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Thomas JA, Ditchman NM, Guidotti Breting L, Narayanan J. Quality of life in people with epilepsy: The associations of anti-seizure medications and biopsychosocial variables. Epilepsy Behav 2024; 152:109664. [PMID: 38320411 DOI: 10.1016/j.yebeh.2024.109664] [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: 10/03/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Abstract
People with epilepsy, on average, experience lower quality of life (QOL) than healthy controls. This study examined the associations between specific anti-seizure medications, biopsychosocial factors, and QOL in people with epilepsy. Analysis of covariance revealed that individuals taking three or more anti-seizure medications had significantly lower QOL than those taking levetiracetam. Findings also demonstrated that when examining biopsychosocial factors as predictors of QOL in hierarchical regression, anxiety, depression, and daytime sleepiness were significant predictors of QOL. Once these factors were entered into the model, number of medications was no longer significant. The final model predicted 59.6% of the variance in QOL. In clinical settings, providers should take a patient-centered approach that includes regular assessment of QOL and an emphasis on good psychological care for those coping with anxiety, depression, and sleep difficulty. These findings underscore the importance of addressing psychological health and sleep factors within the epilepsy population.
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Affiliation(s)
- Julia A Thomas
- Illinois Institute of Technology, 3424 S. State St, Chicago, IL 60616, United States; Barrow Neurological Institute, 222 W. Thomas Road, Ste. 315, Phoenix, AZ 85013, United States.
| | - Nicole M Ditchman
- Illinois Institute of Technology, 3424 S. State St, Chicago, IL 60616, United States.
| | - Leslie Guidotti Breting
- NorthShore University Health System, 909 Davis St, Ste. 160, Evanston, IL 60201, United States.
| | - Jaishree Narayanan
- NorthShore University Health System, 909 Davis St, Ste. 160, Evanston, IL 60201, United States; Tulane University School of Medicine, New Orleans, LA, United States.
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2
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Dong L, Sun T, Tong P, Guo J, Ke X. Prevalence and Correlates of Depression and Anxiety in Patients with Functional Anorectal Pain. J Pain Res 2023; 16:225-232. [PMID: 36726856 PMCID: PMC9885881 DOI: 10.2147/jpr.s400085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
Purpose Patients with functional anorectal pain (FAP) often experience psychological distress, impaired quality of life, increased healthcare utilisation, and even suicidal tendencies. However, limited data exists on the psychological correlates of FAP in Chinese patients. Therefore, this study aimed to examine the prevalence of depression, anxiety, and related psychosocial factors in Chinese patients with FAP. Methods We used a cross-sectional research design and recruited 100 patients with FAP from SuBei Hospital's multidisciplinary clinic for pelvic floor disorders between January and December 2021. Information on patients' demographic and disease characteristics was also collected. Depressive and anxiety symptoms were assessed using the Patient Health Questionnaire Depression (PHQ-9) and the Generalised Anxiety Disorder Questionnaire (GAD-7). Multiple logistic regression analysis was used to examine factors associated with depression and anxiety. Results The prevalence of depressive and anxiety symptoms among patients with FAP was 55% and 46%, respectively. Being a woman, specific marital status (single, divorced, separated, or widowed), longer FAP duration, and sleep disturbance were significantly associated with an increased risk of depressive symptoms. Additionally, specific marital status (single, divorced, separated, or widowed), sleep disturbance, and high Visual Analogue Scale scores were associated with anxiety symptoms. Conclusion Depressive and anxiety symptoms are prevalent in patients with FAP. Several socio-demographic and clinical predictors have been identified. There is a need for psychologists to be involved in the treatment of patients with FAP. Thus, multidisciplinary treatment may be the optimal treatment strategy.
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Affiliation(s)
- Liping Dong
- Affifiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, People’s Republic of China,Department of Clinical Psychology, Yangzhou University Affiliated Northern Jiangsu People’s Hospital, Yangzhou, People’s Republic of China
| | - Ting Sun
- Department of Clinical Psychology, Yangzhou University Affiliated Northern Jiangsu People’s Hospital, Yangzhou, People’s Republic of China
| | - Ping Tong
- Department of Clinical Psychology, Yangzhou University Affiliated Northern Jiangsu People’s Hospital, Yangzhou, People’s Republic of China
| | - Jia Guo
- Department of Proctology of Traditional Chinese Medicine, Yangzhou University Affiliated Northern Jiangsu People’s Hospital, Yangzhou, Jiangsu, People’s Republic of China
| | - Xiaoyan Ke
- Affifiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, People’s Republic of China,Correspondence: Xiaoyan Ke, Child Mental Health Research Center, the Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, People’s Republic of China, Tel +8613305176562, Fax +8602982296194, Email
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3
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Beswick E, Quigley S, Macdonald P, Patrick S, Colville S, Chandran S, Connick P. The Patient Health Questionnaire (PHQ-9) as a tool to screen for depression in people with multiple sclerosis: a cross-sectional validation study. BMC Psychol 2022; 10:281. [PMID: 36443880 PMCID: PMC9706934 DOI: 10.1186/s40359-022-00949-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/11/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Depression has a point prevalence of 25% and lifetime prevalence of 50% in people with multiple sclerosis (pwMS). Due to accessibility and brevity, the 9-item Patient Health Questionnaire (PHQ-9) may be a useful tool in clinical practice for screening and monitoring of depressive symptoms in people with MS (pwMS). METHODS The objective of this study was to evaluate the reliability, validity and acceptability of the PHQ-9 as a screening tool for depressive symptoms in pwMS. PwMS completed online questionnaires at 3 time-points over 4-weeks. The PHQ-9, Multiple Sclerosis Impact Scale (MSIS-29), Centre for Disease Control Health-Related Quality of Life Measure (CDC-HQOL-4) and clinical history. RESULTS 103 participants completed the PHQ-9 at three time points, 43% were categorised as depressed on at least one response. The PHQ-9 exhibited high internal reliability (Cronbach's α = 0.89), and test-re-test agreement (ICC 0.89, 95% CI 0.85-0.91). Convergent validity was indicated through positive correlation with the mental health items on the MSIS-29 (r = 0.46 and r = 0.50) and CDC-HQOL-4 (r = 0.79 and r = 0.73) at both assessment points. Positive correlations between the PHQ-9 and the MSIS-29 (r = 0.86 and r = 0.84) and CDC-HQOL-4 (r = 0.55 and r = 0.37) physical symptom sub-scores did not indicate divergent validity. 93% of ratings evaluated the PHQ-9 as "Very" or "Completely" acceptable. CONCLUSION The PHQ-9 is a reliable and valid measure of depressive symptoms in people with MS. Given its accessibility, ease of administration, and acceptability, we recommend the PHQ-9 as a tool to screen for depressive symptoms in people with MS.
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Affiliation(s)
- Emily Beswick
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, Scotland
| | - Suzanne Quigley
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, Scotland
| | - Pamela Macdonald
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, Scotland
| | - Sarah Patrick
- The School of Medicine & Veterinary Medicine, The University of Edinburgh, Edinburgh, Scotland.,West Scotland Deanery Foundation Programme, NHS Education for Scotland Trainee, Edinburgh, Scotland
| | - Shuna Colville
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, Scotland
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland.,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, Scotland
| | - Peter Connick
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland. .,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, Scotland.
