1
|
Ertan D, Mezouar N, Tarrada A, Maillard L, El-Hage W, Hingray C. Post-epileptic seizure posttraumatic stress Disorder: A mediation analysis. Epilepsy Behav 2024; 157:109863. [PMID: 38824749 DOI: 10.1016/j.yebeh.2024.109863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVE Previous studies investigated the varying prevalence of post-epileptic seizure posttraumatic stress disorder (PS-PTSD). The current study aimed first to compare the profiles of patients with and without PS-PTSD and, second, to study the interaction between other past traumatic experiences, subjective ictal anxiety, psychiatric comorbidities, and PS-PTSD in people with epilepsy (PWE). METHODS We conducted an observational study, investigating past traumatic experiences and PS-PTSD through standardized scales (CTQ-28, LEC-5 and PCL-5). We used semi-structured interviews and validated psychometric scales (NDDIE for depression and GAD-7 for anxiety) to collect data on general psychiatric comorbidities. We also assessed epilepsy specific psychiatric symptoms (interictal and peri-ictal). We performed a mediation analysis through PROCESS for SPSS to evaluate the effect of history of past trauma and subjective ictal anxiety on PS-PTSD through interictal depression and anxiety symptoms. RESULTS We enrolled 135 PWE, including 35 patients with PS-PTSD (29.5 %). Patients with PS-PTSD had significantly higher depression (12.87 vs 10; p = 0.005) and anxiety (7.74 vs 5.01; p = 0.027) scores and higher prevalence of peri-ictal psychiatric symptoms, compared to patients without PS-PTSD. The relationship between other past traumatic experiences and PS-PTSD was totally mediated by interictal depression and anxiety. We found a significant indirect effect of interictal anxiety symptoms on the path between subjective ictal anxiety and PS-PTSD. SIGNIFICANCE Our results showed that patients with PS-PTSD have a more severe psychopathological profile (more peri ictal and inter ictal depressive and anxiety symptoms). Both inter ictal and subjective ictal anxiety appear to have a significant role in PS-PTSD.
Collapse
Affiliation(s)
- Deniz Ertan
- Institut La Teppe Tain l'Hermitage, France; CHRU de Nancy, Département de Neurologie, Nancy, France
| | | | | | | | - Wissam El-Hage
- CHU de Tours, Tours, France; UMR 1253, iBraiN, Université de Tours, INSERM, Tours, France
| | - Coraline Hingray
- CHRU de Nancy, Département de Neurologie, Nancy, France; Pôle Hospitalo-Universitaire de Psychiatrie D'Adultes Du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France.
| |
Collapse
|
2
|
Pepi C, Mercier M, Salimbene L, Galati C, Specchio N, de Palma L. Post-Traumatic Stress-Disorder in Epilepsy: Meta-analysis of current evidence. Epilepsy Behav 2024; 157:109833. [PMID: 38820681 DOI: 10.1016/j.yebeh.2024.109833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 05/02/2024] [Accepted: 05/07/2024] [Indexed: 06/02/2024]
Abstract
Epilepsy, a chronic neurological condition characterized by unpredictable seizures, poses considerable challenges, including disability, stigma, and increased mortality. Psychiatric comorbidities are prevalent in 20-30% of epilepsy patients, notably mood or anxiety disorders, psychotic symptoms, and personality disorders. Trauma and childhood adversities are pivotal risk factors for psychopathology, yet the link between Post-Traumatic Stress Disorder (PTSD) and epilepsy remains underexplored. This meta-analysis is aimed to establish updated estimates of PTSD prevalence among individuals with epilepsy. Fifteen studies, comprising 996 epilepsy patients, were included. The overall pooled prevalence of PTSD in epilepsy patients was 18%. Notably, patients with epilepsy exhibited a three-fold increased risk of developing PTSD compared to the general population. Subgroup analysis revealed a higher PTSD prevalence in uncontrolled studies (25%) compared to controlled studies (14%). Additionally, patients with Psychogenic Non-Epileptic Seizures (PNES) demonstrated higher PTSD prevalence than epilepsy patients, with a threefold higher risk in healthy controls compared to PNES controls. While gender prevalence did not significantly affect PTSD occurrence, drug resistant epilepsy did not correlate with PTSD prevalence. Moreover, age of epilepsy onset showed no significant correlation with PTSD prevalence. This meta-analysis underscores the substantial burden of PTSD among epilepsy patients, potentially attributable to the traumatic nature of seizures and the chronic stigma associated with epilepsy. Improved recognition and management of psychiatric conditions, particularly PTSD, are crucial in epilepsy care pathways to enhance patients' quality of life. Further research and comprehensive diagnostic tools are imperative to better understand and address the prevalence of PTSD in epilepsy patients.
