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Bush KJ, Cullen E, Mills S, Chin RFM, Thomas RH, Kingston A, Pickrell WO, Ramsay SE. Assessing the extent and determinants of socioeconomic inequalities in epilepsy in the UK: a systematic review and meta-analysis of evidence. Lancet Public Health 2024; 9:e614-e628. [PMID: 39095136 DOI: 10.1016/s2468-2667(24)00132-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/03/2024] [Accepted: 06/13/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Socioeconomic inequalities in epilepsy incidence and its adverse outcomes are documented internationally, yet the extent of inequalities and factors influencing the association can differ between countries. A UK public health response to epilepsy, which prevents epilepsy without widening inequalities, is required. However, the data on UK epilepsy inequalities have not been synthesised in a review and the underlying determinants are unknown. METHODS In this systematic review and meta-analysis, we searched six bibliographic databases (MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Scopus) and grey literature published between Jan 1, 1980, and Feb 21, 2024, to identify UK studies reporting epilepsy incidence or epilepsy-related adverse outcomes by socioeconomic factors (individual level or area level). We included longitudinal cohort studies, studies using routinely collected health-care data, cross-sectional studies, and matched cohort studies and excluded conference abstracts and studies not reporting empirical results in the review and meta-analysis. Multiple reviewers (KJB, EC, SER, WOP, and RHT) independently screened studies, KJB extracted data from included studies and a second reviewer (SM or EC) checked data extraction. We used Critical Appraisal Skills Programme checklists to assess quality. We used random-effects meta-analysis to pool incident rate ratios (IRRs) and synthesised results on adverse outcomes narratively. This study was registered on PROPSPERO (CRD42023394143). FINDINGS We identified 2471 unique studies from database searches. We included 26 studies, ten of which reported epilepsy incidence and 16 reported epilepsy-related adverse outcomes according to socioeconomic factors. Misclassification, participation, and interpretive biases were identified as study quality limitations. Meta-analyses showed an association between socioeconomic deprivation and epilepsy incidence, with greater risks of epilepsy incidence in groups of high-deprivation (IRR 1·34 [95% CI 1·16-1·56]; I2=85%) and medium-deprivation (IRR 1·23 [95% CI 1·08-1·39]; I2=63%) compared with low-deprivation groups. This association persisted in the studies that only included children (high vs low: IRR 1·36 [95% CI 1·19-1·57]; I2=0%). Only two studies examined factors influencing epilepsy incidence. There is limited evidence regarding UK inequalities in adverse outcomes. INTERPRETATION Socioeconomic inequalities in epilepsy incidence are evident in the UK. To develop an evidence-based public health response to epilepsy, further research is needed to understand the populations affected, factors determining the association, and the extent of inequalities in adverse outcomes. FUNDING Epilepsy Research Institute UK.
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Affiliation(s)
- Kathryn J Bush
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Emer Cullen
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Susanna Mills
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Richard F M Chin
- Muir Maxwell Epilepsy Centre, Department of Child Life and Health and the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Rhys H Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Kingston
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - William Owen Pickrell
- Swansea University Medical School, Swansea University, Swansea, UK; Neurology Department, Swansea Bay University Health Board, Morriston Hospital, Swansea, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Aljafen BN, Alneseyan R, Muayqil T, Alkhateeb MO, Aldosari MM, Alsermani A, Alnakhli L, Althomali R, Alnami R, Alqahtani R, Ibrahim L, Babtain F. Evaluating the prevalence and risk factors for depression in patients with temporal lobe epilepsy with hippocampal sclerosis: A cross-sectional multicenter study. Epilepsy Behav 2024; 154:109782. [PMID: 38636108 DOI: 10.1016/j.yebeh.2024.109782] [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: 01/05/2024] [Revised: 03/12/2024] [Accepted: 04/04/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Epilepsy frequently accompanies Major Depressive Disorder (MDD). Notably, people with temporal lobe epilepsy and hippocampal sclerosis may face an increased susceptibility to MDD, as evidence indicates the involvement of the limbic system in the development of emotional symptoms. OBJECTIVES To determine the prevalence and predictors of depression in temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) and compare them to those of other epilepsy types. METHODS A sample of 293 epilepsy patients, including 159 non-TLE-HS and 134 TLE-HS, were recruited from three hospitals. Of these, 215 completed a two-section electronic survey. The first section collected demographic and epilepsy data, while the second used the Arabic version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). RESULTS Of 215 patients, 104 (48%) had TLE-HS-38 with right TLE-HS (37%), 56 with left TLE-HS (54%), and 10 with bilateral TLE-HS (10%). The prevalence and severity of depression was assessed with an NDDI-E score of 15 or higher identified 35 patients (16%) with MDD. Valproic acid and lamotrigine were associated with higher NDDI-E scores. No such associations were found for levetiracetam or carbamazepine. Polytherapy in TLE-HS showed a significant correlation with daily poor concentration. CONCLUSION We explored the differences in depression prevalence between TLE-HS and other epilepsy types and concluded they are minimal but slightly higher in TLE-HS. Predictors of depression such as seizure frequency and disease duration influenced MDD prevalence in TLE-HS. Lamotrigine and valproate were linked to higher NDDI-E scores.
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Affiliation(s)
- Bandar N Aljafen
- Neurology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Ruwa Alneseyan
- Neurology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Taim Muayqil
- Neurology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mashael O Alkhateeb
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; Alfasial University, Riyadh, Saudi Arabia
| | - Mubarak M Aldosari
- Epilepsy Program, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Aya Alsermani
- College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Lujain Alnakhli
- College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Renad Althomali
- College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Razan Alnami
- College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Ruba Alqahtani
- College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Lama Ibrahim
- College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Fawzi Babtain
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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Gammoh O, Al-Smadi A, Mansour M, Ennab W, AL Hababbeh S, Al-Taani G, Alsous M, Aljabali AAA, Tambuwala MM. The relationship between psychiatric symptoms and the use of levetiracetam in people with epilepsy. Int J Psychiatry Med 2024; 59:360-372. [PMID: 37837222 PMCID: PMC11044508 DOI: 10.1177/00912174231206056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
Background: Mental health in people with epilepsy (PWE) is often overlooked, especially in developing countries.Purpose: Consequently, the current work had two objectives: (1) to estimate the burden of depression, anxiety, insomnia, and stress, and (2) to examine the association of these psychiatric/psychological symptoms with levetiracetam and other relevant clinical factors in a cohort of Jordanian PWE.Research Design: This is a cross-sectional study. The demographic and clinical data were recorded. Depression was measured by the Patient Health Questionnaire-9 (PHQ-9, Arabic-validated version) and anxiety by the General Anxiety Disorder-7 (GAD-7, Arabic-validated version). The insomnia severity index (ISI-A, Arabic version) was used to assess sleep quality, and the Perceived Stress Scale (PSS-A, Arabic version) was used to measure perceived stress.Study Sample: Data were analyzed from 280 patients, of which 178 (63.6%) received levetiracetam as monotherapy or as adjuvant.Results: Depression was reported in 150 (53.6%), anxiety in 110 (39.3%), insomnia in 131 (46.8%), and clinically significant stress in 211 (75.4%). At univariate analysis, levetiracetam was not associated with psychiatric symptoms. Multivariate logistic regression revealed that severe depressive symptoms were associated with family history (OR = 2.47, 95% CI = 1.42-4.33, P = .001) and seizure type (OR = 1.69, 95% CI = 1.01-2.80, P = .04), severe anxiety symptoms were associated with family history (OR = 1.90, 95% CI = 1.12-3.23, P = .01), severe insomnia was associated with seizure type (OR = 2.16, 95% CI = 1.33-3.5, P = .002) and severe stress was associated with marital status (OR = 2.37, 95% CI = 1.31-4.29, P = .004).Conclusions: The high psychological burden of PWE is a challenging issue that requires attention and prompt action to control its risk factors. Levetiracetam was not associated with psychiatric symptoms in this study.
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Affiliation(s)
- Omar Gammoh
- Faculty of Pharmacy, Department of Clinical Pharmacy and Pharmacy Practice, Yarmouk University, Irbid, Jordan
| | - Ahmed Al-Smadi
- Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
| | | | - Wail Ennab
- Department of Neurology, Al-Bashir Hospital, Amman, Jordan
| | | | - Ghaith Al-Taani
- Faculty of Pharmacy, Department of Clinical Pharmacy and Pharmacy Practice, Yarmouk University, Irbid, Jordan
| | - Mervat Alsous
- Faculty of Pharmacy, Department of Clinical Pharmacy and Pharmacy Practice, Yarmouk University, Irbid, Jordan
| | - Alaa AA Aljabali
- Faculty of Pharmacy, Department of Pharmaceutics and Pharmaceutical Technology, Yarmouk University, Irbid, Jordan
| | - Murtaza M Tambuwala
- Lincoln Medical School, Brayford Pool Campus, University of Lincoln, Lincoln, Lincolnshire, UK
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Gündoğdu A, Bolattürk ÖF, Aygül R, Akyürek F. The Relationship of Fatigue and Depression with Trace Element Levels in Epileptic Patients. Biol Trace Elem Res 2023; 201:1135-1142. [PMID: 35501663 DOI: 10.1007/s12011-022-03258-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/21/2022] [Indexed: 02/07/2023]
Abstract
In this study, it was investigated whether there are trace element abnormalities in epileptic patients, the relationship of trace elements with fatigue and depression, and whether trace elements contribute to the development of fatigue and depression. A total of 87 people, 48 epileptic cases and 39 controls, were included in our study. Trace element levels of lead (Pb), zinc (Zn), copper (Cu), manganese (Mn), and selenium (Se) were measured in a single session on the study day by the same team. Beck Depression Inventory, Fatigue Severity Scale, Mood State Scale, and SF-36 Quality of Life scales were administered to all participants by the same person. The results were compared statistically. Depression rate was found as 35.4% and fatigue rate was 45.8% in epileptics. Se, Cu, and Mn levels were significantly higher in epileptics (p < 0.05), but there was no significant difference in Zn and Pb levels (p > 0.05). In the study, a moderate positive correlation was found between fatigue and depression (r = 0.346, p = 0.016). Fatigue severity scale (FSS) and Beck depression inventory (BDI) scores were found to be significantly higher in epileptics (p < 0.05). Total mood scale (TMS) mean score was compared between patient and control groups, and the difference between the groups was statistically significant (p < 0.005). It was observed that fatigue and depression are more common in epileptics, and there may be abnormalities in trace element plasma levels in epileptics, and it was determined that trace elements did not show a significant difference between those with and without fatigue and depression, and trace elements did not show a significant correlation with fatigue and depression.