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4
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Umemura Y, Khan B, Weill BJ, Buthorn JJ, Skakodub A, Ridder AJ, Nevel KS, Sun Y, Boire A. Discordance Between Perceptions and Experience of Lumbar Puncture: A Prospective Study. Neurol Clin Pract 2022; 12:344-351. [PMID: 36380890 PMCID: PMC9647808 DOI: 10.1212/cpj.0000000000200061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/26/2022] [Indexed: 01/13/2023]
Abstract
Background and Objectives Novel diagnostic techniques and neurologic biomarkers have greatly expanded clinical indications for CSF studies. CSF is most commonly obtained via lumbar puncture (LP). Although it is generally believed that LPs are well tolerated, there is a lack of supportive data for this claim, and patients anticipate LP to be painful. The objective of this study was to prospectively investigate discordance between patient perception and tolerability of LP. Methods Adult patients were surveyed before and after LP regarding their perceptions and experience of LP. Physician perceptions were gathered through a web-based survey. Relative risk and Spearman correlation were used to assess the relationship between responses. Paired binomial and paired ordinal responses were compared by McNemar and paired Wilcoxon rank-sum tests. Results A total of 178 patients completed the surveys. About half of the patients (58%) reported anxiety pre-LP, at median 3.0 of 10. Physicians overpredicted patients' pre-LP anxiety (median score 5.0, p < 0.001). Experienced pain was significantly less than predicted pain (median scores 0 and 3.0, respectively, p < 0.001). Patients who predicted pain were more likely to report pain from LP (relative risk [RR] 1.3). Predicting pain was also correlated with anxiety before LP (p < 0.001). Discussion LP was generally well tolerated. The majority of patients experienced minimal pain. Anticipation of pain was correlated with both feeling anxious and experiencing pain. The results of this study can be used to reassure patients and providers that LP is indeed not as painful as imagined, which may both reduce pre-LP anxiety and improve LP tolerability.
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Affiliation(s)
- Yoshie Umemura
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Baber Khan
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Benjamin J Weill
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Justin J Buthorn
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Anna Skakodub
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Andrew J Ridder
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Kathryn S Nevel
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Yilun Sun
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
| | - Adrienne Boire
- Departments of Neurology (YU, BK, AJR, YS), and Radiation Oncology and Biostatistics (YS), University of Michigan, Ann Arbor; and Human Oncology and Pathogenesis Program (BJW, JJB, AS, KSN), Brain Tumor Center and Department of Neurology (AB), Memorial Sloan Kettering Cancer Center, New York
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Beswick E, Forbes D, Hassan Z, Wong C, Newton J, Carson A, Abrahams S, Chandran S, Pal S. A systematic review of non-motor symptom evaluation in clinical trials for amyotrophic lateral sclerosis. J Neurol 2022; 269:411-426. [PMID: 34120226 PMCID: PMC8738361 DOI: 10.1007/s00415-021-10651-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is increasingly recognised as a multi-system disorder, presenting with common and impactful non-motor symptoms, such as neuropsychiatric symtpoms, cognitive and behavioural changes, pain, disordered sleep, fatigue and problematic saliva. AIM/HYPOTHESIS We aimed to systematically review 25 years of ALS clinical trials data to identify if non-motor features were evaluated, in addition to the traditional measures of motor functioning and survival, and where evaluated to describe the instruments used to assess. We hypothesised that assessment of non-motor symptoms has been largely neglected in trial design and not evaluated with ALS-suitable instruments. METHODS We reviewed clinical trials of investigative medicinal products in ALS, since the licensing of riluzole in 1994. Trial registry databases including WHO International Trials Registry, European Clinical Trials Register, clinicaltrials.gov, and PubMed were systematically searched for Phase II, III or IV trials registered, completed or published between 01/01/1994 and 16/09/2020. No language restrictions were applied. RESULTS 237 clinical trials, including over 29,222 participants, were investigated for their use of non-motor outcome measures. These trials evaluated neuropsychiatric symptoms (75, 32%), cognitive impairment (16, 6.8%), behavioural change (34, 14%), pain (55, 23%), sleep disturbances (12, 5%) and fatigue (18, 8%). Problematic saliva was assessed as part of composite ALS-FRS(R) scores in 184 trials (78%) but with no focus on this as an isolated symptom. 31 (13%) trials including 3585 participants did not include any assessment of non-motor symptoms. CONCLUSIONS Non-motor symptoms such as neuropsychiatric, cognitive and behavioural changes, pain, disordered sleep, fatigue, and problematic saliva have not been consistently evaluated in trials for people with ALS. Where evaluated, non-symptoms were primarily assessed using instruments and impairment thresholds that are not adapted for people with ALS. Future trials should include non-motor symptom assessments to evaluate the additional potential therapeutic benefit of candidate drugs. PROPSERO REGISTRATION CRD42020223648.
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Affiliation(s)
- Emily Beswick
- grid.4305.20000 0004 1936 7988Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK ,grid.4305.20000 0004 1936 7988Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4 SB Scotland, UK ,grid.4305.20000 0004 1936 7988Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Deborah Forbes
- grid.4305.20000 0004 1936 7988Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK ,grid.4305.20000 0004 1936 7988Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4 SB Scotland, UK ,grid.4305.20000 0004 1936 7988Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Zack Hassan
- grid.4305.20000 0004 1936 7988Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK ,grid.4305.20000 0004 1936 7988Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4 SB Scotland, UK ,grid.4305.20000 0004 1936 7988Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Charis Wong
- grid.4305.20000 0004 1936 7988Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK ,grid.4305.20000 0004 1936 7988Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4 SB Scotland, UK ,grid.4305.20000 0004 1936 7988Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Judith Newton
- grid.4305.20000 0004 1936 7988Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK ,grid.4305.20000 0004 1936 7988Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4 SB Scotland, UK ,grid.4305.20000 0004 1936 7988Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Alan Carson
- grid.4305.20000 0004 1936 7988Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Sharon Abrahams
- grid.4305.20000 0004 1936 7988Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK ,grid.4305.20000 0004 1936 7988Human Cognitive Neurosciences, Psychology, School of Philosophy, Psychology and Language Sciences, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Siddharthan Chandran
- grid.4305.20000 0004 1936 7988Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK ,grid.4305.20000 0004 1936 7988Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4 SB Scotland, UK ,grid.4305.20000 0004 1936 7988Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK ,grid.4305.20000 0004 1936 7988Human Cognitive Neurosciences, Psychology, School of Philosophy, Psychology and Language Sciences, The University of Edinburgh, Edinburgh, Scotland, UK ,grid.4305.20000 0004 1936 7988UK Dementia Research Institute, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Suvankar Pal
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland, UK. .,Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4 SB, Scotland, UK. .,Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland, UK.
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Crocker J, Liu K, Smith M, Nakamoto M, Mitchell C, Zhu E, Ma E, Morden FT, Chong A, Van N, Dang N, Borman P, Carrazana E, Viereck J, Liow KK. Early Impact of the COVID-19 Pandemic on Outpatient Neurologic Care in Hawai'i. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:6-12. [PMID: 35028589 PMCID: PMC8742305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In March 2020, Hawai'i instituted public health measures to prevent the spread of Coronavirus disease 2019 (COVID-19), including stay-at-home orders, closure of non-essential businesses and parks, use of facial coverings, social distancing, and a mandatory 14-day quarantine for travelers. In response to these measures, Hawai'i Pacific Neuroscience (HPN) modified practice processes to ensure continuity of neurological treatment. A survey of patients was performed to assess the impact of the COVID-19 pandemic and pandemic-related practice processes for quality improvement. Overall, 367 patients seen at HPN between April 22, 2020, and May 18, 2020, were surveyed via telephone. Almost half (49.6%) participated in a telemedicine appointment, with the majority finding it easy to use (87.4%) and as valuable as face-to-face appointments (68.7%). Many (44.5%) patients said they would have missed a health care appointment without the availability of telemedicine, and 47.3% indicated they might prefer to use telemedicine over in-person appointments in the future. Many reported new or worsening mental health problems, including depression (27.6%), anxiety (38.3%), or sleep disturbances (37.4%). A significant number reported worsening of their condition, with 33.1% of patients who experience migraines reporting increased symptom severity or frequency, 45.8% patients with Alzheimer's disease reporting worsened symptoms, 38.5% of patients with Parkinson's disease who had a recent fall, and 50.0% of patients with multiple sclerosis experiencing new or worsened symptoms. Insights from this survey applied to the practice's pandemic-related processes include emphasizing lifestyle modification, screening for changes in mental health, optimizing treatment plans, and continuing the option of telemedicine.
