Sex Male 62 (65.7%) 51 (47.3%)
Female 59 (55.3%) 36 (39.7%) 0.742 (0.425,1.293)
Marital Single 34 (43.6%) 44 (56.4%)

28 | P a g e
status Married 46 (45.5%) 55 (54.5%) 0.94(0.51, 1.67)
Divorced 7 (25%) 21 (75%) 2.32 (0.883, 6087)
Educatio Primary 24 (45.3%) 29 (54.7%) 0.46 (0.173, (1.224)
nal status Secondary 42 (48.8%) 44 (51.2%) 0.399 (0.159, 0.999)
Diploma 13 (32.5) 27 (67.5%) 0.79(0.28, 0.26)
Degree 8 (27.6%) 21 (72.4%)
Job Gov. employ 12 (28.6%) 30 (71.4%)
(Employ Private bus. 24 (40%) 36 (60%) 0.6 (0.26, 1.4)
ment) Farmer 7 (50%) 7 (50%) 0.4 (0.12, 1.39)
Daily laborer 9 (47.4%) 10 (52.6%) 0.44 (0.15, 1.4)
Student 18 (47%) 20 (52%) 0.44 (0.18, 1.12)
Household w 4 (44.4%) 5 (55.6%) 0.5 (0.11, 2.2)
Jobless 13 (50%) 13 (50%) 0.4 (0.144, 1.11)
PlaceResi Urban 53 (39.3%) 82 (60.7%) 1.35 (0.78, 2.4)
dence Rural 34 (46.6%) 39 (53.4%)
Social Poor 20 (29%) 49 (71%) 2.61(1.27, 5.33) 1.67(0.76,
support 3.7)
Intermediate 34 (45.3%) 41 (54.7%) 1.28 (0.67, 2.5) 1.26 (0.6,
2.6)
Strong 33 (51.6%) 31 (48.4%)
Perceived Yes 39 (33.3%) 78 (66.7%) 2.233 (1.27, 3.9)
Stigma No 48 (52.7%) 43 (47.3%)

Medicati Low 21 (29.6%) 50 (70.4%) 2.89 (1.48, 5.65) 2.5 (1.2,5.05) 0.01
on 4**
Adherenc *
e Medium 21(38.2%) 34 (61.8%) 1.97 (0.98, 3.95) 2.01(1.003,4 0.04
3 ***
High 45 (54.9%) 37 (45.1%) 1 1
Seizure Tonic clonic 68 (38%) 111 (62%) 3.1 (1.3, 7.1) 2.5 (1.03, 0.04
Type 6.606) 4**
*
Complex 19 (65.5%) 10 (34.5%) 1 1
partial

29 | P a g e
 Family No Hx 42 (54.5%) 35 (45.5%) 1 1
History Hx 21 (32.3%) 44 (67.7%) 2.5 (1.26, 4.99) 2.48 (1.12, 0.01
psychosis & 5.17) 5**
other MI *
Hx epilepsy 24 (36.4%) 42 (63.6%) 2.1 (1.07, 4.11) 1.95 (0.94, 0.07
4.04) 2
Duration ≤5years 43 (53.8%) 37 (46.3%) 1 1
of illness 6-10 years 17 (30.9%) 38 (69.1%) 2.59(1.2, 5.3) 2.34 (1.085, 0.03
5.06) ***
≥11 years 27 (37%) 46 (63%) 1.9(1.03, 3.7) 2.12 (1.08, 0.03
4.3) **

Note. ***Statistically significant at p<0.05 by utilizing Backward LR regression Method

30 | P a g e
CHAPTER-SIX DISCUSSION
The aim of this study was to assess the prevalence and associated factors of psychosis among
epilepsy patients at Hawassa University Comprehensive Specialized Hospital (HUCSH) and
Adare General Hospital .In this study the prevalence of psychosis among epilepsy patients was
41.8% .The result of this study is similar to that of the study done in Brazil 44.6%(Maria et al.,
2007). The results of this study support the study carried out elsewhere as psychosis is a common
problem among epileptic patients. Furthermore the results of this study was lower than the study
conducted in Zambia (Venevivi, Mbewe and Paul, 2016), which was a crossectional study on
397 epilepsy patients. The probable explanation for the variation of the results might be due to
use of different tools, geographical areas as well as sample size. For instance in Zambia the Brief
Psychiatric Rating Scale (BPRS) was utilized.