Collapse
Affiliation(s)
- Chiara Pepi
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy
| | - Mattia Mercier
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy
| | - Licia Salimbene
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy
| | - Cristina Galati
- Psychiatry Unit, Provincial Health Service of Catania, Catania, Italy
| | - Nicola Specchio
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy.
| | - Luca de Palma
- Neurology, Epilepsy and Movement Disorders Unit, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies, EpiCARE, Rome, Italy
| |
Collapse
|
3
|
Bauer PR, Bronnec MLA, Schulze-Bonhage A, Altenmüller DM, Fuchs T. Seizures as a Struggle between Life and Death: An Existential Approach to the Psychosocial Impact of Seizures in Candidates for Epilepsy Surgery. Psychopathology 2023; 56:417-429. [PMID: 36927809 DOI: 10.1159/000528924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/28/2022] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Mental health comorbidities such as depression and anxiety are common in epilepsy, especially among people with pharmacoresistant epilepsy who are candidates for epilepsy surgery. The Psychology Task Force of the International League Against Epilepsy advised that psychological interventions should be integrated into comprehensive epilepsy care. METHODS To better understand the psychological impact of epilepsy and epileptic seizures in epilepsy surgery candidates, we analysed interviews with this subgroup of patients using Karl Jaspers' concept of limit situations, which are characterised by a confrontation with the limits and challenges of life. These are especially chance, randomness, and unpredictability, death and finitude of life, struggle and self-assertion, guilt, failure, and falling short of one's aspirations. RESULTS In 43 interviews conducted with 15 people with drug-resistant epilepsy who were candidates for epilepsy surgery, we found that these themes are recurrent and have a large psychosocial impact, which can result in depression and anxiety. For some people, epileptic seizures appear to meet the criteria for traumatic events. CONCLUSION Understanding epilepsy and seizures as existential challenges complements the neurobiological explanations for psychological comorbidities and can help tailor psychological interventions to the specific needs of people with epilepsy, especially those who are candidates for surgical treatment.
Collapse
Affiliation(s)
- Prisca R Bauer
- Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Marie L A Bronnec
- Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Andreas Schulze-Bonhage
- Epilepsy Center, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Dirk-Matthias Altenmüller
- Epilepsy Center, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Thomas Fuchs
- Phenomenological Psychopathology and Psychotherapy, Psychiatric Clinic, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
4
|
Mariotti S, Valentin D, Ertan D, Maillard L, Tarrada A, Chrusciel J, Sanchez S, Schwan R, Vignal JP, Tyvaert L, El-Hage W, Hingray C. Past Trauma Is Associated With a Higher Risk of Experiencing an Epileptic Seizure as Traumatic in Patients With Pharmacoresistant Focal Epilepsy. Front Neurol 2021; 12:669411. [PMID: 34305784 PMCID: PMC8296979 DOI: 10.3389/fneur.2021.669411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: The present study aimed to evaluate the prevalence of traumatic experienced seizures (TES) and of postepileptic seizure PTSD (PS-PTSD) in patients with pharmacoresistant focal epilepsy and to explore the determining factors of TES. Methods: We conducted an observational study enrolling 107 adult refractory epilepsy patients. We used the DSM-5 criteria of traumatic events and PTSD to define TES and PS-PTSD. We assessed all traumatic life events unrelated to epilepsy, general and specific psychiatric comorbidities, and quality of life. Results: Nearly half (n = 48) of the 107 participants reported at least one TES (44.85%). Among these, one-third (n = 16) developed PS-PTSD. The TES group was more likely to experience traumatic events unrelated to epilepsy (p < 0.001), to have generalized anxiety disorder (p = 0.019), and to have specific psychiatric comorbidities [e.g., interictal dysphoric disorder (p = 0.024) or anticipatory anxiety of seizures (p = 0.005)]. They reported a severe impact of epilepsy on their life (p = 0.01). The determining factors of TES according to the multifactorial model were the experience of trauma (p = 0.008), a history of at least one psychiatric disorder (p = 0.03), and a strong tendency toward dissociation (p = 0.03). Significance: Epileptic seizures may be a traumatic experience in some patients who suffer from pharmacoresistant epilepsy and may be the source of the development of PS-PTSD. Previous trauma unrelated to epilepsy and psychiatric history are determining factors of TES. These clinical entities should be explored systematically.