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Affiliation(s)
- Julie Crocker
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
| | - Keke Liu
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
| | - Maiya Smith
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
| | - Max Nakamoto
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
| | - Catherine Mitchell
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawai‘i Pacific Neuroscience, Honolulu, HI (CM, EZ, PB, EC, JV, KKL)
| | - Ena Zhu
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawai‘i Pacific Neuroscience, Honolulu, HI (CM, EZ, PB, EC, JV, KKL)
| | - Enze Ma
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
| | - Frances Tiffany Morden
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
| | - Ariel Chong
- University of Hawai‘i at Manoa, Honolulu, HI (AC, NV)
| | - Nicholas Van
- University of Hawai‘i at Manoa, Honolulu, HI (AC, NV)
| | - Nong Dang
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
| | - Pat Borman
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawai‘i Pacific Neuroscience, Honolulu, HI (CM, EZ, PB, EC, JV, KKL)
| | - Enrique Carrazana
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawai‘i Pacific Neuroscience, Honolulu, HI (CM, EZ, PB, EC, JV, KKL)
| | - Jason Viereck
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawai‘i Pacific Neuroscience, Honolulu, HI (CM, EZ, PB, EC, JV, KKL)
- Clinical & Translational Research, Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JV, KKL)
| | - Kore Kai Liow
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JC, KL, MS, MN, EM, FTM, ND, PB, JV, KKL)
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawai‘i Pacific Neuroscience, Honolulu, HI (CM, EZ, PB, EC, JV, KKL)
- Clinical & Translational Research, Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JV, KKL)
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When Mind Meets the Brain: Essentials of Well-Coordinated Management of Psychiatric Disorders in Neurological Diseases. J Acad Consult Liaison Psychiatry 2021; 62:270-284. [PMID: 34092347 DOI: 10.1016/j.jaclp.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The management of psychiatric disorders in neurological diseases (PDND) creates special challenges that cannot be adequately addressed by either psychiatry or neurology alone. However, the literature on clinician-friendly recommendations on how to coordinate neurological and psychiatric care is limited. OBJECTIVE This narrative review will provide practical instructions on how to efficiently integrate psychiatric and neurological care in inpatient management of PDND. METHODS We reviewed articles published as recently as January, 2021 in five electronic databases. We included articles that assessed human care, focused on adults, and examined how to better coordinate care between different medical specialties, particularly, between psychiatry and neurology. RESULTS Eighty-four manuscripts were included in this review, of which 23 (27%) discussed general principles of well-coordinated care of PDND in inpatient settings (first part of this review), and 61 (73%) were used to provide recommendations in specific neurological diseases (second part of this review). CONCLUSIONS General principles of well-coordinated care of PDND include recommendations for both the primary team (usually neurology) and the consulting team (psychiatry). Primary teams should delineate a specific question, establish roles, and follow up on the recommendations of the consulting team. Consultants should do their independent assessment, be organized and specific in their recommendations, and anticipate potential problems. One of the most important aspect to develop well-coordinated care is the establishment of clear, frank and, preferably oral, communication between the teams. Practical difficulties in the management of PDND include pharmacodynamic and pharmacokinetic interactions as well as mutual dependency between psychiatry and neurology.
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Abstract
This study aimed to review studies focused on the affective comorbidities associated with myasthenia gravis and to determine the extent to which neuromuscular treatment modalities address non-somatic aspects of autoimmune myasthenia gravis. Depression, anxiety, and emotional hyperactivity can aggravate myasthenia gravis, hinder accurate diagnoses, and presumably influence overall health-related quality of life. Studies were identified using PubMed Medline and Web of Science to assess the effects of psychological factors on myasthenia gravis, encompassing 49 years of research worldwide. After analysis, approximately 6,060 patients from 32 studies worldwide between 1971 and 2020 were included. Standard-of-care approaches to diagnosis and treatment continue to under-appreciate the prevalence or impact of mood disorders in myasthenia gravis. The majority of studies evaluated demonstrated an association between myasthenia gravis and mood disorders. However, the initiative to detect and treat affective comorbidities probably remains suboptimal. Although treatments for the somatic effects of myasthenia gravis have evolved over the past century, the paradigm of clinical practice has yet to adequately address the management of psychological impacts on the disease. This review is hoped to raise the necessary awareness in this regard.
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Affiliation(s)
- Christina Law
- Medicine, Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Claire V Flaherty
- Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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9
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Li Z, Hao Y, Han Y, Wu S, Zhu D, Liu M, Dong Q, Wang X, Guan Y. Prevalence and associated physical symptoms of depressive and anxiety symptoms in neurology outpatient clinic. J Neurol Neurosurg Psychiatry 2019; 90:1286-1287. [PMID: 30760642 DOI: 10.1136/jnnp-2018-320130] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/17/2019] [Accepted: 01/21/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Zezhi Li
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Hao
- Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Han
- Department of Neurology, Shanghai Changhai Hospital, Secondary Military Medical University, Shanghai, China
| | - Shuai Wu
- Department of Neurology, Shanghai Changhai Hospital, Secondary Military Medical University, Shanghai, China
| | - Desheng Zhu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Mingyuan Liu
- Department of Neurology, Shanghai Changhai Hospital, Secondary Military Medical University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
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10
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Increased Risks of Suicide Attempt and Suicidal Drug Overdose Following Admission for Head Injury in Patients with Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193524. [PMID: 31547202 PMCID: PMC6801720 DOI: 10.3390/ijerph16193524] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/12/2019] [Accepted: 09/16/2019] [Indexed: 12/11/2022]
Abstract
Aims: To determine the risks of suicide attempt (SA) and suicidal drug overdose (SDO) following the admission for head injury of patients with depression. Design: We analyzed the NHIRD data of patients aged ≥20 years who had received depression diagnoses between 2000 and 2010. They were divided into cohorts of those with admission for head injury (DHI) and those without it (DWI) during the follow-up period and compared against a sex-, age-, comorbidity-, and index-date-matched cohort from the general population. Setting: The Taiwan National Health Insurance Research Database (NHIRD). Participants/Cases: We analyzed the NHIRD data of patients (≥20 years) who had received depression diagnoses between 2000 and 2010. Intervention(s): Regular interventions. Measurements: We calculated the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of SA and SDO in these cohorts after adjustment for age, sex, and comorbidities. Findings: Up to the end of 2011, our results revealed extremely high incidences of SA and SDO with 63.3 and 88.6 per 10,000 person-years, respectively, in the DHI cohort. The DHI cohort had a 37.4-times higher risk for SA and a 17.1-times higher risk for SDO compared with the comparison group and had aHRs of 14.4 and 16.3, respectively, for poisoning by medicinal substances and poisoning by tranquilizers compared with patients in the DWI cohort. Patients with DHI aged <50 years, of female sex, with high incomes, living in more urbanized areas, and without other comorbidities had extraordinarily higher risks for SA. Conclusions: The risks of SA and SDO were proportionally increased by head injury in patients with depression in Taiwan. Our findings provide crucial information to implement efficient suicide prevention strategies in the future.