On the other hand the prevalence of psychosis among epilepsy patients in this study is higher
than the study carried out in Netherlands 5.4 (Feltz-cornelis, Aldenkamp and Ade, 2008),
Australia 5.9 % (Hilger et al., 2016), Mexico 8.3% (Article, 2017), United Kingdom 4.6% (Elst
et al., 2002), Brazil 8.4 (Bragatti et al., 2011) Ireland 7% (Irwin et al., 2014), USA 6.77%
(Kanner, 2009), Barcelona 9% (Carren et al., 2009), Kenya 5.6%(Gloria, 2019) and others
(India, Japan, Austria, Norway, Australia). The possible explanation for this is variation in
sample sizes, geographical areas, socioeconomic and culture of the study participants. Usually
the Mini-International Neuropsychiatric Interview (M.I.N.I.), a short structured interview, which
is utilized in several studies to assess psychiatric disorders in both Europe and USA.

Looking into the associated factors, those epilepsy patients with low adherence of AEDs are 2.9
more likely (AOR=2.9, CI 1.48, 5.65) to experience psychosis than those with strong AED s
adherence. The study further illustrated that those epilepsy patients with medium AEDs
adherence are 1.97 times more likely.(AOR=1.97, CI 0.98, 3.95) to have psychosis than those
with strong adherence to AEDS. These results were consistent with the previous studies
(Kanemoto, Tsuji and Kawasaki, 2001; Adachi et al., 2002; Feltz-cornelis, Aldenkamp and Ade,
2008). In addition to that those epilepsy patients with family history of epilepsy

Among those epilepsy patients who with family history of psychosis or other mental illness, they
are 2.5 more likely (AOR=2.5, CI 1.12, 5.17) to develop psychosis than those with no any family
history. Furthermore epilepsy patients with family history psychosis or other mental illness
31 | P a g e
are1.95 times (AOR=1.95, CI 0.94, 4.04) more likely to develop psychosis than those without
any family history. These results were consistent with other previous studies.(Adachi et al.,
2002; Feltz-cornelis, 2002; Bragatti et al., 2010). This might explain the genetic vulnerability of
epilepsy patients for the subsequent development of psychosis and other psychiatric disorders.

Those epilepsy patients who had a diagnosis of generalized tonic clonic seizure are 2.5 times
more likely (AOR=2.5, CI10.03, 6.606) to develop psychosis than those with complex .partial
seizure. These results were not consistent with other previous studies. This might be due to two
important points. The first one is due to large amounts of generalized tonic-clonic cases in the
sample which could result in inevitable association. Secondly this might be due to lack of
specific diversified diagnosis in Ethiopia. Other classes of seizure need advanced medical
diagnostic instruments that are not easily accessible in our study area, and neither in Ethiopia for
that matter.

32 | P a g e
CHAPTER SEVEN-CONCLUSION AND RECOMENDATION

7.1 Conclusion
Overall the prevalence of psychosis among epilepsy patients was found to be high. Low and
intermediate AEDs adherence, family history of psychosis or other mental illness and epilepsy,
epilepsy patients 6-10 years and as well as longer durations of epilepsy, Generalized tonic clonic
seizure were the factors significantly associated with epilepsy.

7.2 Recommendation
Regular screening for the past and current comorbid psychiatric disorders needs to be
incorporated into the evaluation of every person with epilepsy. Therefore, clinical assessment
which includes obtaining patients family history of mental illness should be included in
management. Management of comorbid psychiatric condition including psychosis.

33 | P a g e
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meta-analysis’.

Cleary, R. A. et al. (2013) ‘Postictal psychosis in temporal lobe epilepsy : Risk factors and
postsurgical outcome ?’, Epilepsy Research, 106(1–2), pp. 264–272. doi:
10.1016/j.eplepsyres.2013.03.015.

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Adherence Scale ( MMAS-8 ) in a psychiatric outpatient setting’. doi:
10.1016/j.ijchp.2014.11.003.

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attitudes , and practices towards persons with epilepsy in South Ethiopia : A comparative
community-based cross-sectional study’, Epilepsy & Behavior, 58, pp. 106–110. doi:
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Residents in Ethiopia : A Cross-Sectional Study’.

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resonance imaging study in patients with temporal lobe epilepsy’, 10, pp. 140–149.

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epilepsy ( Review )’, (12). doi: 10.1002/14651858.CD006118.pub3.www.cochranelibrary.com.