Collapse
Affiliation(s)
- Sara Mariotti
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France.,Université de Lorraine, Faculté de Médecine, Vandœuvre-lès-Nancy, France
| | - Damien Valentin
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France.,Université de Lorraine, Faculté de Médecine, Vandœuvre-lès-Nancy, France
| | - Deniz Ertan
- Université de Lorraine, CNRS, CRAN, UMR 7039, Nancy, France.,Etablissement la Teppe Tain l'Hermitage, Tain-l'Hermitage, France
| | - Louis Maillard
- Université de Lorraine, Faculté de Médecine, Vandœuvre-lès-Nancy, France.,Université de Lorraine, CNRS, CRAN, UMR 7039, Nancy, France.,CHRU de Nancy, Département de Neurologie, Nancy, France
| | - Alexis Tarrada
- Université de Lorraine, CNRS, CRAN, UMR 7039, Nancy, France.,CHRU de Nancy, Département de Neurologie, Nancy, France
| | - Jan Chrusciel
- Pôle Information Médicale Évaluation Performance, CH de Troyes, Troyes, France
| | - Stéphane Sanchez
- Pôle Information Médicale Évaluation Performance, CH de Troyes, Troyes, France
| | - Raymund Schwan
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France.,Université de Lorraine, Faculté de Médecine, Vandœuvre-lès-Nancy, France.,INSERM U1114, Université de Strasbourg, Strasbourg, France
| | - Jean-Pierre Vignal
- Université de Lorraine, CNRS, CRAN, UMR 7039, Nancy, France.,CHRU de Nancy, Département de Neurologie, Nancy, France
| | - Louise Tyvaert
- Université de Lorraine, Faculté de Médecine, Vandœuvre-lès-Nancy, France.,Université de Lorraine, CNRS, CRAN, UMR 7039, Nancy, France.,CHRU de Nancy, Département de Neurologie, Nancy, France
| | - Wissam El-Hage
- UMR 1253, iBrain, Université de Tours, INSERM, Tours, France.,CHU de Tours, Tours, France
| | - Coraline Hingray
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France.,Université de Lorraine, CNRS, CRAN, UMR 7039, Nancy, France.,CHRU de Nancy, Département de Neurologie, Nancy, France
| |
Collapse
|
5
|
Cyr S, Guo DX, Marcil MJ, Dupont P, Jobidon L, Benrimoh D, Guertin MC, Brouillette J. Posttraumatic stress disorder prevalence in medical populations: A systematic review and meta-analysis. Gen Hosp Psychiatry 2021; 69:81-93. [PMID: 33582645 DOI: 10.1016/j.genhosppsych.2021.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE PTSD is increasingly recognized following medical traumas although is highly heterogeneous. It is difficult to judge which medical contexts have the most traumatic potential and where to concentrate further research and clinical attention for prevention, early detection and treatment. The objective of this study was to compare PTSD prevalence in different medical populations. METHODS A systematic review of the literature on PTSD following medical traumas was conducted as well as a meta-analysis with final pooled result and 95% confidence intervals presented. A meta-regression was used to investigate the impact of potential effect modifiers (PTSD severity, age, sex, timeline) on study effect size between prevalence studies. RESULTS From 3278 abstracts, the authors extracted 292 studies reporting prevalence. Using clinician-administered reports, the highest 24 month or longer PTSD prevalence was found for intraoperative awareness (18.5% [95% CI=5.1%-36.6%]) and the lowest was found for epilepsy (4.5% [95% CI=0.2%-12.6%]). In the overall effect of the meta-regression, only medical events or procedures emerged as significant (p = 0.006) CONCLUSION: This review provides clinicians with greater awareness of medical contexts most associated with PTSD, which may assist them in the decision to engage in more frequent, earlier screening and referral to mental health services.