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11
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Giovagnoli AR, Paterlini C, Meneses RF, Martins da Silva A. Spirituality and quality of life in epilepsy and other chronic neurological disorders. Epilepsy Behav 2019; 93:94-101. [PMID: 30851485 DOI: 10.1016/j.yebeh.2019.01.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/17/2019] [Accepted: 01/27/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE The patients with neurological disorders often report a different quality of life (QoL), which is in part explained by clinical-pathological or psychosocial variables. This study evaluated spirituality in patients with chronic brain pathologies, aiming to clarify its specificity and position to a multidimensional model of QoL. METHODS A hundred and ninety-nine adult patients with epilepsy (E) (n = 88), mild cognitive impairment (MCI) (n = 32), ischemic vascular disorders (n = 29), tumors (n = 28), or multiple sclerosis (MS) (n = 22), and 66 healthy subjects were assessed using the World Health Organization Quality of Life (WHOQoL) 100, Spiritual, Religious and Personal Beliefs (SRPB), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI) for the QoL, spirituality, depression, and anxiety. The Multiple Ability Self-Report Questionnaire (MASQ) and neuropsychological tests evaluated the cognitive functions. RESULTS Factor analysis of the SRPB, STAI, and BDI scores yielded four factors: Personal Meaning, Inner Freedom, Awe and Openness, and Mood. Quality of life and spirituality were very similar between the patient groups. In comparison with the controls, all of the patients showed worse QoL, spirituality, mood, and lexical-memory abilities, and the patients with MCI and brain vascular disorders (BVD) also revealed worse cognitive impairments. Trait anxiety, self-rated health, age, and the SRPB Inner independence and Hope and optimism facets predicted the patients' WHOQoL 100 total score; the spiritual, affective, and socioeconomic variables predicted many QoL domains, but diagnosis only affected the Physical domain. Anxiety, self-rated health, Hope and optimism, and Personal beliefs predicted the controls' WHOQoL 100 total score. CONCLUSIONS Spirituality, as marked by the meaning of self, inner independence, and transcendence, is distinct from mood. It cooperates, together with the affective states, to determine the QoL of the patients with chronic brain pathologies whereas diagnosis has a limited impact. These findings support a multidimensional cross-disease model for the QoL in neurological disorders.
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Affiliation(s)
- Anna Rita Giovagnoli
- Department of Diagnostics and Applied Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
| | - Chiara Paterlini
- Department of Diagnostics and Applied Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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12
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Concomitant Psychiatric Symptoms in Neurological Outpatients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050860. [PMID: 30857273 PMCID: PMC6427503 DOI: 10.3390/ijerph16050860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 12/20/2022]
Abstract
To estimate the prevalence of concomitant psychiatric disorders in neurological outpatients and to assess the value of simple screening questionnaires in the identification of psychiatric symptoms, we analyzed a total of 803 patients who visited neurology clinics with neurological symptoms over a six-month period. Using self-reported questionnaires, we assessed psychiatric symptoms, such as stress (Perceived Stress Scale, PSS), depression (Patient Health Question 9, PHQ9), and anxiety (Generalized Anxiety Disorder 7, GAD7). According to the disease subtypes, we analyzed the psychiatric scales based on gender and age group. The prevalence of psychiatric comorbidities was lowest in patients with cerebrovascular disease (CVD) and highest among patients with cognitive decline and epilepsy. The overall prevalence of psychiatric symptoms markedly decreased with age. This decline was statistically significant for all questionnaires (PSS ≥ 14, p for trend = 0.027; PQH9 ≥ 10, p for trend = 0.005; GAD7 ≥ 10, p for trend = 0.002) and was more pronounced in males. Considering the high incidence of undetected psychiatric comorbidities and their associated burden, proactive psychiatric management should be included in neurological care. Psychiatric questionnaires could also be an effective screening tool for identifying psychiatric symptoms accompanying neurological symptoms.
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13
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Taylor KL, Simpson S, Jelinek GA, Neate SL, De Livera AM, Brown CR, O'Kearney E, Marck CH, Weiland TJ. Longitudinal Associations of Modifiable Lifestyle Factors With Positive Depression-Screen Over 2.5-Years in an International Cohort of People Living With Multiple Sclerosis. Front Psychiatry 2018; 9:526. [PMID: 30425659 PMCID: PMC6218592 DOI: 10.3389/fpsyt.2018.00526] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/04/2018] [Indexed: 12/24/2022] Open
Abstract
Background: Depression is common and has a significant impact on quality of life for many people with multiple sclerosis (MS). A preventive management approach via modification of lifestyle risk factors holds potential benefits. We examined the relationship between modifiable lifestyle factors and depression risk and the change in depression over 2.5 years. Methods: Sample recruited using online platforms. 2,224 (88.9%) at baseline and 1,309 (93.4%) at 2.5 years follow up completed the necessary survey data. Depression risk was measured by the Patient Health Questionnaire-2 (PHQ-2) at baseline and Patient Health Questionniare-9 (PHQ-9) at 2.5-years follow-up. Multivariable regression models assessed the relationships between lifestyle factors and depression risk, adjusted for sex, age, fatigue, disability, antidepressant medication use, and baseline depression score, as appropriate. Results: The prevalence of depression risk at 2.5-years follow-up in this cohort was 14.5% using the PHQ-2 and 21.7% using the PHQ-9. Moderate alcohol intake, being a non-smoker, diet quality, no meat or dairy intake, vitamin D supplementation, omega 3 supplement use, regular exercise, and meditation at baseline were associated with lower frequencies of positive depression-screen 2.5 years later. Moderate alcohol intake was associated with greater likelihood of becoming depression-free and a lower likelihood of becoming depressed at 2.5-years follow-up. Meditating at least once a week was associated with a decreased frequency of losing depression risk, against our expectation. After adjusting for potential confounders, smoking, diet, physical activity, and vitamin D and omega-3 supplementation were not associated with a change in risk for depression. Conclusion: In a large prospective cohort study of people with MS and depression, in line with the emerging treatment paradigm of early intervention, these results suggest a role for some lifestyle factors in depression risk. Further studies should endeavor to explore the impact of positive lifestyle change and improving depression in people living with MS.
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Affiliation(s)
- Keryn L. Taylor
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Department of Psychiatry and Psychosocial Cancer Care, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Steve Simpson
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - George A. Jelinek
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Sandra L. Neate
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Alysha M. De Livera
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Chelsea R. Brown
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Emily O'Kearney
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Claudia H. Marck
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Tracey J. Weiland
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
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14
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Emotional and social characteristics of stroke patients with low verbal memory. Aging Clin Exp Res 2018; 30:1203-1210. [PMID: 29340965 DOI: 10.1007/s40520-018-0894-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/09/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cognitive deficits, especially problems with memory observed after stroke often coexist with patients' experience of difficulties in everyday life situations. AIMS The purposes of the study were to explore the relationships between verbal memory, emotional functioning and social competence in stroke patients, and to examine the emotional and social condition of stroke patients with low verbal memory. METHODS Ninety-five participants were assessed with the Rey Auditory Verbal Learning Test, the Neuropsychology Behavior and Affect Profile, and the Social Competency Questionnaire. The participants' relatives (N = 95) also took part in the study evaluating patients' emotional and social functioning. RESULTS Stroke patients with low verbal memory had higher scores in depression, indifference, and inappropriateness than the patients with normal memory. They also obtained higher scores in the self-reported intimacy and lower scores in objectively assessed social exposition than controls. DISCUSSION It is worth considering patients' relationships with relatives that evolve after stroke, especially when the patients experience cognitive difficulties in gaining new information. Collecting verbal information seems to be important for the feeling of effectiveness in some dimensions of elders' social functioning. CONCLUSIONS Because the social engagement may be treated as protective factor in the course of recovery we would recommend that during rehabilitation more attention should be paid to emotional and social functioning of stroke patients with low verbal memory.
