University of Washington:
Adapting the PEARLS Program for People with Epilepsy
- Paul Ciechanowski, MD, MPH. Principal Investigator
Compared with non-depressed people with epilepsy, those with depression and epilepsy have significantly higher rates of suicide, lower social and occupational functioning, decreased quality of life, and higher non-psychiatric health care use. Depression is recognized and adequately treated in only a minority of depressed people with epilepsy. Further, because adults with epilepsy may be homebound due to driver’s license restrictions and limited public transportation, opportunities to obtain care for depression may be limited.
In this project, investigators are taking a successful home-based depression treatment intervention called Program to Encourage Active, Rewarding Lives for Seniors (PEARLS) and adapting it for adults with epilepsy who have minor depression, major depression, and/or dysthymia. The modified intervention consists of problem solving treatment, social and physical activation, pleasant events scheduling, and support and education regarding medication use and coping with epilepsy. The intervention includes a multidisciplinary team of doctors, nurses, and social workers.
After completing revisions to the program, researchers will conduct a randomized controlled trial with participants to test the effectiveness of the intervention versus usual care. They will determine the intervention's acceptability, feasibility, and outcomes for eventual community-based dissemination.
PEARLS Training, April 8-9, 2010
PEARLS investigators, counselors, and administrative staff provided an overview of the program including findings from two randomized trials—one in older adults and one in adults with epilepsy. Participants learned about the foundation of PEARLS as a collaborative-care program that includes roles for the patient, their physician, and a mental health care provider. Participants also learned about the benefits of problem-solving treatment, behavioral activation, and pleasant-events scheduling as effective skill-building therapies for reducing depressive symptoms and as supplements to medication when necessary. PEARLS staff also described the resources needed to implement PEARLS in a local community. Attendees participated in a number of role-plays to apply the PEARLS methods in practice sessions.
Chaytor N, Ciechanowski P, Miller JW, Fraser R, Russo J, Unutzer J, Gilliam F.(2011) Long-term outcomes from the PEARLS randomized trial for the treatment of depression in patients with epilepsy. Epilepsy & Behavior.20(3):545-549.
View PubMed Abstract
Ciechanowski P, Wagner E, Schmaling K, Schwartz S, Williams B, Diehr P, Kulzer J, Gray S, Collier C, LoGerfo J.Community-integrated home-based depression treatment in older adults: a randomized controlled trial.JAMA.291(13):1626-8.
View PubMed Abstract
Ciechanowski P, Chaytor N, Miller J, Fraser R, Russo J, Unutzer J, Gilliam F.(2010).PEARLS Depression Treatment for Individuals with Epilepsy: A Randomized Controlled Trial. Epilepsy & Behavior. 2010 Jul 5. [Epub ahead of print]
doi:10.1016/j.yebeh.2010.06.003View PubMed Abstract
DiIorio C, Bamps Y, Edwards AL, Escoffery C, Thompson NJ, Begley CE, Shegog R, Clark NM, Selwa L, Stoll S, Fraser RT, Ciechanowski P, Johnson EK, Kobau R, Price PH.(2010). The Prevention Research Centers' Managing Epilepsy Well Network. Epilepsy & Behavior. 2010 Sep 22. [Epub ahead of print].
doi:10.1016/j.yebeh.2010.07.027.View PubMed Abstract