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Affiliation(s)
- Ayşe Gündoğdu
- Neurology Department, Medicine Faculty Süleyman Demirel University, Isparta, Turkey
| | - Ömer Faruk Bolattürk
- Neurology Department, Medicine Faculty, Mustafa Kemal University, Hatay, Turkey.
| | - Recep Aygül
- Neurology Department, Medicine Faculty, Selçuk University, Konya, Turkey
| | - Fikret Akyürek
- Department of Biochemistry, Faculty of Medicine, Selçuk University, Konya, Turkey
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Gillespie DC, Flewitt BI, Sacripante R, Burns V, Young L, Chin RF, Duncan SE. Questionnaire-based screening for mental distress in epilepsy: Outline and feasibility of an outpatient screening and intervention pathway. Epilepsy Behav 2023; 142:109085. [PMID: 36801165 DOI: 10.1016/j.yebeh.2023.109085] [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: 10/18/2022] [Revised: 12/19/2022] [Accepted: 01/01/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE Mental distress is present in a significant proportion of people with epilepsy (PWE), with a negative impact across life domains. It is underdiagnosed and under-treated despite guidelines recommending screening for its presence (e.g., SIGN, 2015). We describe a tertiary-care epilepsy mental distress screening and treatment pathway, with a preliminary investigation of its feasibility. METHODS We selected psychometric screening instruments for depression, anxiety, quality of life (QOL), and suicidality, establishing treatment options matched to instrument scores on the Patient Health Questionnaire 9 (PHQ-9), along 'traffic light' lines. We determined feasibility outcomes including recruitment and retention rates, resources required to run the pathway, and level of psychological need. We undertook a preliminary investigation of change in distress scores over a 9-month interval and determined PWE engagement and the perceived usefulness of pathway treatment options. RESULTS Two-thirds of eligible PWE were included in the pathway with an 88% retention rate. At the initial screen, 45.8% of PWE required either an 'Amber-2' intervention (for moderate distress) or a 'Red' one (for severe distress). The equivalent figure at the 9-month re-screen was 36.8%, reflective of an improvement in depression and QOL scores. Online charity-delivered well-being sessions and neuropsychology were rated highly for engagement and perceived usefulness, but computerized cognitive behavioral therapy was not. The resources required to run the pathway were modest. CONCLUSION Outpatient mental distress screening and intervention are feasible in PWE. The challenge is to optimize methods for screening in busy clinics and to determine the best (and most acceptable) interventions for screening positive PWE.
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Affiliation(s)
- David C Gillespie
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, NHS Lothian, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - Bethany Iona Flewitt
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, NHS Lothian, UK
| | - Riccardo Sacripante
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, NHS Lothian, UK; Human Cognitive Neuroscience, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | | | | | - Richard F Chin
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Royal Hospital for Children and Young People, Edinburgh, UK
| | - Susan E Duncan
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, NHS Lothian, UK; Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Yıldız Miniksar D, Kılıç B, Kaytan İ, Özpınar E, Miniksar ÖH, Topçu Y, Aydın K. The Impact of COVID-19 Pandemic and Quarantine Process a Center in Turkey on Anxiety Levels of Pediatric Patients with Epilepsy. GÜNCEL PEDIATRI 2022. [DOI: 10.4274/jcp.2022.53325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Qin SK, Yang ZX, Guan ZW, Zhang JH, Ping X, Lu Y, Pei L. Exploring the association between epilepsy and depression: A systematic review and meta-analysis. PLoS One 2022; 17:e0278907. [PMID: 36520790 PMCID: PMC9754200 DOI: 10.1371/journal.pone.0278907] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE This study offers meta-analytic data on the potential association between epilepsy and depression especially for the prevalence of depression in epilepsy or vice versa. METHODS The relevant studies were searched and identified from nine electronic databases. Studies that mentioned the prevalence and/or incidence of epilepsy and depression were included. Hand searches were also included. The search language was English and the search time was through May 2022. Where feasible, random-effects models were used to generate pooled estimates. RESULTS After screening electronic databases and other resources, 48 studies from 6,234 citations were included in this meta-analysis. The period prevalence of epilepsy ranged from 1% to 6% in patients with depression. In population-based settings, the pooled period prevalence of depression in patients with epilepsy was 27% (95% CI, 23-31) and 34% in clinical settings (95% CI, 30-39). Twenty studies reported that seizure frequency, low income, unemployment of the patients, perception of stigma, anxiety, being female, unmarried status, disease course, worse quality of life, higher disability scores, and focal-impaired awareness seizures were risk factors for depression. CONCLUSION Our study found that epilepsy was associated with an increased risk of depression. Depression was associated with the severity of epilepsy.
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Affiliation(s)
- Shao-kun Qin
- Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
- Hebei Key Laboratory of Turbidity, Shijiazhuang, Hebei, China
| | - Zi-xian Yang
- Hebei Key Laboratory of Turbidity, Shijiazhuang, Hebei, China
- School of Chinese Medicine, North China University of Science and Technology, Tangshan, Hebei, China
| | - Zhen-wei Guan
- Hebei Key Laboratory of Turbidity, Shijiazhuang, Hebei, China
- Hebei Academy of Chinese Medicine Sciences, Shijiazhuang, Hebei, China
| | - Jin-hu Zhang
- Hebei Key Laboratory of Turbidity, Shijiazhuang, Hebei, China
- Hebei Academy of Chinese Medicine Sciences, Shijiazhuang, Hebei, China
| | - Xin Ping
- Hebei Key Laboratory of Turbidity, Shijiazhuang, Hebei, China
- Hebei Academy of Chinese Medicine Sciences, Shijiazhuang, Hebei, China
| | - Ye Lu
- Hebei Key Laboratory of Turbidity, Shijiazhuang, Hebei, China
- Hebei Academy of Chinese Medicine Sciences, Shijiazhuang, Hebei, China
- * E-mail: (YL); (LP)
| | - Lin Pei
- Hebei Key Laboratory of Turbidity, Shijiazhuang, Hebei, China
- Hebei Academy of Chinese Medicine Sciences, Shijiazhuang, Hebei, China
- * E-mail: (YL); (LP)
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Hagemann A, Lahr D, May TW, Speicher P, Hausfeld H, Coban I, Müffelmann B, Bien CG, Specht U. Efficacy of a specialized inpatient rehabilitation program in patients with early versus chronic epilepsy. Epilepsy Behav 2022; 142:108999. [PMID: 36446667 DOI: 10.1016/j.yebeh.2022.108999] [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: 06/08/2022] [Revised: 11/03/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a specialized inpatient rehabilitation program in patients with early in comparison with chronic epilepsy. METHODS We performed a prospective, open pre/post study using a parallel group design. Patients with early epilepsy (EE, treatment with anti-seizure medication [ASM] ≤ 1 year) or with chronic epilepsy (CE, ASM treatment > 5 years) completed questionnaires at the time of their admission to the rehabilitation program and at discharge. Outcome measures comprised scales from the PESOS questionnaire (PErformance, SOciodemographic aspects, Subjective estimation; e.g., emotional adaptation to epilepsy) as well as screening instruments for depression (Neurological Disorders Depression Inventory for Epilepsy, NDDI-E) and anxiety (Generalized Anxiety Disorder Scale, GAD-7). Linear mixed models (LMMs) were used to determine the effects of the program in the total group and to compare the effects between patients with EE and CE. RESULTS The analyses included 79 patients with EE and 157 patients with CE. Baseline comparisons revealed differences in disease-related and sociodemographic variables (e.g., patients with EE were older, those with CE had a higher seizure frequency and a higher rate of unemployment; all p < .01). LMMs showed significant improvements in emotional adaptation to epilepsy, depression, anxiety, overall quality of life and overall health as well as in perceived overall restrictions because of epilepsy and the subjective level of information about epilepsy (all p < .001). Despite the different duration of epilepsy, baseline levels as well as improvements did not differ between patients with EE and CE (all p > .05) except for the perceived level of information, which was significantly lower in patients with EE at admission and improved to a higher extent in this group (both p < .001). CONCLUSION Both patients with EE and patients with CE who are referred to a specialized comprehensive rehabilitation program benefit from the participation in this program with respect to emotional adaptation to epilepsy, aspects of quality of life, and level of information about epilepsy.
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Affiliation(s)
- Anne Hagemann
- Society for Epilepsy Research, Maraweg 21, 33617 Bielefeld, Germany.
| | - Denise Lahr
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Theodor W May
- Society for Epilepsy Research, Maraweg 21, 33617 Bielefeld, Germany.
| | - Pascal Speicher
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Heiko Hausfeld
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Ingrid Coban
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Birgitt Müffelmann
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Christian G Bien
- Society for Epilepsy Research, Maraweg 21, 33617 Bielefeld, Germany; Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Ulrich Specht
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
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Tsamakis K, Teagarden DL, Villarreal HK, Morton ML, Janocko NJ, Groover O, Loring DW, Drane DL, Karakis I. Depression and Anxiety in Adult Persons With Epilepsy and Their Caregivers: A Survey-Based Study at a Tertiary Care Center. J Nerv Ment Dis 2022; 210:212-218. [PMID: 34719659 DOI: 10.1097/nmd.0000000000001436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT This study evaluated the rates of depression and anxiety and their determinants in adult persons with epilepsy and their caregivers. Both completed surveys about demographic, disease-related, and psychosocial characteristics. One hundred patients and caregivers participated. A mood disorder was present in 89% of patients and 56% of caregivers. In the univariate analysis, the presence of mood disorder in the patient was associated with being unmarried, unemployed, frequent hospitalizations, side effects from polypharmacy, patient stigma, patient quality of life, caregiver anxiety, and caregiver burden. In the multivariate analysis, medication side effects sustained as an important determinant. In the univariate analysis, the presence of mood disorder in the caregiver was associated with seizure frequency, patient anxiety, patient quality of life, caregiver stigma, and caregiver burden. In the multivariate analysis, patient anxiety level and caregiver burden sustained as important determinants. Adult persons with epilepsy and their caregivers experience high rates of mood disorders, explained by certain clinical factors.