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15
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Kotwas I, McGonigal A, Bastien-Toniazzo M, Bartolomei F, Micoulaud-Franchi JA. Stress regulation in drug-resistant epilepsy. Epilepsy Behav 2017; 71:39-50. [PMID: 28494323 DOI: 10.1016/j.yebeh.2017.01.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/29/2016] [Accepted: 01/25/2017] [Indexed: 12/17/2022]
Abstract
The prevalence of psychological distress, especially depressive and anxiety disorders, is higher in epilepsy than in other chronic health conditions. These comorbid conditions contribute even more than epileptic seizures themselves to impaired quality of life in patients with epilepsy (PWE). The link between these comorbidities and epilepsy appears to have a neurobiological basis, which is at least partly mediated by stress through psychological and pathophysiological pathways. The impact of stress in PWE is also particularly important because it is the most frequently reported seizure trigger. It is therefore crucial for clinicians to take stress-related conditions and psychiatric comorbidities into account when managing PWE and to propose clinical support to enhance self-control of stress. Screening tools have been specially designed and validated in PWE for depressive disorders and anxiety disorders (e.g. NDDI-E, GAD-7). Other instruments are useful for measuring stress-related variables (e.g. SRRS, PSS, SCS, MHLCS, DSR-15, ERP-R, QOLIE-31) in order to help characterize the individual "stress profile" and thus orientate patients towards the most appropriate treatment. Management includes both pharmacological treatment and nonpharmacological methods for enhancing self-management of stress (e.g. mindfulness-based therapies, yoga, cognitive-behavioral therapies, biofeedback), which may not only protect against psychiatric comorbidities but also reduce seizure frequency.
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Affiliation(s)
- Iliana Kotwas
- Laboratoire Parole et Langage UMR 7309, Aix-Marseille Université, Marseille, France.
| | - Aileen McGonigal
- Service de Neurophysiologie Clinique, Centre Hospitalo Universitaire de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France; Unité mixte INSERM Epilepsie et Cognition UMR 751, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France
| | | | - Fabrice Bartolomei
- Service de Neurophysiologie Clinique, Centre Hospitalo Universitaire de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France; Unité mixte INSERM Epilepsie et Cognition UMR 751, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France
| | - Jean-Arthur Micoulaud-Franchi
- Service d'explorations fonctionnelles du système nerveux, Clinique du sommeil, CHU de, Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; USR CNRS 3413 SANPSY, CHU Pellegrin, Université de Bordeaux, France
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16
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Hensel JM, Taylor VH, Fung K, Vigod SN. Rates of Mental Illness and Addiction among High-Cost Users of Medical Services in Ontario. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:358-66. [PMID: 27254845 PMCID: PMC4872244 DOI: 10.1177/0706743716644764] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To quantify the burden of mental illness and addiction among high-costing users of medical services (HCUs) using population-level data from Ontario, and compare to a referent group of nonusers. METHOD We conducted a population-level cohort study using health administrative data from fiscal year 2011-2012 for all Ontarians with valid health insurance as of April 1, 2011 (N = 10,909,351). Individuals were grouped based on medical costs for hospital, emergency, home, complex continuing, and rehabilitation care in 2011-2012: top 1%, top 2% to 5%, top 6% to 50%, bottom 50%, and a zero-cost nonuser group. The rate of diagnosed psychotic, major mood, and substance use disorders in each group was compared to the zero-cost referent group with adjusted odds ratios (AORs) for age, sex, and socioeconomic status. A sensitivity analysis included anxiety and other disorders. RESULTS Mental illness and addiction rates increased across cost groups affecting 17.0% of the top 1% of users versus 5.7% of the zero-cost group (AOR, 3.70; 95% confidence interval [CI], 3.59 to 3.81). This finding was most pronounced for psychotic disorders (3.7% vs. 0.7%; AOR, 5.07; 95% CI, 4.77 to 5.38) and persisted for mood disorders (10.0% vs. 3.3%; AOR, 3.52; 95% CI, 3.39 to 3.66) and substance use disorders (7.0% vs. 2.3%; AOR, 3.82; 95% CI, 3.66 to 3.99). When anxiety and other disorders were included, the rate of mental illness was 39.3% in the top 1% compared to 21.3% (AOR, 2.39; 95% CI, 2.34 to 2.45). CONCLUSIONS A high burden of mental illness and addiction among HCUs warrants its consideration in the design and delivery of services targeting HCUs.
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Affiliation(s)
- Jennifer M Hensel
- Department of Psychiatry, Women's College Hospital, Toronto, Ontario Department of Psychiatry, University of Toronto, Toronto, Ontario Women's College Research Institute, Toronto, Ontario
| | - Valerie H Taylor
- Department of Psychiatry, Women's College Hospital, Toronto, Ontario Department of Psychiatry, University of Toronto, Toronto, Ontario Women's College Research Institute, Toronto, Ontario
| | - Kinwah Fung
- Women's College Research Institute, Toronto, Ontario Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Simone N Vigod
- Department of Psychiatry, Women's College Hospital, Toronto, Ontario Department of Psychiatry, University of Toronto, Toronto, Ontario Women's College Research Institute, Toronto, Ontario Institute for Clinical Evaluative Sciences, Toronto, Ontario
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17
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Raglio A, Attardo L, Gontero G, Rollino S, Groppo E, Granieri E. Effects of music and music therapy on mood in neurological patients. World J Psychiatry 2015; 5:68-78. [PMID: 25815256 PMCID: PMC4369551 DOI: 10.5498/wjp.v5.i1.68] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 01/12/2015] [Accepted: 02/11/2015] [Indexed: 02/05/2023] Open
Abstract
Mood disorder and depressive syndromes represent a common comorbid condition in neurological disorders with a prevalence rate that ranges between 20% and 50% of patients with stroke, epilepsy, multiple sclerosis, and Parkinson’s disease. Notwithstanding, these conditions are often under-diagnosed and under-treated in the clinical practice and negatively affect the functional recovery, the adherence to treatment, the quality of life, and even the mortality risk. In addition, a bidirectional association between depression and neurological disorders may be possible being that depressive syndromes may be considered as a risk factor for certain neurological diseases. Despite the large amount of evidence regarding the effects of music therapy (MT) and other musical interventions on different aspects of neurological disorders, no updated article reviewing outcomes such as mood, emotions, depression, activity of daily living and so on is actually available; for this reason, little is known about the effectiveness of music and MT on these important outcomes in neurological patients. The aim of this article is to provide a narrative review of the current literature on musical interventions and their effects on mood and depression in patients with neurological disorders. Searching on PubMed and PsycInfo databases, 25 studies corresponding to the inclusion criteria have been selected; 11 of them assess the effects of music or MT in Dementia, 9 explore the efficacy on patients with Stroke, and 5 regard other neurological diseases like Multiple Sclerosis, Amyotrophic Lateral Sclerosis/motor neuron disease, Chronic quadriplegia, Parkinson’s Disease, and Acquired Brain dysfunctions. Selected studies are based on relational and rehabilitative music therapy approaches or concern music listening interventions. Most of the studies support the efficacy of MT and other musical interventions on mood, depressive syndromes, and quality of life on neurological patients.