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patients and other chronic medically ill patients and the role of cerebral pathology in the onset of
psychosis : A clinical epidemiological study’, 49, pp. 446–456. doi:
10.1016/j.seizure.2007.12.004.

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Chronic psychosis’, pp. 44–48.

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of Epileptic Patients at Yirgalem General Hospital , Southern Ethiopia : A Prospective Cross-
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ANNEXES

Annex -1 Declaration
We, the group, declare that this paper entitled “ Prevalence and associated factors of psychosis
among epilpesy patients attending at HUCSH and Adare General Hospital2020 G.C is our own
original work and as far as we are concerned this is the first of its kind in Ethiopia.Therfore, we
strictly insist that under our supervision we recommend that the students have fullfilled the
requirements and and all the source of material used for this thesis has been fully acknowledged .

NAME. SIGNATURE. DATE

1. MELAT ASSEFA
2. MENGISTU ADDISU
3. MUBAREK MOHAMMED
4. TEFERA ADDIS
5. SEIFESLASSIE WENDWOSEN

This thesis has been submitted for examination with our approval as research advisors.

NAME SIGNATURE DATE

1. YACOB ABRAHAM ________________ _________________

2. FIKRU TADESSE ________________ __________________

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Annex-2 Information Sheet and Consent Form
Hello! We are Hawassa university psychiatric nursing students, We are here to collect data for
the research purpose which is conducted to complete a thesis for Bachelor Degree of
Psychiatry Nursing. The purpose of the study is to determine the prevalence and associated
factors of psychosis among epilepsy patients attending Hawassa University Comprehensive and
Specialized Hospital 2020 G.C.

You are selected to be one of the participants in the study. We would like to ask you to fill this
questionnaire that takes 15 to 20 minute of your time. No harm is imposed to you except the time
you commit for interview, some of the question may look too personal but it is helpful for the
study. In addition, there is no payment for participation even though the result of the study may
benefit as a citizen. Your name will not be written in this form and all information that you give
will be kept strictly confidential your participation is voluntary and you are not obliged to answer
any question if you do not wish to answer. However, your honest answers to these questions are
important since it provide relevant information to design interventions that aims to improve the
quality of life among patient with schizophrenia.

The information you provide is confidential and it will be used only for study purpose and it will
not be disclosed to anyone. A code number will be used to identify the participant therefore,
writing your name is not needed.

Do you agree to participate in the study? Please make (X) mark to indicate the agreement.

a) Agree _____ b) Disagree_____

Thank you!!

Interviewer name______________________ Signature_______________

Checked by supervisor: Name____________________ Signature______ Date_______

40 | P a g e
Result of interview: 1. Completed------------- 2. Incomplete------------

Annex -3 English Version of the Questionnaire

INSTRUCTION:. Circle the alternatives you have chosen number given parallel to the answer
you choose and for questions that you give direct answer, write the answer in the space provided.

You will be tried to respond all questions. Thank you very much for your coordination.

Section one: Socio demographic information

No. Questionnaire Alternative

Q1 Sex 1.Male
2.Female
Q2 Age Age in years--------------
Q3 Marital status? 1.single
2.Married
3.divorced
4.widowed
Q4 Religion? 1.Orthodox
2.protestant
3.muslim
4.Catholic
5.others(specify)---------------
Q5 Ethnicity? 1.amhara
2.oromo
3.tigre
4.gurage
5.others(specify)-----------------
Q6 Job? 1.governmet employed
2.private business
3.farmer

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 4.daily laborer
5.student
6.house hold worker
7.Jobless
8.others
Q7 Educational level? 1. Primary
2. .secondary,
3. diploma,
4. First degree
0ther…………………..
Q8 Place of residence? 1. rural
2.urban

Section two: Measurement of social support

The following three questions ask about how you experience your social relationships. The
inquiry is about your immediate personal experiences. Please indicate the option that represents
your experience

Q50 How many people are so close None 1 or 2 3-5 More

3 to you that you can count on 1 2 3 than 5
them it you have great personal 4
problems (choose one option)?
Q50 How much concern do people A lot of Some Uncertain Little No
4 show in what you are doing concern concern 3 concern concern
(choose one option)? and and and and
interest interest interest interest
5 4 2 1
Q50 How easy is it to get practical Very Easy Possible Difficult Very
5 help from neighbors if you easy 4 3 2 difficult
should need it (choose one 5 1
option)?