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Sawant N, Singh R, Vaswani R. A study on behavioral disorders, academic difficulties, and parental handling patterns in children with epilepsy. J Pediatr Neurosci 2022. [DOI: 10.4103/jpn.jpn_210_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sah SK, Rai N, Sah MK, Timalsena M, Oli G, Katuwal N, Rajbhandari H. Comorbid depression and its associated factors in patients with epilepsy treated with single and multiple drug therapy: A cross-sectional study from Himalayan country. Epilepsy Behav 2020; 112:107455. [PMID: 33181908 DOI: 10.1016/j.yebeh.2020.107455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Depressive disorder is the most common psychiatric comorbidity in individuals with epilepsy (IWE) and is associated with a significant negative impact with increased morbidity and mortality rate. However, the magnitude of comorbid depression in such patients in the Nepalese setting is still poorly understood. Therefore, we aimed to determine the magnitude of depression in individuals diagnosed as having epilepsy and further examine the influencing factors associated with it. METHODS This cross-sectional observational study was conducted from April 2018 to September 2018 at Nepal Epilepsy Center, Lazimpat, Kathmandu, Nepal. One hundred and forty-two eligible subjects were enrolled for analysis. The core outcome variable evaluated in this study was depressive disorder, whereas age, gender, types of epilepsy, frequency of seizures, duration of epilepsy, and drug use were evaluated as covariates. The mean ages of the patients were 31.45 ± 12.05 years, and 87 (61.3%) were male. The prevalence of depression was found to be 31% (95% confidence interval [CI]; lower limit: 23.39% and upper limit: 38.60%), with majority subjects had a mild type of depression, and 63.63% (95% CI; lower limit: 55.05% and upper limit: 70.94%). The frequency of drug use remained a significant predictor for depression in individuals with epilepsy (P = 0.002), and the odds of having depression in individuals receiving polytherapy were 3.82 higher than in those receiving monotherapy (95%: 1.61-9.05, P = 0.002). CONCLUSION Our study indicated a high rate of depression in a substantial number of IWE in the Nepalese setting. Polytherapy emerged as an independent predictor for depression. The high coexistence of depression in this vulnerable population and an increased risk for comorbid in polytherapy necessitate incorporating depression screening and proper treatment into the existing epilepsy program. Furthermore, revising treatment guidelines on comorbid depression to reduce polytherapy and encouraging health education on epilepsy to reduce stigma may also be warranted.
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Affiliation(s)
- Shiv Kumar Sah
- Purbanchal University, Little Buddha College of Health Science, Minbhawan, Kathmandu, Nepal; Gastro and Liver Foundation, Nepal.
| | - Nabin Rai
- Purbanchal University, Little Buddha College of Health Science, Minbhawan, Kathmandu, Nepal
| | - Mukesh Kumar Sah
- Purbanchal University, Little Buddha College of Health Science, Minbhawan, Kathmandu, Nepal
| | - Milan Timalsena
- Purbanchal University, Little Buddha College of Health Science, Minbhawan, Kathmandu, Nepal
| | - Gayatri Oli
- Purbanchal University, Little Buddha College of Health Science, Minbhawan, Kathmandu, Nepal
| | - Nagendra Katuwal
- Nepal Army Institute for Health Sciences (NAIHS), Sanobharyang, Kathmandu, Nepal
| | - Hemav Rajbhandari
- Kathmandu Model Hospital, Nepal Epilepsy Center, Lazimpat, Kathmandu, Nepal
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Melikova SY. [The problem of depression in women with epilepsy during pregnancy and after childbirth]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 119:70-73. [PMID: 32207734 DOI: 10.17116/jnevro201911911270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The review analyzes the results of recent studies on depression and anxiety in women with epilepsy during pregnancy and after childbirth. It has been confirmed that the risk of depression and anxiety during pregnancy and after childbirth is higher in women with epilepsy compared to general population. Risk factors for these disorders, effects of drugs (AEDs, antidepressants) on pregnancy, fetus and course of epilepsy are considered. Postpartum depression is more common in late-age and multiple pregnancies. Further study of depression and anxiety in women with epilepsy during pregnancy and after childbirth can help prevent possible risks both for mother and for the baby.
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Campbell R, Petranovich CL, Cheek S, Morrison L, Hart B. Subjective Cognitive Concerns and Attitudes toward Genetic Testing Are Associated with Depressive Symptoms and Quality of Life after Genetic Testing for the Cerebral Cavernous Malformation Common Hispanic Mutation (CCM1). ACTA ACUST UNITED AC 2020; 10:118-127. [PMID: 32467778 PMCID: PMC7255433 DOI: 10.4236/jbbs.2020.102007] [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] [Indexed: 12/03/2022]
Abstract
Purpose This study aimed to characterize mood and quality of life and to examine the associations of these areas with subjective cognitive concerns and attitudes toward genetic testing for the Common Hispanic Mutation, a gene that has been associated with increased risk for CCM1. Method Fifty-four adults with previous genetic testing for the Common Hispanic Mutation completed a mail survey that included assessments of the above identified areas. Results Self-reported depressive symptoms and quality of life did not differ between those with positive and negative genetic test results. The negative group expressed a more favorable attitude toward genetic testing (p < 0.001). There was a trend toward more subjective cognitive concerns in the positive group (p = 0.06). Using generalized linear regression, more subjective cognitive concerns were associated with poorer quality of life and more depressive symptoms (p < 0.001). Poorer attitude toward genetic testing was also associated with poorer quality of life (p < 0.05). Conclusions Subjective cognitive concerns and negative attitudes toward genetic testing may influence emotional well-being after genetic testing for the Common Hispanic Mutation. Additional research is needed that uses objective neuropsychological measures to understand the associations of subjective cognitive concerns, emotional well-being, and cognitive test performance in individuals with CCM1. There is also a need for research that focuses on protective factors and resiliency following genetic testing for CCM1 and the development of mental health interventions to preempt psychosocial difficulties.
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Affiliation(s)
- Richard Campbell
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Christine L Petranovich
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.,Department of Rehabilitation Medicine, Children's Hospital Colorado and the School of Medicine, University of Colorado Denver, Aurora, CO, USA
| | | | - Leslie Morrison
- Department of Neurology and Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Blaine Hart
- Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Wubie MB, Alebachew MN, Yigzaw AB. Common mental disorders and its determinants among epileptic patients at an outpatient epileptic clinic in Felegehiwot Referral Hospital, Bahirdar, Ethiopia: cross-sectional study. Int J Ment Health Syst 2019; 13:76. [PMID: 31890001 PMCID: PMC6935222 DOI: 10.1186/s13033-019-0333-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 12/18/2019] [Indexed: 12/05/2022] Open
Abstract
Background Epilepsy is a chronic neurological condition that is highly predisposed to a variety of mental health problems due to its huge biological, social and psychological burdens. Despite this, there is a paucity of research in this area. Therefore, assessing common mental disorders and its determinants among epileptic patients would be of great importance. Objective This study was aimed to asses prevalence and associated factors of common mental disorders among people with epilepsy attending Felegehiwot Referral Hospital, Bahirdar, Ethiopia, 2019. Methods Institutional based analytic cross-sectional study design was utilized from January to February 2019 at Felegehiwot Referral Hospital among 422 epileptic patients who were diagnosed clinically and on follow up treatment. Systematic random sampling was applied to recruit participants. Interviewer based and pretested Self Reporting Questionnaire‐20 was used to screen common mental illness with a cut-off point 7 and above as having a common mental disorder. Bivariate and multivariable logistic regression analysis with 95% CI were computed and variables with p < 0.05 in the final model were considered as associated factors for common mental disorders. Result Four hundred twenty-two patients with epilepsy were included in our study with a response rate of 100% and 64.5% were males. The mean age of participants was 59 ± 13.37 years. Common mental disorder among epileptic patients was found to be 35.8%. There was a statistically significant association between marital status, comorbid medical illness, nicotine dependence, alcohol misuse, and medication non-adherence with common mental disorders at p < 0.05. Conclusion The prevalence of common mental distress was high (35.8%) suggesting that it is a public health issue. Marital status, comorbid medical illness, nicotine dependence, alcohol misuse, and medication non-adherence were the factors having an association with a common mental disorder. Therefore, early screening and recognition of mental distress symptoms should be a routine activity while managing epileptic patients.
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Affiliation(s)
- Mengesha Birkie Wubie
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mogesie Necho Alebachew
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Asmare Belete Yigzaw
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Lopes TM, Campos BM, Zanão TA, Balthazar MLF, Yasuda CL, Cendes F. Hippocampal atrophy disrupts the language network but not hemispheric language lateralization. Epilepsia 2019; 60:744-755. [DOI: 10.1111/epi.14694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Tátila Martins Lopes
- Neuroimaging LaboratoryDepartment of NeurologyUniversity of Campinas Campinas SP Brazil
| | - Brunno Machado Campos
- Neuroimaging LaboratoryDepartment of NeurologyUniversity of Campinas Campinas SP Brazil
| | - Tamires Araújo Zanão
- Neuroimaging LaboratoryDepartment of NeurologyUniversity of Campinas Campinas SP Brazil
| | | | - Clarissa Lin Yasuda
- Neuroimaging LaboratoryDepartment of NeurologyUniversity of Campinas Campinas SP Brazil
| | - Fernando Cendes
- Neuroimaging LaboratoryDepartment of NeurologyUniversity of Campinas Campinas SP Brazil
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Prevos-Morgant M, Leavy Y, Chartrand D, Jurasek L, Osborne Shafer P, Shinnar R, Goodwin M. Benefits of the epilepsy specialist nurses (ESN) role, standardized practices and education around the world. Rev Neurol (Paris) 2019; 175:189-193. [PMID: 30683450 DOI: 10.1016/j.neurol.2018.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/20/2018] [Accepted: 10/15/2018] [Indexed: 11/27/2022]
Abstract
Epilepsy, often considered as a stigmatizing disease, affects 65 million people worldwide and is frequently associated with comorbidities that increase both direct and indirect costs. The degree of impact on quality of life and the cost of care differs depending on the social and health care organizations in place, political, medico-economic and/or socio-cultural contexts. Across the globe, healthcare is provided by nurses in primary care, urgent or emergency care, and within specialized domains of practice. In Epilepsy the global care could be enhanced by developing standardized nursing education in close collaboration with other caregivers. The impact of epilepsy nursing care has been documented in some developed countries, but the diversity of nursing practices and professional education of nurses raise difficulties in generalizing these findings. Specialized education in epilepsy will improve access, treatment and ultimately the quality of life of patients.
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Affiliation(s)
- M Prevos-Morgant
- Medical center « La Teppe », 25, avenue de la Bouteme, 26602 Tain-l'Hermitage, France; Institute of epilepsy IDEE, 59, boulevard Pinel, 69500 Bron, France.
| | - Y Leavy
- NHS Lothian, Edinburgh, Scotland, United Kingdom
| | - D Chartrand
- Ste Justine University Hospital, Montreal, Canada
| | - L Jurasek
- Alberta Health Services, Alberta, Canada
| | | | - R Shinnar
- Montefiore Medical Center, New York, United States
| | - M Goodwin
- Northampton General Hospital, United Kingdom
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Fisher PL, Reilly J, Noble A. Metacognitive beliefs and illness perceptions are associated with emotional distress in people with epilepsy. Epilepsy Behav 2018; 86:9-14. [PMID: 30036766 DOI: 10.1016/j.yebeh.2018.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/05/2018] [Accepted: 07/08/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Emotional distress is common in people with epilepsy (PWE) for which efficacious interventions are required. Developing evidence-based treatments should be based on testable models of the psychological mechanisms maintaining psychopathology. The Self-Regulatory Executive Function (S-REF) model proposes that maladaptive metacognitive beliefs and processes are central to the development and maintenance of emotional distress. Although preliminary support exists for the role of metacognitive beliefs in emotional distress in PWE, their role has yet to be tested when controlling for the contribution made by illness perceptions. METHODS Four hundred and fifty-seven PWE completed an online survey, which assessed anxiety, depression, metacognitive beliefs, illness perceptions, general demographic factors, and epilepsy characteristics. RESULTS Hierarchical regression analyses demonstrated that metacognitive beliefs and illness perceptions were both associated with anxiety and depression when controlling for the influence of demographic variables and epilepsy characteristics. However, metacognitive beliefs accounted for more variance in anxiety and depression than illness perceptions. CONCLUSION Metacognitive beliefs appear to make a greater contribution to anxiety and depression in PWE than illness perceptions. Prospective studies are now needed to establish the causal role of metacognitive beliefs in both the development and persistence of emotional distress.