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18
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Yang P, Sun M, Li L, Shen Y. 8-hydroxy-dipropylaminotetralin promotes neural plasticity in epileptic rats with depression. Neural Regen Res 2015; 7:565-71. [PMID: 25745445 PMCID: PMC4346978 DOI: 10.3969/j.issn.1673-5374.2012.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 02/04/2012] [Indexed: 01/16/2023] Open
Abstract
Rats with chronic pilocarpine-induced temporal lobe epilepsy complicated with depression were studied. Anti-5-bromodeoxyuridine immunofluorescence staining and Timms staining showed that neurogenesis within the hippocampal dentate gyrus and mossy fiber sprouting were increased in model rats. Neurogenesis within the hippocampal dentate gyrus was further enhanced, while mossy fiber sprouting was decreased in model rats administered carbamazepine alone or in combination with the 5-hydroxytryptamine 1A receptor agonist, 8-hydroxy-dipropylaminotetralin (0.1 and 1 mg/kg). Among the groups, the effect was the most significant in rats receiving carbamazepine in conjunction with 1 mg/kg 8-hydroxy-dipropylaminotetralin. Thus, high dose 8-hydroxy-dipropylaminotetralin can improve neural plasticity in epileptic rats with depression.
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Affiliation(s)
- Ping Yang
- Department of Psychosomatic Diseases, Second People's Hospital of Hunan Province, Changsha 410007, Hunan Province, China
| | - Meizhen Sun
- Department of Neurology, First Affiliated Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Liang Li
- Department of Anatomy, Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
| | - Yihua Shen
- Department of Psychosomatic Diseases, Second People's Hospital of Hunan Province, Changsha 410007, Hunan Province, China
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19
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Taylor KL, Hadgkiss EJ, Jelinek GA, Weiland TJ, Pereira NG, Marck CH, van der Meer DM. Lifestyle factors, demographics and medications associated with depression risk in an international sample of people with multiple sclerosis. BMC Psychiatry 2014; 14:327. [PMID: 25467385 PMCID: PMC4263016 DOI: 10.1186/s12888-014-0327-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/10/2014] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Depression is the most common co-morbidity for people with Multiple Sclerosis (MS); irrespective of disease severity, depression has the greatest impact on quality of life. An emerging paradigm in the treatment of depression is lifestyle medicine. There is significant potential to prevent and treat depression through modification of lifestyle risk factors for people with MS. This study sought to understand the association between lifestyle risk factors, medication and depression risk through the analysis of self-reported data from a large international sample of people with MS. METHODS This cross-sectional analysis recruited a total of 2459 participants via Web 2.0 platforms. Survey data included socio-demographics; a range of lifestyle risk factors; medication; disease variables and depression risk using the Patient Health Questionnaire-2 (PHQ-2). RESULTS In total approximately one fifth (19.3%) of our sample screened positive for depression (PHQ-2 score ≥3). Several demographic factors were significantly associated with this depression risk in bivariate analysis. Regression analyses showed that poor diet, low levels of exercise, obesity, smoking, marked social isolation and taking interferon were associated with greater depression risk. Participants who supplemented with omega 3s, particularly flaxseed oil, had frequent fish consumption, supplemented with vitamin D, meditated, and had moderate alcohol consumption had significantly reduced depression risk. CONCLUSIONS This study demonstrates a significant association between modifiable lifestyle factors and depression risk. Planned longitudinal follow up may clarify causality. Clinicians and people with MS should be aware of the wide range of modifiable lifestyle factors that may reduce depression risk as part of a comprehensive secondary and tertiary preventive medical approach to managing MS.
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Affiliation(s)
- Keryn L Taylor
- Department of Psychiatry, St Vincent's Hospital Melbourne, Victoria, VIC, 3065, Australia. .,Department of Medicine, The University of Melbourne St Vincent's Hospital, Melbourne, Victoria, Australia.
| | - Emily J Hadgkiss
- Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia.
| | - George A Jelinek
- Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia. .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Tracey J Weiland
- Department of Medicine, The University of Melbourne St Vincent's Hospital, Melbourne, Victoria, Australia. .,Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia.
| | - Naresh G Pereira
- Faculty of Medicine, Notre Dame University, Fremantle, Western Australia, Australia.
| | - Claudia H Marck
- Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia.
| | - Dania M van der Meer
- Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia.
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20
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May depression be a form of epilepsy? Some remarks on the bioelectric nature of depression. Med Hypotheses 2009; 73:746-52. [DOI: 10.1016/j.mehy.2009.04.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Revised: 04/14/2009] [Accepted: 04/18/2009] [Indexed: 11/21/2022]
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21
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Vaaler AE, Morken G, Linaker OM, Sand T, Kvistad KA, Bråthen G. Symptoms of epilepsy and organic brain dysfunctions in patients with acute, brief depression combined with other fluctuating psychiatric symptoms: a controlled study from an acute psychiatric department. BMC Psychiatry 2009; 9:63. [PMID: 19793395 PMCID: PMC2760550 DOI: 10.1186/1471-244x-9-63] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 09/30/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In psychiatric acute departments some patients present with brief depressive periods accompanied with fluctuating arrays of other psychiatric symptoms like psychosis, panic or mania. For the purpose of the present study we call this condition Acute Unstable Depressive Syndrome (AUDS). The aims of the present study were to compare clinical signs of organic brain dysfunctions and epilepsy in patients with AUDS and Major Depressive Episode (MDE). METHODS Out of 1038 consecutive patients admitted to a psychiatric acute ward, 16 patients with AUDS and 16 age- and gender-matched MDE patients were included in the study. Using standardized instruments and methods we recorded clinical data, EEG and MRI. RESULTS A history of epileptic seizures and pathologic EEG activity was more common in the AUDS group than in the MDE group (seizures, n = 6 vs. 0, p = 0.018; pathologic EEG activity, n = 8 vs. 1, p = 0.015). Five patients in the AUDS group were diagnosed as having epilepsy, whereas none of those with MDE had epilepsy (p = 0.043). There were no differences between the groups regarding pathological findings in neurological bedside examination and cerebral MRI investigation. CONCLUSION Compared to patients admitted with mood symptoms fulfilling DSM 4 criteria of a major depressive disorder, short-lasting atypical depressive symptoms seem to be associated with a high frequency of epileptic and pathologic EEG activity in patients admitted to psychiatric acute departments. TRIAL REGISTRATION NCT00201474.
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Affiliation(s)
- Arne E Vaaler
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Gunnar Morken
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway,Division of Psychiatry, Department Østmarka, St. Olavs University Hospital, Trondheim, Norway,Division of Psychiatry, Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway
| | - Olav M Linaker
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway,Division of Psychiatry, Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway
| | - Trond Sand
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway,Department of neurology and clinical neurophysiology, St. Olavs University Hospital, Trondheim, Norway
| | - Kjell A Kvistad
- Department of Circulation and Diagnostic Imaging, NTNU, Trondheim, Norway,Department of Diagnostic Imaging, St Olavs University Hospital, Trondheim, Norway
| | - Geir Bråthen
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway,Department of neurology and clinical neurophysiology, St. Olavs University Hospital, Trondheim, Norway
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22
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The contribution of seizures to psychosocial ill-health. Epilepsy Behav 2009; 15 Suppl 1:S41-5. [PMID: 19303942 DOI: 10.1016/j.yebeh.2009.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Accepted: 03/05/2009] [Indexed: 11/21/2022]
Abstract
Persons with a chronic health condition may be disadvantaged compared to others, though the precise pattern of disadvantage will vary from one condition to another. Persons with epilepsy have been shown to be at increased risk of both psychological morbidity and social disadvantage. Various clinical characteristics of epilepsy have been linked to these psychosocial risks, primary among which is seizure frequency: studies linking seizure frequency to psychosocial ill-health are reviewed here. Given the apparently powerful influence of seizure frequency, it is unsurprising that psychosocial health trajectories in epilepsy are very closely linked to its clinical course-but the relationship is not a completely linear one. Recent research has begun to unravel factors other than seizure frequency which appear promoting or protective of psychosocial ill-health. The need for a more nuanced approach to understanding the causes of psychosocial ill-health is highlighted, as is an important distinction between epilepsy as biomedically defined disease and as socially defined illness.