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Section 3 -Kilifi stigma scale of epilepsy (KSSE)

Questionnaire Alternatives
Not at Sometimes= Always
all=0 1 =2
Q1 Do you feel different from other people?
Q2 Do you feel lonely?
Q3 Do you feel embarrassed?
Q4 Do you feel disappointed in yourself?
Q5 Do you feel you cannot have a rewarding
life?
Q6 Do you feel you cannot contribute
anything in society?
Q7 Do you feel you cannot join others in
public places?
Q8 Do you feel other people are
uncomfortable with you?
Q9 Do you feel other people don‘t want to go
to occasions with you?
Q10 Do you feel other people treat you like an
inferior person?
Q11 Do you feel other people would prefer to
avoid you?
Q12 Do you feel other people avoid
exchanging greetings with you?
Q13 Do you feel you are mistreated by other

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 people?
Q14 Do you feel other people discriminate
against you?
Q15 Do you feel other people treat you like an
outcast?

Section - 4 Morisky Medication-Taking Adherence Scale-MMAS

No. Questions No=0 Yes=1

Q1 Do you sometimes forget to take your medication?
Q2 People sometimes miss taking their medicines for reasons other than
forgetting. Thinking over the past two weeks, were there any days when
you did not take your medicine?
Q3 Have you ever cut back or stopped taking your medicine without telling
your doctor because you felt worse when you took it?
Q4 When you travel or leave home, do you sometimes forget to bring along
your medicine?
Q5 Did you forget to take all your medicines yesterday?
Q6 When you feel like your symptoms are under control, do you
sometimes stop taking your medicine?
Q7 Taking medicine every day is a real inconvenience for some people. Do
you ever feel hassled about sticking to your treatment plan?
Q8 How often do you have difficulty remembering to take all your A=0 B-
medicine? E=1
A. Never/rarely
B. Once in a while
C. Sometimes
D. Usually
E. All the time

44 | P a g e
Section 5 Types of Seizures and other associated clinical factores

No. Category Response

Q1 Seizure type 1. Tonic-Clonic seizure
2. Myoclonic seizure
3. Absence seizure
4. Simple partial seizure
5. Complex partial seizure
6. Others

Q2 Duration of illness 1. <=5years

2. 6-10years
3. >=11years
Q3 Duration of treatment 1. <=5years
2. 6-10years
3. >=11years
Q4 Medication Type 1. Yes
2. No
Q5 Family History 1. History of Epilepsy
2. History of Psychosis
3. No History

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Section 6 Psychosis screening questionnaire (PSQ)

No. Category Response

Q1 Over the past year have there been times when 1. Yes
you felt very happy indeed without a break for 2. Unsure
days on end? 3. No
a) Was there an obvious reason for this? 1. Yes
2. Unsure
3. No
b) Did your relatives or friend s it think it was 1. Yes
strange or complain about it ? 2. Unsure
3. No
Q2 Over the past year have you ever felt that your 1. Yes
thoughts were directly interfered with or 2. Unsure
controlled by some outside force or person 3. No
a) Did this come about in a way that many people 1. Yes
would find hard to believe , for instance , 2. Unsure
through telepathy ? 3. No
Q3 Over the past year have there been times when 1. Yes
you felt that people were against you? 2. Unsure
3. No
a) Have there been times when you felt that people 1. Yes
were deliberately acting to harm you or your 2. Unsure
interest? 3. No
b) Have there been times when you felt that a group 1. Yes
of people was plotting to cause you serious harm 2. Unsure
or injury? 3. No
Q4 Over the past year have there been times when 1. Yes

46 | P a g e
 you felt something strange as going on? 2. Unsure
3. No
a) Did you feel it was so strange that other people 1. Yes
would find it hard to believe ? 2. Unsure
3. No
Q5 Over the past year have there been times when 1. Yes
you heard or saw things that other people could 2. Unsure
not 3. No
a) Did you at any time hear voices saying quite a 1. Yes
few words or sentences when there was no one 2. Unsure
around that might account for it? 3. No

47 | P a g e
Annex-4 Amharic Version of The questionnaire
የአማርኛትርጉምቃለ-መጠየቅእናየፍቃድቅጽ

ሰላም!