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Affiliation(s)
- Peter L Fisher
- Psychological Sciences, University of Liverpool, Liverpool, United Kingdom.
| | - James Reilly
- Psychological Sciences, University of Liverpool, Liverpool, United Kingdom.
| | - Adam Noble
- Psychological Sciences, University of Liverpool, Liverpool, United Kingdom.
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Do DH, Siegler JE. Diagnoses and other predictors of patient absenteeism in an outpatient neurology clinic. Neurol Clin Pract 2018; 8:318-326. [PMID: 30140583 DOI: 10.1212/cpj.0000000000000488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 04/05/2018] [Indexed: 11/15/2022]
Abstract
Background We sought to determine the neurologic diagnosis or diagnostic categories that are associated with a higher probability of honoring a scheduled follow-up visit in the outpatient clinic. Methods We conducted a retrospective analysis of patients evaluated over a 3-year period (July 2014-June 2017) at a single neurology clinic in an urban location. Adult patients who honored an initial scheduled outpatient appointment were included. Only diagnoses with a ≥0.5% prevalence at our center were analyzed. Mixed-effects logistic regression was used to determine association of independent variables and honored follow-up visits. Results Of 61,232 scheduled outpatient subsequent encounters for 20,729 unique patients, the overall absenteeism rate was 12.5% (95% confidence interval [CI] 12.2%-12.8%). Independent risk factors associated with absenteeism included younger age, black or Latino race/ethnicity, Medicaid/Medicare payor status, and longer delay from appointment scheduling to appointment date. In mixed-effects logistic regression, diagnoses associated with the lowest odds of showing were medication overuse headache (show rate 79.2%, odds ratio [OR] for honoring appointment 0.67, 95% CI 0.48-0.93) and depression (rate 85.9%, OR 0.82, 95% CI 0.70-0.97), whereas the diagnoses associated with the greatest odds of showing included Charcot-Marie-Tooth disease (rate 96.3%, OR 2.54, 95% CI 1.44-4.49) and aphasia (rate 95.9%, OR 2.34, 95% CI 1.28-4.30). Conclusions Certain chronic neurologic diseases, such as medication overuse headache and depression, were associated with a significantly lower odds of honoring scheduled follow-up conditions. As these conditions influence quality of life and productivity, patients with these illnesses may benefit from selective targeting to encourage adherence with scheduled follow-up appointments.
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Affiliation(s)
- David H Do
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia
| | - James E Siegler
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia
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19
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Viguera AC, Fan Y, Thompson NR, Lapin B, Chaitoff A, Griffith SD, Miller DM, Jehi L, Katzan IL. Prevalence and Predictors of Depression Among Patients With Epilepsy, Stroke, and Multiple Sclerosis Using the Cleveland Clinic Knowledge Program Within the Neurological Institute. PSYCHOSOMATICS 2018; 59:369-378. [DOI: 10.1016/j.psym.2017.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 12/20/2022]
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20
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Affective and behavioral dysfunction under antiepileptic drugs in epilepsy: Development of a new drug-sensitive screening tool. Epilepsy Behav 2018; 83:175-180. [PMID: 29709877 DOI: 10.1016/j.yebeh.2018.03.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/20/2018] [Accepted: 03/31/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Behavioral problems and psychiatric symptoms are common in patients with epilepsy and have a multifactorial origin, including adverse effects of antiepileptic drugs (AEDs). In order to develop a screening tool for behavioral AED effects, the aim of this study was to identify behavioral problems and symptoms particularly sensitive to AED drug load and the presence/absence of AEDs with known negative psychotropic profiles. METHODS Four hundred ninety-four patients with epilepsy were evaluated who had been assessed with three self-report questionnaires on mood, personality, and behavior (Beck Depression Inventory, BDI; Neurological Disorders Depression Inventory for Epilepsy extended, NDDI-E; and Fragebogen zur Persönlichkeit bei zerebralen Erkrankungen, FPZ). Drug-sensitive items were determined via correlation analyses and entered into an exploratory factor analysis for scale construction. The resulting scales were then analyzed as a function of drug treatment. RESULTS Analyses revealed 30 items, which could be allocated to six behavioral domains: Emotional Lability, Depression, Aggression/Irritability, Psychosis & Suicidality, Risk- & Sensation-seeking, and Somatization. Subsequent analysis showed significant effects of the number of AEDs on behavior, as in Emotional Lability (F=2.54, p=.029), Aggression/Irritability (F=2.29, p=.046), Psychosis & Suicidality (F=2.98, p=.012), and Somatization (F=2.39, p=.038). Affective and behavioral difficulties were more prominent in those patients taking AEDs with supposedly negative psychotropic profiles. These effects were largely domain-unspecific and primarily manifested in polytherapy. CONCLUSION Drug-sensitive behavioral domains and items were identified which qualify for a self-report screening tool. The tool indicates impairments with a higher drug load and when administering AEDs with negative psychotropic profiles. The next steps require normalization in healthy subjects and the clinical validation of the newly developed screening tool PsyTrack along with antiepileptic drug treatment.
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Dehn LB, Pfäfflin M, Brückner S, Lutz MT, Steinhoff BJ, Mayer T, Bien CG, Nussbeck FW, May TW. Relationships of depression and anxiety symptoms with seizure frequency: Results from a multicenter follow-up study. Seizure 2017; 53:103-109. [DOI: 10.1016/j.seizure.2017.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/11/2017] [Accepted: 11/13/2017] [Indexed: 02/07/2023] Open
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22
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Xu Y, Hackett ML, Glozier N, Nikpour A, Bleasel A, Somerville E, Lawson J, Jan S, Hyde L, Todd L, Martiniuk A, Ireland C, Anderson CS. Frequency and predictors of psychological distress after a diagnosis of epilepsy: A community-based study. Epilepsy Behav 2017; 75:190-195. [PMID: 28881320 DOI: 10.1016/j.yebeh.2017.07.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of the study was to determine the frequency and predictors of psychological distress after a diagnosis of epilepsy. METHODS The Sydney Epilepsy Incidence Study to Measure Illness Consequences (SEISMIC) was a prospective, multicenter, community-based study of people of all ages with newly diagnosed epilepsy in Sydney, Australia. Analyses involved multivariate logistic regression and multinomial logit regression to identify predictors of psychological distress, assessed using the Hospital Anxiety and Depression Scale (HADS) and the Strengths and Difficulties Questionnaire (SDQ), as part of structured interviews. RESULTS Psychological distress occurred in 33% (95% confidence interval [CI] 26 to 40%) and 24% (95% CI 18 to 31%) of 180 adults at baseline and 12months, respectively, and 23% (95% CI 14 to 33%) of 77 children at both time points. Thirty adults and 7 children had distress at baseline who recovered at 12months, while 15 adults and 7 children had new onset of distress during this period. History of psychiatric or behavioral disorder (for adults, odds ratio [OR] 6.82, 95% CI 3.08 to 15.10; for children, OR 28.85, 95% CI 2.88 to 288.60) and higher psychosocial disability (adults, OR 1.17, 95% CI 1.07 to 1.27) or lower family functioning (children, OR 1.80, 95% CI 1.08 to 3.02) were associated with psychological distress (C statistics 0.80 and 0.78). CONCLUSIONS Psychological distress is common and fluctuates in frequency after a diagnosis of epilepsy. Those with premorbid psychological, psychosocial, and family problems are at high risk of this adverse outcome.
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Affiliation(s)
- Ying Xu
- Sydney Medical School, University of Sydney, Australia; Neurological and Mental Health Division, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, 83-117 Missenden Road, Camperdown, NSW 2050, Australia
| | - Maree L Hackett
- Sydney Medical School, University of Sydney, Australia; Neurological and Mental Health Division, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, 83-117 Missenden Road, Camperdown, NSW 2050, Australia
| | - Nick Glozier
- Brain and Mind Centre, University of Sydney, 94 Mallett St, Camperdown, NSW 2050, Australia
| | - Armin Nikpour
- Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners, NSW 2006, Australia
| | - Andrew Bleasel
- Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW 2145, Australia
| | - Ernest Somerville
- Prince of Wales Hospital, Barker St, Randwick, NSW 2031, Australia; Faculty of Medicine, UNSW, High St, Randwick 2031, Australia
| | - John Lawson
- Faculty of Medicine, UNSW, High St, Randwick 2031, Australia; Department of Neurology, Sydney Children's Hospital, High St, Randwick 2031, Australia
| | - Stephen Jan
- Office of the Chief Scientist, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, 83-117 Missenden Road, Camperdown, NSW 2050, Australia
| | - Lorne Hyde
- Epilepsy Action Australia, PO Box 879, Epping, NSW 1710, Australia
| | - Lisa Todd
- Epilepsy Action Australia, PO Box 879, Epping, NSW 1710, Australia
| | | | - Carol Ireland
- Epilepsy Action Australia, PO Box 879, Epping, NSW 1710, Australia
| | - Craig S Anderson
- Sydney Medical School, University of Sydney, Australia; Neurological and Mental Health Division, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, 83-117 Missenden Road, Camperdown, NSW 2050, Australia; Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners, NSW 2006, Australia; The George Institute for Global Health at Peking University Health Science Centre, Level 18, Tower B, Horizon Tower, No. 6 Zhichun Rd, Haidian District, Beijing 100088, PR China.