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Jacoby A, Baker GA. Quality-of-life trajectories in epilepsy: a review of the literature. Epilepsy Behav 2008; 12:557-71. [PMID: 18158270 DOI: 10.1016/j.yebeh.2007.11.013] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Accepted: 11/18/2007] [Indexed: 12/01/2022]
Abstract
The potential psychosocial sequelae of epilepsy are well-documented, but it cannot be assumed that trajectories for quality of life (QOL) of people with epilepsy will inevitably follow its clinical course. In this article, we draw on available literature to suggest likely QOL trajectories associated with epilepsy and the broad range of disease-, patient-, and other-focused factors that appear important in determining them. We conclude that both the likely shape and time frame for QOL trajectories associated with particular clinical scenarios can be delineated, but that their shape can be altered by a much wider range of factors than those represented as epilepsy disease progression. We identify contributory factors currently relatively unexplored and highlight implications for treatment and areas for future research.
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Affiliation(s)
- Ann Jacoby
- Division of Public Health, University of Liverpool, UK.
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Abstract
Myasthenia gravis (MG) is a chronic, autoimmune disease involving neuromuscular junctions. It is frequently associated with symptoms such as loss of muscle strength, difficulty in respiration and swallowing, diplopia and ptosis. All chronic diseases, including MG, may have psychiatric consequences in terms of coping and adaptation. Psychiatric morbidity usually appears as anxiety disorders, such as panic disorder and generalised anxiety disorder, and as depressive disorders. However, there are very few data on the prevalence and aetiology of such psychiatric symptoms in patients with MG, and those available in the literature are generally from old studies with poor methodology. The interaction between MG and psychiatric disorders needs to be appreciated, especially in the primary care setting, since the symptoms may overlap. MG may be under-recognised initially because the psychiatric symptoms may coincide with those of the actual disease, such as fatigue, lack of energy and shortness of breath. On the other hand, co-morbid psychiatric symptoms that appear during the course of the illness may be misdiagnosed as true myasthenic symptoms; thus, leading to unnecessary drug treatment. Differentiation of the aetiology of these symptoms might alter the treatment choice and, therefore, affect the treatment success rate and patients' well-being. Psychiatric treatments must be carefully planned because of the risk of aggravating the underlying neurological disease. Even though there appears to be an intricate relationship between MG and psychiatric symptoms, there is very limited information on this subject. As such, prospective, randomised, controlled pharmaco/psychotherapy studies are needed to better direct the management of patients and, thus, improve quality of life during the course of the illness.
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Montel S, Bungener C. Les troubles de l’humeur et des émotions dans la sclérose en plaques : une revue de la littérature. Rev Neurol (Paris) 2007; 163:27-37. [PMID: 17304170 DOI: 10.1016/s0035-3787(07)90352-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Even though mood and emotion are closely related concepts, they differ in some ways. This article aims to review the main mood and emotional disorders most often found in Multiple Sclerosis (MS). STATE OF ART Studies related to four fields are presented and discussed: assessment tools and methodological problems; prevalence, etiology and symptoms of mood as well as emotional disorders in MS; relationship between cognition and emotion. Beside these main subjects, we tackle some interesting questions which concern patients as well as clinicians, such as the risk of depression and protective factors, the relationship between depression and fatigue and the impact of beta-interferon on depression. PROSPECTIVES We focus on a new promising trend aiming to link neuroimaging data to psychological variables. CONCLUSIONS These four fields cover a large portion of the questions about mood and emotional disorders in MS. Due to their frequency as well as to their impact on quality of life, specific attention should be given to these disorders.
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Affiliation(s)
- S Montel
- Laboratoire de Psychopathologie et Neuropsychologie Cliniques, Université Paris Descartes et Centre d'Investigation Clinique de l'Hôpital La Pitié-Salpêtrière.
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Mackin RS, Areán P, Elite-Marcandonatou A. Problem solving therapy for the treatment of depression for a patient with Parkinson's disease and mild cognitive impairment: a case study. Neuropsychiatr Dis Treat 2006; 2:375-9. [PMID: 19412485 PMCID: PMC2671813 DOI: 10.2147/nedt.2006.2.3.375] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The present investigation reports on the use of problem solving therapy (PST) to treat depression in an 83-year-old woman with Parkinson's disease (PD) and concurrent mild cognitive impairment (MCI). A neuropsychological evaluation was conducted prior to the intervention and the patient demonstrated mild deficits of executive functioning and memory. The PST treatment consisted of 12 one-hour sessions that occurred weekly. Depressive symptoms were evaluated using the Hamilton Depression Rating scale and the Montgomery-Asberg Depression rating scale. At a post-treatment assessment (week 12), clinician assessment indicated that the client no longer met criteria for MDD. Weekly depression severity ratings showed significant reduction in severity of depressive symptoms over 12 weeks. Results at 1-month and 6-month follow-up demonstrated that the therapeutic gains were not only maintained, but that the client continued to improve. These results suggest that PST may be an effective treatment for the treatment of depression for individuals with a PD and concurrent MCI.
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Affiliation(s)
- R Scott Mackin
- Department of Psychiatry, University of California, San Francisco, CA, USA.
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Schachter SC. Quality of life for patients with epilepsy is determined by more than seizure control: the role of psychosocial factors. Expert Rev Neurother 2006; 6:111-8. [PMID: 16466318 DOI: 10.1586/14737175.6.1.111] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Antiepileptic drugs remain the cornerstone of epilepsy treatment for minimizing, if not eliminating, seizures. However, many factors other than the degree of seizure control influence the quality of life for patients with epilepsy. This review focuses on psychosocial factors that have been associated with quality of life in this population, especially mood disorders, stigma seizure worry, self-esteem and self-mastery. Irrespective of their level of seizure control from antiepileptic drugs, patients may also benefit from targeted psychosocial interventions that reduce the negative impact of these factors on their quality of life.
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Grabowska-Grzyb A, Jedrzejczak J, Nagańska E, Fiszer U. Risk factors for depression in patients with epilepsy. Epilepsy Behav 2006; 8:411-7. [PMID: 16466966 DOI: 10.1016/j.yebeh.2005.12.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Revised: 12/06/2005] [Accepted: 12/09/2005] [Indexed: 11/26/2022]
Abstract
PURPOSE Symptoms of depression are present in 40 to 60 percent of patients with epilepsy. Prior research indicated significant correlation between the incidence and frequency of focal seizures and clinical depression, especially in patients with temporal lobe epilepsy. Anticonvulsive drugs and psychosocial factors contribute to the occurrence of depression as well. The aim of the study was to determine the major depression risk factors in patients with epilepsy. METHODS The research was conducted on 203 patients with epilepsy (117 females and 86 males), aged 18 to 50 years, with total time of illness ranging from 60 to 580 months. All subjects underwent the same research protocol, which was applied interictally. Interictal depression was diagnosed according to ICD-10 diagnostic criteria for affective and delusional disorders. The diagnosis was supported by Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HAM-D) and Montgomery-Asberg Depression Rating Scale (MADRS). Statistical analysis included chi2 test, Fisher's exact test and stepwise logical regression model analysis. RESULTS In our study 100 patients with epilepsy out of 203 suffered from concurrent depression (49.2%); 76 of them had severe depression (37.4%) and 24 patients had mild depression (11.8%). Complex partial seizures and absence of secondary generalized tonic-clonic seizures were found to be the risk factors for depression. Treatment with clonazepam, frequent hospitalizations (drug-resistancy) and lack of occupational activity were revealed to be additional significant contributing factors. CONCLUSIONS Depression in patients with epilepsy is a serious medical and social problem since it afflicts almost one half of all patients treated in epilepsy referral centers. It seems to be correlated with certain types of epileptic seizures, with high frequency of seizures, sub-optimal pharmacologic treatment and lack of occupational and social activity.