እኛየሐዋሳዩኒቨርሲቲየአእምሮህክምናነርሲንግተማሪዎችነን፣ለሳይካትሪነርስየመጀመሪያዲግሪለመመረቅየተካ

ሄደውንለምርምርዓላማመረጃለመሰብሰብእዚህተገኝተናል፡፡

የጥናቱዓላማበኢትዮጵያአዲስአበባ፣አማኑኤልአእምሯዊስፔሻላይዝድሆስፒታልበሚገኙትየሚጥልበሽታህመ

ምተኞችመካከልየስነልቦናስርጭትንእናተጓዳኝነገሮችንለማወቅነው፡፡

ከጥናቱተሳታፊዎችአንዱለመሆንተመርጠዋል፡፡ከእርስዎጊዜከ 15 እስከ 20

ደቂቃየሚወስድውንይህንመጠይቅእንዲሞሉእንጠይቃለን።ለቃለ-

መጠይቅከፈፀሙበትጊዜበስተቀርምንምጉዳትበእርስዎላይየለውም፣አንዳንድጥያቄዎችበጣምግላዊቢመስሉም

ለጥናቱጠቃሚናቸው፡፡በተጨማሪምየጥናቱውጤትእንደዜጋሊጠቅምቢችልምለተሳትፎክፍያየለም፡፡

ስምዎበዚህቅጽአይፃፍምእናምየሚሰጡትመረጃሁሉተሳትፎዎበጥብቅበሚስጥርይቀመጣልእናምእርስዎመልስ

ለመስጠትካልፈለጉማንኛውንምጥያቄየመመለስግዴታየለብዎትም፡፡

ሆኖምስኪዞፈሪንያውስጥበሕመምተኞችመካከልየኑሮጥራትእንዲሻሻልለማድረግእንደሚያስኬዱጣልቃገብነቶ

ችዲዛይንለማድረግተገቢመረጃስለሚሰጥእነዚህእውነተኛጥያቄዎችእውነተኛመልሶችዎጠቃሚናቸው፡፡

ያቀረቡትመረጃሚስጥራዊነውእናምለጥናትዓላማብቻየሚያገለግልሲሆንለማንምአይገለጽም፡፡

ስለዚህተሳታፊውንለመለየትየኮድቁጥርጥቅምላይይውላል፣ስምንመጻፍአያስፈልግም።

በጥናቱለመሳተፍተስማምተዋል? ስምምነቱንለማመልከትእባክዎየ ‹X› ምልክትያድርጉ፡፡

ሀ) እስማማለሁ _____ ለ) አልስማማም_____

አመሰግናለሁ!!