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Abstract
Behavioural changes associated with epilepsy can be challenging for patients and clinicians. Evidence suggests an association between aggression and epilepsy that involves various neurophysiological and neurochemical disturbances. Anti-epileptics have variable effects on behaviour and cognition that need consideration. Early detection and careful consideration of history, symptomatology and possible common comorbid psychiatric disorders is essential. Appropriate investigations should be considered to aid diagnosis, including electroencephalogram (EEG), video EEG telemetry and brain imaging. Optimising treatment of epilepsy, treatment of psychiatric comorbidities and behavioural management can have a major positive effect on patients' recovery and well-being.Learning Objectives• Understand the epidemiology of aggression in epilepsy• Comprehend the link between anti-epileptics and aggression, including the important role of pharmacodynamics• Be aware of the pharmacological treatments available for managing aggressive behaviour in epilepsy
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Stephen LJ, Wishart A, Brodie MJ. Psychiatric side effects and antiepileptic drugs: Observations from prospective audits. Epilepsy Behav 2017; 71:73-78. [PMID: 28551500 DOI: 10.1016/j.yebeh.2017.04.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/09/2017] [Accepted: 04/03/2017] [Indexed: 01/21/2023]
Abstract
Psychiatric comorbidities are common in people with epilepsy. A retrospective study of characteristics associated with withdrawal due to psychiatric side effects was undertaken in patients with treated epilepsy participating in prospective audits with new antiepileptic drugs (AEDs). A total of 1058 treated patients with uncontrolled seizures (942 focal-onset seizures, 116 generalized genetic epilepsies [GGEs]) participated in eight prospective, observational audits from 1996 to 2014. These patients were prescribed adjunctive topiramate (n=170), levetiracetam (n=220), pregabalin (n=135), zonisamide (n=203), lacosamide (n=160), eslicarbazepine acetate (n=52), retigabine (n=64), or perampanel (n=54). Doses were titrated according to efficacy and tolerability to optimize zeizure outcomes and reduce side effects. Psychiatric comorbidities were recorded prior to and after the addition of each AED. At baseline, patients with focal-onset seizures (189 of 942; 20.1%) were statistically more likely to have psychiatric diagnoses compared to patients with GGEs (14 of 116, 12.1%; p=0.039). Following adjunctive AED treatment, neuropsychiatric adverse effects led to AED withdrawal in 1.9-16.7% of patients. Patients with a pre-treatment psychiatric history (22 of 209; 10.5%) were statistically more likely to discontinue their new AED due to psychiatric issues compared to patients with no previous psychiatric diagnosis (50 of 849; 5.9%; p=0.017). Patients receiving sodium channel blocking AEDs (4 of 212, 1.9%) were statistically less likely to develop intolerable psychiatric problems, compared to those on AEDs possessing other mechanisms of action (68 of 846, 8.0%; p=0.012). Depression was the commonest problem, leading to discontinuation of AEDs in 2.8% (n=30) patients. Aggression was statistically more common in men (11 of 527, 2.1%) compared to women (1 of 531, 0.2%; p=0.004). Patients with learning disability (12 of 122, 9.8%; p=0.0015) were statistically less likely to have psychiatric issues prior to adjunctive AED treatment compared to other patients (208 of 936, 22.2%), but there were no statistically significant differences once the new AEDs were added (8 of 122 patients with learning disability, 6.6%; 64 of 936 other patients, 6.8%). Awareness of these issues may assist clinicians in avoiding, identifying and treating psychiatric comorbidities in people with epilepsy.
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Affiliation(s)
- Linda J Stephen
- Epilepsy Unit, West Glasgow Ambulatory Care Hospital, Scotland, UK.
| | - Abbie Wishart
- Epilepsy Unit, West Glasgow Ambulatory Care Hospital, Scotland, UK
| | - Martin J Brodie
- Epilepsy Unit, West Glasgow Ambulatory Care Hospital, Scotland, UK
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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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Yrondi A, Arbus C, Valton L, Schmitt L. Troubles de l’humeur et chirurgie de l’épilepsie : une revue de la littérature. Encephale 2017; 43:154-159. [DOI: 10.1016/j.encep.2016.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/12/2016] [Accepted: 02/01/2016] [Indexed: 11/08/2022]
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Błaszczyk B, Czuczwar SJ. Epilepsy coexisting with depression. Pharmacol Rep 2017; 68:1084-92. [PMID: 27634589 DOI: 10.1016/j.pharep.2016.06.011] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/14/2016] [Accepted: 06/17/2016] [Indexed: 12/15/2022]
Abstract
Depression episodes in epilepsy is the most common commorbidity, affecting between 11% and 62% of patients with epilepsy. Although researchers have documented a strong association between epilepsy and psychiatric comorbidities, the nature of this relationship is poorly understood. The manifestation of depression in epilepsy is a complex issue having many interacting neurobiological and psychosocial determinants, including clinical features of epilepsy (seizure frequency, type, foci, or lateralization of foci) and neurochemical or iatrogenic mechanisms. Other risk factors are a family history of psychiatric illness, particularly depression, a lack of control over the seizures and iatrogenic causes (pharmacologic and surgical). In addition, treatment with antiepileptic drugs (AEDs) as well as social coping and adaptation skills have also been recognised as risk factors of depression associated with epilepsy. Epilepsy may foster the development of depression through being exposed to chronic stress. The uncertainty and unpredictability of seizures may instigate sadness, loneliness, despair, low self-esteem, and self-reproach in patients with epilepsy and lead to social isolation, stigmatization, or disability. Often, depression is viewed as a reaction to epilepsy's stigma and the associated poor quality of life. Moreover, patients with epilepsy display a 4-5 higher rate of depression and suicide compared with healthy population.
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Affiliation(s)
- Barbara Błaszczyk
- Faculty of Health Sciences, High School of Economics, Law and Medical Sciences, Kielce, Poland; Private Neurological Practice, Kielce, Poland.
| | - Stanisław J Czuczwar
- Department of Pathophysiology, Medical University of Lublin, Lublin, Poland; Department of Physiopathology, Institute of Rural Health, Lublin, Poland.
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Owolabi SD, Owolabi LF, Udofia O, Sale S. Depression in patients with epilepsy in Northwestern Nigeria: Prevalence and clinical correlates. Ann Afr Med 2017; 15:179-184. [PMID: 27853032 PMCID: PMC5402830 DOI: 10.4103/1596-3519.194279] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The impact of seizure disorder on people living with epilepsy (PWE) is worsened by the occurrence of comorbid psychiatric disorders, such as depression, which have been found commonly in PWE. Despite the dire consequences comorbid depression has on PWE, it still remains underdiagnosed and undertreated. OBJECTIVE To determine the prevalence of depression and associated clinical factors in PWE in Northwestern Nigeria. MATERIALS AND METHODS A total of 255 consecutive patients with epilepsy aged 18 years and above, from two health facilities, were recruited in this cross-sectional study. Following completion of a structured proforma detailing sociodemographic and seizure characteristics, Mini International Neuropsychiatric Interview was administered to diagnose depression in the patients. RESULTS A total of 255 patients, with a mean age of 32 years (standard deviation = 1.31), comprising 147 (57.6%) males and 108 (42.4%) females were studied. Majority (79.2%) of the patients had primarily generalized seizure type. Overall, depressive disorder was present in 52 (20.4%) patients. A significant association was found between previous hospitalization for epilepsy (P = 0.009), increased frequency of seizures, (P = 0.004), and prolonged duration of epilepsy, (P = 0.006). The independent predictors of depression included duration of epilepsy (P = 0.0001), previous hospitalization for epilepsy (P = 0.011), and frequency of seizures (P = 0.028). CONCLUSION Depression was common in PWE. Female gender, previous hospitalization for epilepsy, increased frequency of seizures and prolonged duration of epilepsy were associated with depression in PWE. Previous hospitalization for epilepsy, increased frequency of seizures, and prolonged duration of epilepsy were independent predictors of depression.
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Affiliation(s)
| | - Lukman Femi Owolabi
- Department of Medicine, Neurology Unit, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | - Owoidoho Udofia
- Department of Psychiatry, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Shehu Sale
- Department of Psychiatry, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
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Major depressive episode, cognition, and epilepsy. Epilepsy Behav 2016; 64:219-223. [PMID: 27764732 DOI: 10.1016/j.yebeh.2016.09.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 08/21/2016] [Accepted: 09/16/2016] [Indexed: 12/28/2022]
Abstract
PURPOSE In patients with epilepsy (PWE), relationships between depression, epilepsy characteristics, and cognitive aspects are complex. This study aimed to assess the occurrence of possible major depressive episode in PWE and to verify whether it is associated with the clinical aspects of the disease and cognition. METHODS Two hundred consecutive PWE with a mean age and standard deviation of 47.6 (±15.1) years were included in the study. We determined whether their Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) scores were associated with their clinical, cognitive, and QOLIE-31 aspects using a significance level of 5% (p<0.05). RESULTS Twenty-six patients (13%) had an NDDI-E score >15, suggestive of major depressive episode. Logistic regression showed that NDDI-E >15 was associated with seizure frequency (p=0.022) and worse performance in the category fluency test (p=0.003). An NDDI-E >15 was also correlated with lower quality of life (p<0.001). CONCLUSION The present findings suggest that possible major depressive episode is associated not only with epilepsy characteristics but also with cognitive aspects, such as category fluency, and quality of life.
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Fela-Thomas A, Akinhanmi A, Esan O. Prevalence and correlates of major depressive disorder (MDD) among adolescent patients with epilepsy attending a Nigerian neuropsychiatric hospital. Epilepsy Behav 2016; 54:58-64. [PMID: 26655450 DOI: 10.1016/j.yebeh.2015.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 09/19/2015] [Accepted: 11/08/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND A high prevalence of mood disorders exists in patients with epilepsy. In most cases, this is not detected and, consequently, not treated. This study aimed to determine the prevalence and correlates of major depressive disorder (MDD) among adolescents with epilepsy attending a child and adolescent clinic in Nigeria. METHODS We recruited 156 participants consecutively for the study. Adherence was assessed using the 8-item Morisky Medication Adherence Questionnaire, while the K-SADS was used to assess the presence of major depressive disorder. Seizure control was evaluated by the frequency of seizures within a year. RESULTS Major depressive disorder (DSM-IV criteria) was diagnosed in 28.2% of the participants. The age of participants (p=0.013), seizure control (p=0.03), medication adherence (p=0.045), frequency of seizures in the preceding 4weeks (p<0.001), and duration of illness (p<0.001) were all significantly associated with the presence of MDD. Participants with seizures occurring more than once weekly in the preceding 4weeks were 16 times more likely to have a MDD compared with those with no seizures in the preceding 4weeks (p<0.001, 95% C.I. [4.13, 65.43]), while participants with a duration of illness more than 10years were more than four times likely to have MDD compared with those with an illness duration of 5-10years (p<0.01, 95% C.I. [0.07, 0.70]). CONCLUSION The prevalence of MDD among patients with epilepsy was high. Poor seizure control, poor medication adherence, and long duration of illness were associated with the presence of MDD among such patients. Intervention should focus on ensuring good seizure control and optimal adherence in order to mitigate the impact of MDD in patients with epilepsy.
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Affiliation(s)
| | | | - Oluyomi Esan
- Department of Psychiatry, University of Ibadan, Ibadan, Oyo State, Nigeria.