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Affiliation(s)
- Ałbena Grabowska-Grzyb
- Department of Neurology and Epileptology, Postgraduate Medical Training Centre. 231, Czerniakowska Street, Warsaw, Poland.
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Schachter SC. The Visual Art of Contemporary Artists With Epilepsy. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2006; 74:119-31. [PMID: 16730511 DOI: 10.1016/s0074-7742(06)74010-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Steven C Schachter
- Harvard Medical School, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA
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Shanmugham B, Karp J, Drayer R, Reynolds CF, Alexopoulos G. Evidence-based pharmacologic interventions for geriatric depression. Psychiatr Clin North Am 2005; 28:821-35, viii. [PMID: 16325731 DOI: 10.1016/j.psc.2005.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Bindu Shanmugham
- Weill-Cornell Institute of Geriatric Psychiatry, 21 Bloomingdale Road, White Plains, NY 10605, USA.
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Beyenburg S, Mitchell AJ, Schmidt D, Elger CE, Reuber M. Anxiety in patients with epilepsy: systematic review and suggestions for clinical management. Epilepsy Behav 2005; 7:161-71. [PMID: 16054870 DOI: 10.1016/j.yebeh.2005.05.014] [Citation(s) in RCA: 236] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Accepted: 05/24/2005] [Indexed: 11/18/2022]
Abstract
Up to 50 or 60% of patients with chronic epilepsy have various mood disorders including depression and anxiety. Whereas the relationship between epilepsy and depression has received much attention, less is known about anxiety disorders. It is now recognized that anxiety can have a profound influence on the quality of life of patients with epilepsy. The relationship between anxiety disorders and epilepsy is complex. It is necessary to distinguish between different manifestations of anxiety disorder: ictal, postictal, and interictal anxiety. Preexisting vulnerability factors, neurobiological factors, iatrogenic influences (antiepileptic drugs, epilepsy surgery), and psychosocial factors are all likely to play a role, but with considerable individual differences. Despite the high prevalence of anxiety disorders in patients with epilepsy, there are no systematic treatment studies or evidence-based guidelines for best treatment practice. Nevertheless, a practical approach based on the temporal relationship between anxiety and epileptic seizures allows clinicians to consider appropriate treatment strategies to reduce the psychiatric comorbidity in patients with epilepsy.
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Affiliation(s)
- Stefan Beyenburg
- Department of Neurology, Centre Hospitalier de Luxembourg, Rue Barblé 4, L-1210 Luxembourg, Luxembourg.
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Beyenburg S, Schmidt D. [Patients with epilepsy and anxiety disorders. Diagnosis and treatment]. DER NERVENARZT 2005; 76:1077-8, 1081-2, 1084-6 passim. [PMID: 15717111 DOI: 10.1007/s00115-004-1867-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Up to 50-60% of patients with epilepsy may develop psychiatric complications, in particular depression, anxiety, and psychotic disorders. Although this comorbidity has received a great deal of attention in recent years, the anxiety spectrum of psychiatric disturbances in epilepsy patients has not been extensively studied, although this comorbidity has a significant effect on the medical management and quality of life. The etiology is multifactorial, including neurobiological and shared pathophysiological mechanisms as well as psychosocial and iatrogenic factors (e.g., influence of antiepileptic drugs, epilepsy surgery). Despite the high prevalence of comorbid anxiety in epilepsy, very little is known about optimal treatment strategies. This article reviews the complex interrelationships between anxiety disorders and epilepsy from a clinical point of view. The evaluation of anxiety relative to ictal, peri-ictal, and postictal states is described, and medical treatment options for anxiety disorders in patients with epilepsy are discussed, illustrating that their treatment extends far beyond seizure control.
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Affiliation(s)
- S Beyenburg
- Département des Neurosciences, Centre Hospitalier de Luxembourg.
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Jones JE, Hermann BP, Woodard JL, Barry JJ, Gilliam F, Kanner AM, Meador KJ. Screening for Major Depression in Epilepsy with Common Self-report Depression Inventories. Epilepsia 2005; 46:731-5. [PMID: 15857440 DOI: 10.1111/j.1528-1167.2005.49704.x] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Major depression is a common psychiatric comorbidity in chronic epilepsy that is frequently unrecognized and untreated. A variety of self-report mood inventories are available, but their validity as well as ability to detect major depression in epilepsy remains uncertain. The purpose of this study was to determine the ability of two common depressive symptom inventories to identify major depression in people with epilepsy. METHODS In total, 174 adult patients with epilepsy underwent standardized psychiatric interview techniques [Mini International Neuropsychiatric Interview (MINI) and Mood Disorders module of the Structured Clinical Interview for DSM-IV Axis I Disorders-Research Version (SCID-I)] to determine the presence of current major depression. Subjects completed two self-report depression inventories [Beck Depression Inventory-II (BDI-II), Center for Epidemiological Study of Depression (CES-D)]. The ability of these self-report measures to identify major depression as identified by the gold standard structured interviews was examined by using diagnostic efficiency statistics. RESULTS Both the BDI-II and the CES-D exhibited significant ability to identify major depression in epilepsy. All ROC analyses were highly significant (mean area under the curve, 0.92). Mean sensitivity (0.93) and specificity (0.81) were strong, with excellent negative predictive value (0.98) but lower positive predictive value (0.47). CONCLUSIONS Common self-report depression measures can be used to screen for major depression in clinical settings. Use of these measures will assist in the clinical identification of patients with major depression so that treatment can be initiated.
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Affiliation(s)
- Jana E Jones
- Department of Neurology, University of Wisconsin-Madison, 53792, USA.
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Nelson LD, Elder JT, Groot J, Tehrani P, Grant AC. Personality testing and epilepsy: comparison of two MMPI-2 correction procedures. Epilepsy Behav 2004; 5:911-8. [PMID: 15582840 DOI: 10.1016/j.yebeh.2004.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2004] [Revised: 08/07/2004] [Accepted: 08/10/2004] [Indexed: 11/16/2022]
Abstract
The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is widely used for assessing psychopathology. However, its reliability in people with neurologic disease has been questioned. This concern is especially true for epilepsy, a disease with symptoms, i.e., seizures, that frequently include experiences likely to suggest psychopathology. Correction procedures, in which select items are removed and the test is rescored, may improve MMPI-2 specificity. The MMPI-2 was administered to 27 subjects with epilepsy, and the results were compared before and after application of three correction procedures: rational, statistical, and combined. The statistical correction resulted in clinically significant T-score changes (> or = 5 points) in two MMPI-2 clinical scales, while a combined correction procedure produced clinically significant changes in three scales. In the subgroup of patients with intractable epilepsy, two noncorrected scale T-scores > or = 65 fell to the normal range with both the statistical and combined procedures. These results suggest cautious interpretation of standard MMPI-2 scores in patients with epilepsy.
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Affiliation(s)
- Linda D Nelson
- Department of Neurology, University of California Irvine, Irvine, CA, USA
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Gélisse P, Crespel A. Critères de gravité des épilepsies partielles pharmaco-résistantes chez l’adulte. Rev Neurol (Paris) 2004. [DOI: 10.1016/s0035-3787(04)71185-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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