የቃለመጠይቅስም ______________________ ፊርማ _______

48 | P a g e
በተቆጣጣሪቼክተደርጓልስም ______ ፊርማ______ ቀን_______

የቃለመጠይቅውጤት 1.ተጠናቅቋል ------------- 2.አልተጠናቀቀም ------------

የአማርኛትርጉምቃለ-መጠየቅ

ክፍል 1፡የማህበራዊእናየግልመረጃዎችንለመሰብሰብየተዘጋጁጥያቄዎ

ተ.ቁ ጥያቄዎች አማራጭመልሶች

Q1 ፆታ 1.ወንድ
2.ሴት
Q2 ዕድሜ
--------------
Q3 የጋብቻሁኔታ? 1. ያላገባ

2. ያገባ

3. የተፋታ

4. የሞተበት

Q4 ሃይማኖት? 1. ኦርቶዶክስ

2. ፕሮቴስታንት

3.ሙስሊም

4. ካቶሊክ

5. ሌላ (ይግለጹ) ---------------

Q5 ብሄር? 1.አማራ

2. ኦሮሞ

49 | P a g e
 3.ትግሬ

4. መከላከያ

5. ሌላ (ይግለጹ) ---------------

Q6 ሥራ? 1.የመንግስትሰራተኛ

2. የግልስራ

3. ገበሬ

4. የጉልበትሰራተኛ

5. ተማሪ

6. የቤትሰራተኛ

7. ሥራ-አልባ

8. ሌላ……………

Q7 የትምህርትደረጃ? 1. የመጀመሪያደረጃ

2. ሁለተኛደረጃ

3. ዲፕሎማ

4. የመጀመሪያድግሪ

Q8 የቤተሰብአባላት? ……………………..
Q9 የመኖሪያቦታ? 1. ገጠር
2. ከተማ
ክፍልሁለት-ማህበራዊድጋፍንመለካት

የሚከተሉትሶስትጥያቄዎችማህበራዊግንኙነቶችዎንእንዴትእንደሚለማመዱይጠይቃሉ፡፡

ጥያቄውስለእርስዎየቅርብጊዜየግልልምዶችነው፡፡እባክዎየእርስዎንተሞክሮየሚወክልአማራጭንያመልክቱ

503. ምንያህሌሠውአደጋ (ችግር) 1. ምንም

በሚያጋጥሞትጊዜበቅርብየችግርዎተካፊይሊሆንልዎትይችላል? 2. 1 ወይም 2

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 3. 3-5
4. ከ 5 በላይ
5. ብዙ
4. ጥቂት
3.እርግጠኛ
504. ምንያህሌሠውስለእርስዎግዴይለዋል?
አይደለሁም
2. በጣምትንሽ
1. ምንም
5. በጣምቀላል
4. ቀላል
505. ከቅርብጎረቤትዎበተጨባጭእርዲታየማግኘትእድልዎምንያህልነው? 3. መጠነኛ
2. ከባድ
1. በጣምከባድ

ክፍል 3 -ኪሊፊየሚጥልበሽታ (KSSE)

መጠይቅ አማራጮች
በጭራሽ= አንዳንድጊዜ ሁልጊዜ
0 =1 =2
Q1 ከሌሎችሰዎችየተለዩእንደሆኑይሰማዎታል?
Q2 ብቸኝነትይሰማዎታል?
Q3 ሀፍረትይሰማዎታል?
Q4 በራስዎውስጥቅርተሰኝተዋል?
Q5 ጥሩሕይወትሊኖርዎትእንደማይችልይሰማዎታል?
Q6 በህብረተሰብውስጥምንምማበርከትእንደማይችሉይሰማዎ

ታል?
Q7 በሕዝባዊቦታዎችውስጥከሌሎችጋርመቀላቀልእንደማይች

ሉይሰማዎታል?
Q8 ሌሎችሰዎችለእርስዎየማይመቹእንደሆኑይሰማዎታል?
Q9 ሌሎችሰዎችከእርስዎጋርወደአጋጣሚዎችመሄድየማይፈል

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 ጉእንደሆኑይሰማዎታል?
Q10 ሌሎችሰዎችእንደዝቅተኛሰውሲቆጥሩዎትይሰማዎታል?

Q11 ሌሎችሰዎች

እርስዎንለማስወገድእንደሚመርጡይሰማዎታል?
Q12 ሌሎችሰዎችከእርስዎጋርሰላምታእንዳይለዋወጡይሰማዎ

ታል?
Q13 በሌሎችሰዎችእንደተበደሉይሰማዎታል?
Q14 ሌሎችሰዎችበእርስዎላይአድልዎእንደሚያደርጉይሰማዎታ

ል?
Q15 ሌሎችሰዎችእንደገለል ƒ ሰውያየዎትይመስልዎታል?

ክፍል 4፡ሞሪስኪየመድሀኒትክትትልመለኪያቅጽ::

አይደለ
ተ.ቁ ጥያቄዎች አዎ
ም
M
አሌፎአሌፎመድሃኒቶንመዉሰድይረሳሉ? 0 1
M1
M
ላለፉትሁለትሳምንታትዉሰጥመዳኒቶንሳይወስዱትየቀሩጊዜነበር? 0 1
M2
መዳንቶትንስወሰዱየሚብስቦትእየመሰልትመድሃኒቶንሀኪሞትንሳያማክሩ
M
ያቐረጡበት 0 1
M3
ጊዜነበር?
M ጉዞላይ/
0 1
M4 ከቤትበሚወጡበትጊዜአንዳንዴመድሃኒቶንይዘዉመዉጣትይረሳሉ?
M
ትላንትናሁለንምመድሃኒቶንወስድረስትዋል? 0 1
M5
M
አንዳንዴህመሞትየተሻሇዎትስመስሇዎትመድሃኒቶንመዉሰድያቆማለ? 0 1
M6
በየቀኑመድሃኒትመዉሰድአሰሌቺነዉ፣በእዉነቱአንቱመድሃኒቶንበትክክልሳ
M
የቆርጡ 0 1
M7
ተጨንቀዉበትለመዉሰድጥረትየደርጉነበር?
M ለምንያክልጊዜመድሃኒቶትንመወሰድይረሳለ? 1.
M8 በጭራሽአሌረ
ሳም

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 0፡
ከስንትጊዜአን
ዴ
2.
አንድአነድጊዜ
3. በብዛት
ሁሌጊዜ

ክፍል 5፡ የሚጥልህመምናየተያያዙጥያቄዎች

ተ.ቁ ጥያቄዎች ምላሽ

Q1 የሚጥልሕመምአይነት 7. ቶኒክ-ክሎኒክ

8. ማይክሎኒክ
9. አብሰንስ
10. ሰሲምፕልሲይዠር
11. ኮምፕሌክስ
12. ሌላ………..