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Social anxiety and its psychosocial impact on the lives of people with epilepsy. Epilepsy Behav 2015; 51:286-93. [PMID: 26318791 DOI: 10.1016/j.yebeh.2015.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/02/2015] [Accepted: 08/03/2015] [Indexed: 11/23/2022]
Abstract
Little is known about social anxiety among people with epilepsy (PWE), although PWE are more likely to be diagnosed with social anxiety disorder than the general population. The purpose of this study was to determine which psychosocial and seizure-related variables are associated with social anxiety. It was hypothesized that social anxiety would be positively correlated with perceived seizure severity, stigma, impact of epilepsy, fear of negative evaluation, and experiential avoidance. Further, social anxiety would be negatively correlated with epilepsy knowledge and disclosure of epilepsy. Finally, if a seizure occurred in public and others were unaware of the epilepsy, participants would report greater judgment, anxiety, and rumination compared with those in a situation where others were aware of the epilepsy. A total of 101 individuals with epilepsy participated in this online study. Social anxiety was found to correlate with both psychosocial and seizure-related variables in the expected directions. Further, social anxiety predicted significant variance in stigma and disclosure beyond known predictors of stigma. Participants in both conditions (disclosed diagnosis of epilepsy versus undisclosed diagnosis of epilepsy) were equally distressed by having a seizure in public. These findings provide an initial basis for discerning how to best assess and support PWE with social anxiety.
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Employability in people with epilepsy: A systematic review. Epilepsy Res 2015; 116:67-78. [DOI: 10.1016/j.eplepsyres.2015.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/12/2015] [Accepted: 06/23/2015] [Indexed: 11/20/2022]
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Micoulaud-Franchi JA, Barkate G, Trébuchon-Da Fonseca A, Vaugier L, Gavaret M, Bartolomei F, McGonigal A. One step closer to a global tool for rapid screening of major depression in epilepsy: validation of the French NDDI-E. Epilepsy Behav 2015; 44:11-6. [PMID: 25597527 DOI: 10.1016/j.yebeh.2014.12.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 12/06/2014] [Accepted: 12/09/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Depression in people with epilepsy (PWE) is underdiagnosed and undertreated. The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) is a screening questionnaire used for detecting major depressive episode (MDE) in PWE, and is already validated in 10 languages. However a version in French, one of the world's widely spoken languages, was, until now, lacking. We aimed to translate and validate the French NDDI-E. METHODS This study was performed under the auspices of the ILAE. People with epilepsy >18years of age were recruited from 2 specialist epilepsy units in Marseille, France. Two native French speakers and 2 native English speakers performed a forward-backward translation. The Mini International Neuropsychiatric Interview (MINI) was performed as the gold standard, and the Center for Epidemiological Studies Depression symptoms index (CES-D) was performed for external validity. Data were compared between PWE with MDE and PWE without MDE using the chi-square test and Student's t-test. Internal structural validity, external validity, and receiver operator characteristics were analyzed. RESULTS Testing was performed on 116 PWE: mean age=40.39years (SD=13.83, range: [18-81]years old); 58.6% (68) were women; 87.1% had focal epilepsy. Using the MINI, we found that 33 (28.4%) patients had current MDE and that 15 (12.9%) patients had dysthymia; also, we found that 37 (31.9%) patients presented suicidal ideation and/or behavior. Cronbach's alpha coefficient was 0.838, indicating satisfactory internal consistency. Correlation between the NDDI-E and the CES-D scores was high (r(116)=0.817, p<0.0001), indicating good external validity. Receiver operator characteristic analysis showed an area under the curve of 0.958 (95% CI=0.904-0.986), (p<0.0001), indicating good capacity of the NDDI-E to detect MDE (defined by MINI). The cutoff for maximal sensitivity and specificity was 15. The mean NDDI-E score in PWE with MDE was 18.27 (SD=2.28), and the mean NDDI-E score in PWE without MDE was 10.61 (SD=3.63). SIGNIFICANCE This study validated the French NDDI-E, with a cutoff score of 15/24 for MDE, similar to previous studies, and reinforces the NDDI-E as a global tool for detection of MDE.
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Affiliation(s)
- Jean-Arthur Micoulaud-Franchi
- Pôle de Psychiatrie "Solaris", Centre Hospitalier Universitaire de Sainte-Marguerite, 270 Bd de Sainte-Marguerite, 13009 Marseille, France; Laboratoire de Neurosciences Cognitives, UMR CNRS 7291, 31 Aix-Marseille Université, 13331 Marseille, France
| | - Gérald Barkate
- Hôpital Henri Gastaut, Etablissement Hospitalier Spécialisé dans le traitement des Epilepsies, 300 Boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Agnès Trébuchon-Da Fonseca
- Service de Neurophysiologie Clinique, APHM, Hôpital de la Timone, 13005 Marseille, France; INSERM UMR 1106, INS, 27 Bd Jean Moulin, 13385 Marseille, France; Aix Marseille Université, Faculté de Médecine, Marseille, France
| | - Lisa Vaugier
- Service de Neurophysiologie Clinique, APHM, Hôpital de la Timone, 13005 Marseille, France; Service de Neurophysiologie Clinique, APHM, Hôpital Nord, 13015 Marseille, France
| | - Martine Gavaret
- Service de Neurophysiologie Clinique, APHM, Hôpital de la Timone, 13005 Marseille, France; INSERM UMR 1106, INS, 27 Bd Jean Moulin, 13385 Marseille, France; Aix Marseille Université, Faculté de Médecine, Marseille, France
| | - Fabrice Bartolomei
- Service de Neurophysiologie Clinique, APHM, Hôpital de la Timone, 13005 Marseille, France; INSERM UMR 1106, INS, 27 Bd Jean Moulin, 13385 Marseille, France; Aix Marseille Université, Faculté de Médecine, Marseille, France; Hôpital Henri Gastaut, Etablissement Hospitalier Spécialisé dans le traitement des Epilepsies, 300 Boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Aileen McGonigal
- Service de Neurophysiologie Clinique, APHM, Hôpital de la Timone, 13005 Marseille, France; INSERM UMR 1106, INS, 27 Bd Jean Moulin, 13385 Marseille, France; Aix Marseille Université, Faculté de Médecine, Marseille, France.
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Abstract
OBJECTIVE Anxiety disorders and symptoms are highly prevalent and problematic comorbidities in people with epilepsy (PWE), yet they remain poorly understood and often go undetected. This research aimed to further our understanding about anxiety in PWE. METHODS Study 1 assessed the effectiveness of the commonly utilised yet unvalidated measure (Hospital Anxiety Depression Scale-Anxiety subscale; HADS-A) to identify DSM-IV anxiety disorders in 147 adult epilepsy outpatients. RESULTS This study found that although the HADS-A had reasonable specificity (75%), its poor sensitivity (61%) and inadequate area under the curve (.68) deemed it unreliable as a screener for anxiety disorders in this population. METHODS Study 2 aimed to further our understanding of the relationship between anxiety disorders, as defined by clinical interview, and psychosocial correlates in PWE. One hundred and twenty-two participants from Study 1 completed a battery of psychosocial measures. RESULTS Multivariate analysis revealed that the presence of an anxiety disorder was associated with unemployment, which was found to be the only independent predictor. That is, despite the fact that psychosocial factors together contributed to the variance in anxiety disorders none were revealed to be significant independent predictors. CONCLUSION These findings add to the literature indicating that the HADS may indicate distress, but does not adequately identify people with anxiety disorders and highlights the urgent need for the development of a reliable anxiety screening measure for PWE. Further, the results suggest that anxiety disorders in PWE are likely to be multiply determined with respect to psychosocial factors and require further investigation.
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Lacey CJ, Salzberg MR, D'Souza WJ. Risk factors for depression in community-treated epilepsy: systematic review. Epilepsy Behav 2015; 43:1-7. [PMID: 25546730 DOI: 10.1016/j.yebeh.2014.11.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/23/2014] [Accepted: 11/20/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Depression is one of the most common psychiatric comorbidities in epilepsy; however, the factors contributing to this association remain unclear. There is a growing consensus that methodological limitations, particularly selection bias, affect many of the original studies. A systematic review focussed on community-based studies offers an alternative approach for the identification of the risk factors for depression. METHODS Searches were performed in MEDLINE (Ovid), 2000 to 31 December 2013, EMBASE, and Google Scholar to identify studies examining risk factors for depression in epilepsy. Community-based studies of adults with epilepsy that reported at least one risk factor for depression were included. RESULTS The search identified 17 studies that met selection criteria, representing a combined total of 12,212 people with epilepsy with a mean sample size of 718. The most consistent risk factors for depression were sociodemographic factors, despite the fact that most studies focus on epilepsy-related factors. SIGNIFICANCE Most studies lacked a systematic conceptual approach to investigating depression, and few risk factors were consistently well studied. Future community-based studies require a detailed systematic approach to improve the ability to detect risk factors for depression in epilepsy. Psychological factors were rarely studied in community-based samples with epilepsy, although the consistent association with depression in the few studies that did suggests this warrants further examination.
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Affiliation(s)
- Cameron J Lacey
- Department of Psychiatry, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia; Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Michael R Salzberg
- Department of Psychiatry, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Wendyl J D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia.
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Bosak M, Turaj W, Dudek D, Siwek M, Szczudlik A. Depressogenic medications and other risk factors for depression among Polish patients with epilepsy. Neuropsychiatr Dis Treat 2015; 11:2509-17. [PMID: 26491329 PMCID: PMC4599173 DOI: 10.2147/ndt.s91538] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this study was to assess the prevalence of depression among patients with epilepsy and to establish the risk factors of depression in that group, with special focus on the use of potentially depressogenic medications. PATIENTS AND METHODS We studied 289 consecutive patients who visited epilepsy outpatient clinic (University Hospital of Krakow) and met inclusion criteria. All patients were screened with Beck Depression Inventory (BDI), and those with BDI score ≥12 were further evaluated by a psychiatrist. RESULTS Mean age of patients was 35.7 years, and mean duration of epilepsy was 14.7 years. Idiopathic generalized epilepsy was diagnosed in 63 patients (21.8%), focal epilepsy was found in 189 subjects (65.4%), and unclassified epilepsy was diagnosed in 37 patients (12.8%). Frequent seizures (>1 per month) were reported in 107 patients (37.0%). Thirty-five patients (12.1%) reported an ongoing treatment with one or more of the predefined potentially depressogenic medication (β-blockers, combined estrogen and progestogen, corticosteroid, or flunarizine). In a group of 115 patients (39.8%) who scored ≥12 points in BDI, depression was finally diagnosed in 84 subjects (29.1%) after psychiatric evaluation. Only 20 of those patients (23.8%) were treated with antidepressant. Independent variables associated with the diagnosis of depression in the logistic regression model included frequent seizures (odds ratio [OR] =2.43 [95% confidence interval, 95% CI =1.38-4.29], P=0.002), use of potentially depression-inducing medications (OR =3.33 [95% CI =1.50-7.39], P=0.003), age (OR =1.03 [95% CI =1.01-1.05] per year], P=0.005), and use of oxcarbazepine (OR =2.26 [95% CI =1.04-4.9], P=0.038). CONCLUSION The prevalence of depression among consecutive Polish patients with epilepsy reached 29.1%. Less than quarter of them received antidepressant treatment at the moment of evaluation. Independent variables associated with depression included age, frequent seizures, and the use of oxcarbazepine or predefined depressogenic medications.