Collapse
Affiliation(s)
- Samuel Cyr
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - De Xuan Guo
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Marie-Joëlle Marcil
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Patrice Dupont
- Health Sciences Library, Université de Montréal, Montreal, Quebec, Canada
| | - Laurence Jobidon
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - David Benrimoh
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Montreal, Montreal, Quebec, Canada
| | - Judith Brouillette
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
| |
Collapse
|
6
|
Labudda K, Illies D, Bien CG, Neuner F. Postepileptic seizure PTSD: A very rare psychiatric condition in patients with epilepsy. Epilepsy Behav 2018; 78:219-225. [PMID: 29122493 DOI: 10.1016/j.yebeh.2017.08.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE It has been shown that relatives of patients with epilepsy could experience a seizure as a traumatic event followed by a posttraumatic stress disorder (PTSD). In one questionnaire study, 51% of the patients with epilepsy were reported to have a PTSD caused by a traumatic seizure, termed postepileptic seizure PTSD by the authors. However, it remained unclear whether these patients had further psychiatric comorbidities and if certain seizure features may foster the development of the proposed epilepsy-specific PTSD. METHODS We conducted a structured clinical interview assessing psychiatric disorders in 120 patients with difficult-to-treat epilepsies. We also used a modified version of the Posttraumatic Stress Diagnostic Scale conducted as an interview to assess the number of patients who fulfilled the criteria for a PTSD caused by an epileptic seizure. We additionally compared certain features of traumatic versus nontraumatic seizures. RESULTS Fifty of the 120 patients identified a seizure that fulfilled the criteria for a traumatic event, whereas 28 patients identified a worst seizure not meeting the trauma definition. Six patients fulfilled all PTSD criteria caused by a traumatic seizure. However, three of these patients also had a regular PTSD, and in two further patients, the results of the clinical interview suggested that the PTSD-like symptoms could be better explained by an adjustment disorder. We could not identify seizure characteristics differentiating traumatic from nontraumatic seizures. CONCLUSION Our results showed that it is recommendable to conceptualize an epileptic seizure as being potentially traumatic in nature when assessing PTSD in patients with epilepsy, although we could not identify specific characteristics that could differentiate between traumatic and nontraumatic seizures. However, while using interview-based psychiatric assessment, we found a very low rate of a postepileptic seizure PTSD. It is worth conducting a comprehensive psychiatric diagnostic interview to differentiate PTSD-like symptoms from other comorbidities, such as epilepsy-related adjustment disorder.
Collapse
Affiliation(s)
- Kirsten Labudda
- Bielefeld University, Department of Psychology, Bielefeld, Germany; Epilepsy Center Bethel, Krankenhaus Mara, Bielefeld, Germany.
| | - Dominik Illies
- Bielefeld University, Department of Psychology, Bielefeld, Germany; Epilepsy Center Bethel, Krankenhaus Mara, Bielefeld, Germany
| | | | - Frank Neuner
- Bielefeld University, Department of Psychology, Bielefeld, Germany
| |
Collapse
|
7
|
Gao W, Zhao J, Li Y, Cao FL. Post-traumatic stress disorder symptoms in first-time myocardial infarction patients: roles of attachment and alexithymia. J Adv Nurs 2015; 71:2575-84. [PMID: 26171644 DOI: 10.1111/jan.12726] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2015] [Indexed: 11/28/2022]
Abstract
AIMS To explore the roles of attachment and alexithymia in the severity of post-traumatic stress disorder symptoms and to specify the relationship between sub-dimensions of attachment, alexithymia and posttraumatic stress disorder symptoms in patients with first-time myocardial infarction in mainland China. BACKGROUND Patients experiencing myocardial infarction have a risk of developing post-traumatic stress disorder symptoms. However, there have been few studies on the roles of attachment and alexithymia. DESIGN A cross-sectional survey design. METHODS Ninety-seven patients participated in the assessment of post-traumatic stress disorder symptoms, attachment and alexithymia from June-December in 2012. To assess post-traumatic stress disorder symptoms and their correlates, we administered the Post-traumatic Stress Disorder Checklist-Civilian Version, the 20-item Toronto Alexithymia Scale and the Experiences in Close Relationships Scale 5-17 days after the remission of first myocardial infarction attack. RESULTS Twenty-five (25·77%) patients met the criteria of posttraumatic stress disorder symptoms. Greater attachment anxiety and avoidance were associated with more severe posttraumatic stress disorder symptoms. Except for externally oriented thinking, all dimensions of alexithymia were significantly correlated with post-traumatic stress symptoms. In the regression model, attachment anxiety and difficulties identifying feelings were found to be predictive and the total regression equation explained 24·2% variance of posttraumatic stress disorder symptoms among myocardial infarction patients. CONCLUSION First-time myocardial infarction patients were at risk of developing posttraumatic stress disorder symptoms. Attachment anxiety and difficulties identifying feelings were positively associated with posttraumatic stress disorder symptoms in the early stage of myocardial infarction rehabilitation. It is essential to evaluate the causal relationship between attachment, alexithymia and posttraumatic stress disorder symptoms in longitudinal studies.
Collapse
Affiliation(s)
- Wen Gao
- School of Nursing, Shandong University, Jinan, China
| | - Jing Zhao
- The Second Hospital of Shandong University, Jinan, China
| | - Yang Li
- School of Nursing, Shandong University, Jinan, China
| | - Feng-Lin Cao
- School of Nursing, Shandong University, Jinan, China
| |
Collapse
|
8
|
|