Q2 የሕመምጊዜ 1. 5 ዓመትእናበላይ

2. 6-10 ዓመት

3. 11 ዓመትእናበላይ
Q3 የሕክምናቆይታ 1. 5 ዓመትእናበላይ

2. 6-10 ዓመት

3. 11 ዓመት እናበላይ
Q4 የመድኃኒትየጎንዮሽጉዳቶች 1. አዎ

2. አይደለም

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ቁጥር ጥያቄ ምላሽ
1 . አዎ
ባለፈው ዓመት በመጨረሻ ቀናት ሳያቋርጡ ያለ እረፍት በጣም ደስተኛ
Q1 2. እርግጠኛ አይደለሁም
ሆነው የተሰማዎት ጊዜዎች ነበሩ?
3. የለም
1 . አዎ
ሀ) ለዚህ ግልጽ የሆነ ምክንያት ነበር? 2. እርግጠኛ አይደለሁም
3. የለም
1 . አዎ
ዘመዶችዎ ወይም ጓደኛዎ እንግዳ ነገር ነው ብለው ያስቡ ነበር ወይም
ለ) 2. እርግጠኛ አይደለሁም
ስለእሱ አጉረመረሙ?
3. የለም
1 . አዎ
ባለፈው ዓመት ሀሳቦችዎ በቀጥታ በውጭ ኃይል ወይም ሰው በቀጥታ
Q2 2. እርግጠኛ አይደለሁም
ጣልቃ እንደሚገቡ ወይም እንደተቆጣጠሩ ተሰምተው ያውቃሉ
3. የለም
1 . አዎ
ይህ ለምሳሌ ብዙ ሰዎች ለማመን በሚቸገሩበት መንገድ የመጣ ነው
ሀ) 2. እርግጠኛ አይደለሁም
ለምሳሌ በቴሌፓቲ?
3. የለም
1 . አዎ
ባለፈው ዓመት ሰዎች እርስዎን እንደሚቃወሙ የተሰማዎት ጊዜዎች
Q3 2. እርግጠኛ አይደለሁም
ነበሩ?
3. የለም
ሀ) ሰዎች ሆን ብለው እርስዎን ወይም ፍላጎትዎን ለመጉዳት እንደ ሆኑ 1 . አዎ

2. እርግጠኛ አይደለሁም
የሚሰማዎት ጊዜ አለ?
3. የለም
የተወሰኑ ሰዎች እርስዎን ከባድ ጉዳት ወይም ጉዳት 1 . አዎ
ለ) ሊያደርሱብዎት 2. እርግጠኛ አይደለሁም
ሲያሴሩ የተሰማዎት ጊዜ አለ? 3. የለም
1 . አዎ
ባለፈው ዓመት እንደ አንድ እንግዳ ነገር
Q4 2. እርግጠኛ አይደለሁም
እንደተሰማዎት ጊዜያት ነበሩ?
3. የለም

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 1 . አዎ
ሌሎች ሰዎች ለማመን ይቸገራሉ የሚል እንግዳ ነገር
ሀ) 2. እርግጠኛ አይደለሁም
ሆኖ ተሰማዎት?
3. የለም
ባለፈው ዓመት ሌሎች ሰዎች የማይችሏቸውን ነገሮች 1 . አዎ
Q5 ሲሰሙ ወይም 2. እርግጠኛ አይደለሁም
ሲመለከቱ ያዩባቸው ጊዜያት ነበሩ 3. የለም
ተጠያቂ ሊሆን የሚችል ማንም ሰው በሌለበት ጊዜ
በጣም ጥቂት 1 . አዎ
ሀ) ቃላትን ወይም ዓረፍተ ነገሮችን የሚናገሩ ድምፆችን 2. እርግጠኛ አይደለሁም
በማንኛውም ጊዜ 3. የለም
ሰምተህ ታውቃለህ?

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