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Affiliation(s)
- Magdalena Bosak
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Turaj
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Dominika Dudek
- Department of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
| | - Marcin Siwek
- Department of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Szczudlik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
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Tunde-Ayinmode MF, Abiodun OA, Ajiboye PO, Buhari OIN, Sanya EO. Prevalence and clinical implications of psychopathology in adults with epilepsy seen in an outpatient clinic in Nigeria. Gen Hosp Psychiatry 2014; 36:703-8. [PMID: 25264339 DOI: 10.1016/j.genhosppsych.2014.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 07/31/2014] [Accepted: 08/11/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND The psychopathological and clinical characteristics of adult patients with epilepsy attending our neurology clinic were evaluated to determine prevalence of psychopathology and its associated factors towards improving services and initiating collaborative care which is currently nonexistent. METHODS The study was a two-stage procedure conducted over 1 year using the General Health Questionnaire in the first stage and Schedule for Clinical Assessment in Neuropsychiatry in the second stage. Diagnosis of psychiatric disorders was based on International Classification of Diseases: 10th Revision criteria. RESULTS Sixty-three patients were interviewed. Mean age was 34.43 ± 13.7 years; more than half of the patients had less than one seizure episode per month. Fourteen patients (22.2%) had partial epilepsy; 40 (63.5%), generalized; and 9 (14.3%), unclassified seizures. The rate of psychiatric morbidity was found to be 28.6%. Depressive disorders were the most common (66.7%), followed by psychotic disorders (11.1%), anxiety disorders (11.1%) and dementia (11.1%). Psychopathology was more common in women (P=.007), those older than 40 years (P = .038) and those with partial epilepsy (P = .017). CONCLUSION About one third of patients with epilepsy studied had undetected and untreated psychopathology. Our neurology clinic urgently needs currently nonexistent collaborative care involving neurologists, psychiatrists and primary care physicians in order to improve the mental health of the patients with epilepsy.
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Affiliation(s)
| | - Olatunji Alao Abiodun
- Department of Behavioral Sciences, College of Health Sciences, University of Ilorin, Nigeria.
| | - Peter Omoniyi Ajiboye
- Department of Behavioral Sciences, College of Health Sciences, University of Ilorin, Nigeria.
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Leaffer EB, Hesdorffer DC, Begley C. Psychosocial and sociodemographic associates of felt stigma in epilepsy. Epilepsy Behav 2014; 37:104-9. [PMID: 25010324 DOI: 10.1016/j.yebeh.2014.06.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/01/2014] [Accepted: 06/04/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lack of a sufficient range in socioeconomic status (SES) in most prior studies of felt stigma and epilepsy has hampered the ability to better understand this association. METHODS We assessed the burden and associates of felt stigma in 238 individuals with prevalent epilepsy aged 18 and older, comparing low SES with high SES. RESULTS Reported levels of stigma were higher in low SES than in high SES (p<0.0001), and all psychosocial variables were associated with stigma, including depression severity (p<0.0001), knowledge of epilepsy (p=0.006), quality of life (p<0.0001), social support (p<0.0001), and self-efficacy (p=0.0009). Stigma was statistically significantly associated with quality of life in the low SES group and with depression severity and social support in the high SES group. CONCLUSIONS Low SES alone did not account for felt stigma; rather, we found that quality of life, depressive symptoms, and social support have the greatest impact on reported felt stigma in individuals with prevalent epilepsy.
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Affiliation(s)
- Emily B Leaffer
- GH Sergievsky Center, Columbia University, New York, NY, USA
| | - Dale C Hesdorffer
- GH Sergievsky Center, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Charles Begley
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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Seo JG, Cho YW, Lee SJ, Lee JJ, Kim JE, Moon HJ, Park SP. Validation of the generalized anxiety disorder-7 in people with epilepsy: a MEPSY study. Epilepsy Behav 2014; 35:59-63. [PMID: 24798411 DOI: 10.1016/j.yebeh.2014.04.005] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/05/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
Abstract
The Generalized Anxiety Disorder-7 (GAD-7) is a valuable instrument to screen for anxiety in primary care patients. However, it has not been validated in people with epilepsy (PWE). Therefore, we validated the GAD-7 and examined its differential effect from adverse effects of antiepileptic drugs (AEDs) on the detection of anxiety in Korean PWE. Eligible patients who visited outpatient clinics in 4 tertiary care hospitals and 1 secondary care hospital underwent several instruments including the Mini International Neuropsychiatric Interview-Plus Version 5.0.0 (MINI-Plus 5.0.0), the Korean version of the Neurological Disorders Depression Inventory for Epilepsy (K-NDDI-E), the Korean version of the Liverpool Adverse Event Profile (K-LAEP), and the Quality of Life in Epilepsy-10 (QOLIE-10). Two hundred forty-three patients were enrolled in the study, and 51 (21.0%) patients had GAD by the MINI-Plus 5.0.0. Cronbach's α coefficient for the GAD-7 was 0.924. At a cutoff score of 6, the GAD-7 had a sensitivity of 92.2%, a specificity of 89.1%, a positive predictive value of 69.1%, and a negative predictive value of 97.7%. The GAD-7 score was well correlated with the K-NDDI-E score, the K-LAEP score, and the QOLIE-10 overall and subscale scores. The impact of adverse effects of AEDs on the GAD-7 was less than that on the K-NDDI-E. In conclusion, the GAD-7 is a reliable and valid screening tool for detecting GAD in PWE.
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Affiliation(s)
- Jong-Geun Seo
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yong Won Cho
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Se-Jin Lee
- Department of Neurology, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Jang-Joon Lee
- Department of Neurology, Daegu Fatima Hospital, Republic of Korea
| | - Ji-Eun Kim
- Department of Neurology, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Hye-Jin Moon
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Sung-Pa Park
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
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Lacey CJ, Salzberg MR, D'Souza WJ. Risk factors for psychological distress in community-treated epilepsy. Epilepsy Behav 2014; 35:1-5. [PMID: 24785427 DOI: 10.1016/j.yebeh.2014.03.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 03/28/2014] [Accepted: 03/31/2014] [Indexed: 11/25/2022]
Abstract
The study aimed to determine risk factors for psychological distress in a community-treated sample of patients with epilepsy. This study investigated the Tasmanian Epilepsy Register participants. Participants included were as follows: aged 13 years and over, able to complete the individual computer-assisted participant interview, and diagnosed with epilepsy following an epilepsy specialist review of the diagnostic epilepsy interview, which was interpreted using standardized diagnostic guidelines. Psychological distress was assessed with the Kessler-10 questionnaire. Risk factors were grouped into four domains: sociodemographic factors, disease-related factors, psychological factors, and treatment-related factors. High or very high levels of psychological distress were reported by 22% of the participants, with 7.8% having very high distress. The regression model showed that psychological distress was significantly associated with female gender (F=18.1, p<0.001), diabetes mellitus (F=8.7, p=0.003), intellectual disability (F=7.1, p=0.06), and not receiving phenytoin (F=5.1, p=0.02). While the model was significant (F=5.78, p<0.001), only 11% of the variance of the K-10 score was explained by these factors (adjusted R-squared=0.11). This study identifies female gender and comorbid medical conditions as risk factors for psychological distress and the use of phenytoin as a protective factor. The few factors identified and the limited variance explained suggest that a focus on epilepsy-related variables is unlikely to explain key influences underlying psychiatric comorbidity in patients with epilepsy.
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Affiliation(s)
- Cameron J Lacey
- Department of Psychiatry, St Vincent's Hospital Melbourne, University of Melbourne, 59 Victoria Parade, Fitzroy, 3065 Melbourne, Victoria, Australia; Department of Medicine, St Vincent's Hospital Melbourne, University of Melbourne, 59 Victoria Parade, Fitzroy, 3065 Victoria, Australia.
| | - Michael R Salzberg
- Department of Psychiatry, St Vincent's Hospital Melbourne, University of Melbourne, 59 Victoria Parade, Fitzroy, 3065 Melbourne, Victoria, Australia
| | - Wendyl J D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, University of Melbourne, 59 Victoria Parade, Fitzroy, 3065 Victoria, Australia
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Bautista RED, Shapovalov D, Saada F, Pizzi MA. The societal integration of individuals with epilepsy: perspectives for the 21st century. Epilepsy Behav 2014; 35:42-9. [PMID: 24798409 DOI: 10.1016/j.yebeh.2014.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/06/2014] [Accepted: 04/07/2014] [Indexed: 11/16/2022]
Abstract
Epilepsy is a common neurologic disorder seen throughout the world. Advances in therapy have made it possible for persons with epilepsy (PWEs) to have improved seizure control and a better quality of life. However, it is not entirely clear whether this has resulted in their successful integration into society. This review examines the societal integration of PWEs, identifying both the progress made and the challenges that continue to hamper further advances. In general, PWEs are more integrated in western-oriented cultures. However, there continue to be ongoing difficulties due to poor education and intellectual functioning, poor social and family support, the undertreatment of coexisting psychiatric conditions, transportation and mobility limitations, and problems obtaining employment. This review also discusses the effects of low socioeconomic status on integration and the persisting prejudices that affect certain racial groups. Most importantly, this review underscores the fact that societal stigma towards PWEs is still very much alive. At the beginning of the 21st century, PWEs still encounter difficulties in their quest for full societal integration. Along with medical advances being made to improve seizure control, much still has to be done to bring about the reforms necessary to help PWEs live more meaningful and productive lives.
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Affiliation(s)
- Ramon Edmundo D Bautista
- Comprehensive Epilepsy Program, University of Florida Health Sciences Center/Jacksonville, Jacksonville, FL, USA.
| | - Denys Shapovalov
- Comprehensive Epilepsy Program, University of Florida Health Sciences Center/Jacksonville, Jacksonville, FL, USA
| | - Fahed Saada
- Comprehensive Epilepsy Program, University of Florida Health Sciences Center/Jacksonville, Jacksonville, FL, USA
| | - Michael A Pizzi
- Comprehensive Epilepsy Program, University of Florida Health Sciences Center/Jacksonville, Jacksonville, FL, USA
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Amruth G, Praveen-Kumar S, Nataraju B, Kasturi P. Study of psychiatric comorbidities in epilepsy by using the Mini International Neuropsychiatric Interview. Epilepsy Behav 2014; 33:94-100. [PMID: 24632481 DOI: 10.1016/j.yebeh.2014.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 01/17/2014] [Accepted: 02/02/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Epilepsy is a neurological condition affecting men and women of all age groups and is associated with psychiatric comorbid conditions. There is a paucity of published data available regarding psychiatric comorbid conditions in patients with epilepsy (PWEs) from developing countries. METHODS We compared the psychiatric comorbid conditions in 80 PWEs, 80 patients with asthma (asthma control (AC) subjects), and 80 healthy controls (normal control (NC) subjects) using the Mini International Neuropsychiatric Interview (MINI) for the diagnosis of Axis I psychiatric disorders. RESULTS Psychiatric comorbid conditions are more common in PWEs (32.50%) as compared with the AC (17.5%) and NC (7.5%) subjects. Longer duration of seizures, increased frequency of seizures, recent recurrence of seizures, anticonvulsant polypharmacy, poor compliance with medications, and family history of seizures were associated with increased psychiatric comorbidity. CONCLUSION Patients with epilepsy are more likely to have psychiatric comorbid disorders compared with the other patients with chronic illness or with the healthy controls. It is of immense clinical importance to identify the comorbid psychiatric disorders in PWEs as the treatment of these disorders apart from a good seizure control may significantly improve their quality of life.
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Affiliation(s)
- G Amruth
- Department of Neurology, Bangalore Medical College & Research Institute, Bangalore, India
| | - S Praveen-Kumar
- Department of Neurology, Bangalore Medical College & Research Institute, Bangalore, India.
| | - B Nataraju
- Department of Psychiatry, Bangalore Medical College & Research Institute, Bangalore, India
| | - P Kasturi
- Department of Psychiatry, Bangalore Medical College & Research Institute, Bangalore, India
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Shorvon S. What epilepsy comorbidities are important to model in the laboratory? Clinical perspectives. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 813:265-71. [PMID: 25012383 DOI: 10.1007/978-94-017-8914-1_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In recent years, there has been a focus on studies of comorbidity in epilepsy. The concept of epilepsy comorbidity is complex. This is partly because epilepsy is essentially a symptom for which there are many underlying causes, with multiple genetic and environmental influences. These causal conditions themselves carry comorbidities which vary from condition to condition. The fact that some psychiatric comorbidities are 'bidirectional' complicates this further. These issues reduce the usefulness of any unitary study of 'epilepsy comorbidity'. Epilepsy comorbidities can be divided into direct/indirect and somatic/psychiatric categories. Only some aspects are susceptible to experimental modeling. This chapter briefly reviews the clinical studies of cause, frequency, epidemiology and mortality of comorbidities, and their use as biomarkers for epilepsy.
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Affiliation(s)
- Simon Shorvon
- UCL Institute of Neurology. Box 5, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK,
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The impact of self-efficacy, alexithymia and multiple traumas on posttraumatic stress disorder and psychiatric co-morbidity following epileptic seizures: a moderated mediation analysis. Psychiatry Res 2013; 210:1033-41. [PMID: 23978734 DOI: 10.1016/j.psychres.2013.07.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 05/27/2013] [Accepted: 07/30/2013] [Indexed: 01/28/2023]
Abstract
This study investigated the incidence of posttraumatic stress disorder (PTSD) and psychiatric co-morbidity following epileptic seizure, whether alexithymia mediated the relationship between self-efficacy and psychiatric outcomes, and whether the mediational effect was moderated by the severity of PTSD from other traumas. Seventy-one (M=31, F=40) people with a diagnosis of epilepsy recruited from support groups in the United Kingdom completed the Posttraumatic Stress Diagnostic Scale, the Hospital Anxiety and Depression Scale, the Toronto Alexithymia Scale-20 and the Generalized Self-Efficacy Scale. They were compared with 71 people (M=29, F=42) without epilepsy. For people with epilepsy, 51% and 22% met the diagnostic criteria for post-epileptic seizure PTSD and for PTSD following one other traumatic life event respectively. For the control group, 24% met the diagnostic criteria for PTSD following other traumatic life events. The epilepsy group reported significantly more anxiety and depression than the control. Partial least squares (PLS) analysis showed that self-efficacy was significantly correlated with alexithymia, post-epileptic seizure PTSD and psychiatric co-morbidity. Alexithymia was also significantly correlated with post-epileptic seizure PTSD and psychiatric co-morbidity. Mediation analyses confirmed that alexithymia mediated the path between self-efficacy and post-epileptic seizure PTSD and psychiatric co-morbidity. Moderated mediation also confirmed that self-efficacy and PTSD from one other trauma moderated the effect of alexithymia on outcomes. To conclude, people can develop posttraumatic stress disorder symptoms and psychiatric co-morbidity following epileptic seizure. These psychiatric outcomes are closely linked with their belief in personal competence to deal with stressful situations and regulate their own functioning, to process rather than defend against distressing emotions, and with the degree of PTSD from other traumas.
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Jacoby A, Baker GA, Crossley J, Schachter S. Tools for assessing quality of life in epilepsy patients. Expert Rev Neurother 2013; 13:1355-69. [PMID: 24215282 DOI: 10.1586/14737175.2013.850032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this review, we attempt to bring the reader up to date with recent developments in the area of assessment of quality of life (QOL) of patients with epilepsy, in both the research and clinical contexts. We present evidence from recent publications on the major and most commonly used QOL instruments for both adults and children with epilepsy, including both strengths and limitations. We discuss both generic measures and ones that have been developed specifically for use in the epilepsy population. We draw attention to some of the broader issues that render the QOL assessment endeavor a somewhat complex one - in particular, that epilepsy is not a single condition, with a common clinical trajectory; and that QOL measures as currently configured almost universally focus on its negative impacts, largely neglecting the possibility of those affected being able to retain reasonable social adjustment and life satisfaction. Finally, we suggest that further work needs to focus on plugging the current evidence gaps in relation to psychometric and cross-cultural applicability issues; and on the value of QOL instruments in the clinical care setting. We conclude by highlighting a number of issues from the QOL literature that will, in our view, be the focus of increasing research interest in the next few years.
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Affiliation(s)
- Ann Jacoby
- Department of Public Health & Policy, University of Liverpool, Liverpool, L69 3GB, UK
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Abstract
This study investigated (1) the incidence of posttraumatic stress disorder following epileptic seizure (post-epileptic seizure PTSD) and psychiatric co-morbidity and (2) the extent to which alexithymia traits related to the severity of the preceding outcomes. Seventy-one people with epilepsy participated in the study and completed the Posttraumatic Stress Diagnostic Scale, Hospital Anxiety and Depression Scale (HADS), and Toronto Alexithymia Scale. The control group comprised 71 people without epilepsy who completed the HADS. Fifty-one percent met the diagnostic criteria for full-PTSD; 30 % for partial-PTSD and 19 % for no-PTSD. The epilepsy group reported significantly more anxiety and depression than the control with demographic variables controlled for. Difficulty identifying feelings predicted post-epileptic seizure PTSD, anxiety and depression. It was positively correlated with post-epileptic seizure PTSD and depression, while it was negatively correlated with anxiety. People can develop PTSD and psychiatric co-morbid symptoms following epileptic seizures. The severity of these symptoms was related to difficulty in identifying internal feelings and emotions.
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Affiliation(s)
- Man Cheung Chung
- Natural Science and Public Health, Zayed University, PO Box 144534, Abu Dhabi, UAE.
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Hagemann A, May TW, Nieder E, Witte-Bölt K, Pohlmann-Eden B, Elger CE, Tergau F, Schulze-Bonhage A, Straub HB, Arnold S, Brandt C. Quality of life, anxiety and depression in adult patients after add-on of levetiracetam and conversion to levetiracetam monotherapy. Epilepsy Res 2013; 104:140-50. [DOI: 10.1016/j.eplepsyres.2012.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 08/08/2012] [Accepted: 08/10/2012] [Indexed: 10/27/2022]
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Onwuekwe I, Ekenze O, Bzeala-Adikaibe, Ejekwu J. Depression in patients with epilepsy: a study from enugu, South East Nigeria. Ann Med Health Sci Res 2012; 2:10-3. [PMID: 23209983 PMCID: PMC3507132 DOI: 10.4103/2141-9248.96929] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Depression is a common psychiatric disorder in epilepsy patients. A bidirectional interaction is thought to be present between epilepsy and depression. There are few studies of this relationship in Nigerian Africans. Objectives: This was a cross-sectional study of the frequency and pattern of depression in a cohort of epilepsy patients in Enugu, South East Nigeria. Materials and Methods: Adult patients with epilepsy seen at the University of Nigeria Teaching Hospital, Enugu, from May to September 2009 were assessed for depression using the Becks Inventory for Depression. Informed consent was obtained from each patient. Clinical data obtained were analyzed using Statistical Package for the Social Sciences, version 15. The hospital's ethical review committee approved the study. Results: I0 n all, 83 subjects were studied (50 males and 33 females). They were aged from 18 to 75 years, with an average of 29.87 years. Most subjects were <25 years of age, single (53, 64%) and had at least secondary school education (65, 78%). Depression was present in 71 (85.5%) subjects – minimal 57 (68.7%), mild 10 (12%), and moderate 4 (4.8%). No case of severe depression was seen. Patients <25 years of age were the most affected. Depression was not significantly associated with age, gender, seizure type, or educational level. Conclusion: A significant proportion of Nigerian African epilepsy patients have depression, which may be easily overlooked, with far-reaching consequences on patients’ quality of life, morbidity, and mortality rates. There is need to regularly assess for and manage epilepsy-related depression in this population.
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Affiliation(s)
- Io Onwuekwe
- Neurology Unit, Department of Medicine, University of Nigeria Teaching Hospital, P. M. B. 01129 Enugu, Nigeria
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Fiest KM, Dykeman J, Patten SB, Wiebe S, Kaplan GG, Maxwell CJ, Bulloch AGM, Jette N. Depression in epilepsy: a systematic review and meta-analysis. Neurology 2012; 80:590-9. [PMID: 23175727 DOI: 10.1212/wnl.0b013e31827b1ae0] [Citation(s) in RCA: 267] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of depression in persons with epilepsy (PWE) and the strength of association between these 2 conditions. METHODS The MEDLINE (1948-2012), EMBASE (1980-2012), and PsycINFO (1806-2012) databases, reference lists of retrieved articles, and conference abstracts were searched. Content experts were also consulted. Two independent reviewers screened abstracts and extracted data. For inclusion, studies were population-based, original research, and reported on epilepsy and depression. Estimates of depression prevalence among PWE and of the association between epilepsy and depression (estimated with reported odds ratios [ORs]) are provided. RESULTS Of 7,106 abstracts screened, 23 articles reported on 14 unique data sources. Nine studies reported on 29,891 PWE who had an overall prevalence of active (current or past-year) depression of 23.1% (95% confidence interval [CI] 20.6%-28.31%). Five of the 14 studies reported on 1,217,024 participants with an overall OR of active depression of 2.77 (95% CI 2.09-3.67) in PWE. For lifetime depression, 4 studies reported on 5,454 PWE, with an overall prevalence of 13.0% (95% CI 5.1-33.1), and 3 studies reported on 4,195 participants with an overall OR of 2.20 (95% CI 1.07-4.51) for PWE. CONCLUSIONS Epilepsy was significantly associated with depression and depression was observed to be highly prevalent in PWE. These findings highlight the importance of proper identification and management of depression in PWE.
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Affiliation(s)
- Kirsten M Fiest
- Department of Community Health Sciences, University of Calgary, Canada
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