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Fagerberg T, Söderman E, Gustavsson JP, Agartz I, Jönsson EG. Thirteen-year follow-up of long-term treated psychotic disorder: personality aspects. Nord J Psychiatry 2022; 76:386-393. [PMID: 34620037 DOI: 10.1080/08039488.2021.1981436] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Personality is an aspect that can affect the symptoms and social function in individuals with psychotic disorders. Several studies have investigated personality in schizophrenia and other long-term psychotic disorders. No study has examined the stability of personality traits exceeding five years in patients with schizophrenia and related disorders. The aim of this study was to investigate the stability of personality traits over a 13-year period among patients with schizophrenia and related disorders and healthy individuals and to evaluate case-control differences. METHODS At three occasions during a 13-year period patients with schizophrenia and related disorders (n = 28) and healthy individuals (n = 57) completed Swedish universities Scales of Personality (SSP). Mean-level change and case-control differences were investigated for all the individuals using within- and between-subject analyses, respectively. Analyses were performed on three occasions for all 13 subscales and the three overall factors of SSP. Also, correlations, means, and SDs were calculated. RESULTS Tests of within-subject correlations showed differences in two subscales: Lack of Assertiveness, which were influenced by age, and Physical Trait Aggression, where patients' ratings were stable, whereas controls rated themselves less aggressive at a higher age. Between-subjects correlations showed differences regarding diagnosis, time, age, gender, or age × gender in nine of the 13 subscales as well as in factor Neuroticism. CONCLUSION Long-term follow-up showed generally high stability of personality traits measured with SSP. Between-subject analyses over the 13 years showed that patients differed compared to controls for the SSP factor Neuroticism as well as the subscale Detachment, which is in accordance with previous studies within this population.
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Affiliation(s)
- Tomas Fagerberg
- Human Brain Informatics (HUBIN), Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden
| | - Erik Söderman
- Human Brain Informatics (HUBIN), Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden
| | - J Petter Gustavsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Agartz
- Human Brain Informatics (HUBIN), Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden.,NORMENT - TOP study, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Erik G Jönsson
- Human Brain Informatics (HUBIN), Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden.,NORMENT - TOP study, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Iurina E, Bailles E, Carreño M, Donaire A, Rumià J, Boget T, Bargalló N, Setoain X, Roldan P, Conde-Blanco E, Centeno M, Pintor L. Personality changes in patients suffering from drug-resistant epilepsy after surgical treatment: a 1-year follow-up study. Epilepsy Res 2021; 177:106784. [PMID: 34688182 DOI: 10.1016/j.eplepsyres.2021.106784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/29/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine changes in dimensions of personality in a sample of patients suffering from drug-resistant epilepsy at the 1-year follow-up following surgery, compared to non-surgically treated controls. METHODS We conducted a prospective comparative controlled study, including drug-resistant epilepsy surgery candidates. Demographic, psychiatric, neurological, and psychological data were recorded. Presurgical and 12-months follow-up evaluations were performed. Personality dimensions were measured by the NEO Five-Factor Inventory, Revised version (NEO-FFI-R), anxiety and depression symptoms were assessed by the Hospital Anxiety and Depression Scale (HADS: HADA-Anxiety and HADD-Depression), psychiatric evaluations were performed using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Axis-I disorders classification. Statistical analysis consisted of comparative tests, correlation analysis, and the stepwise multiple regression test (ANOVA). RESULTS A 1-year follow-up was completed by 70 out of 80 patients. Through the study, the surgical group decreased in neuroticism and increased in agreeableness. The controls increased in consciousness, and these changes were predicted by the earlier age of epilepsy onset and lesser score in HADD at the baseline. No personality changes were associated with seizure frequency. The presurgical evaluation concluded that both groups had no differences in demographic, psychiatric, or neurological variables with the only exception being for the number of seizures per month, which was higher in the surgical group. Psychiatric comorbidity in patients was associated with their higher degree of neuroticism and agreeableness at the baseline. Comparing control and surgical groups at the one-year follow-up, the agreeableness personality variable was higher in the surgical group, and as expected, HADS scores were higher in the control group, and seizure frequency was also higher in the control group. SIGNIFICANCE Higher agreeableness was the most relevant difference in personality dimensions in patients who underwent surgical treatment compared with the non-surgical treatment group. After surgery patients decreased in neuroticism and increased in agreeableness scores.
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Affiliation(s)
- Elena Iurina
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona (UAB), Barcelona, 08007, Spain.
| | - Eva Bailles
- Mental Health Service, Nostra Senyora de Meritxell Hospital, Andorra
| | - Mar Carreño
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Antonio Donaire
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Jordi Rumià
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Teresa Boget
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Núria Bargalló
- Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Xavier Setoain
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Imaging Group, Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 08034, Barcelona, Spain
| | - Pedro Roldan
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Estefanía Conde-Blanco
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - María Centeno
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Luis Pintor
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, 08036, Spain; Department of Medicine, University of Barcelona (UB), 08036, Barcelona, Spain
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Camargo Camargo L, Tejada Angarita KS, Suarez Marín MM, Fandiño Franky J. Psychiatric alterations after previous temporal lobectomy: Report of cases and review. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 50:301-307. [PMID: 34742698 DOI: 10.1016/j.rcpeng.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 05/25/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Anterior temporal lobectomy (LTA) is a surgical procedure commonly used for the treatment of temporal lobe epilepsy refractory to medical management, with high success rates in the control of seizures. However, an important association with psychiatric illnesses has been described that can alter the postoperative outcome in these patients. METHODS A series of 2 cases of patients who, despite successful crisis control, developed psychiatric complications in the postoperative period of anterior temporal lobectomy. RESULTS The cases included a male patient with no history of previous mental illness, who developed a major depressive episode in the postoperative period, and a female patient with previous psychosis who presented as a surgical complication exacerbation of psychosis, diagnosed with paranoid schizophrenia. CONCLUSIONS Psychiatric disorders can occur in postoperative temporal lobe epilepsy patients with or without a history of mental illness. The most frequent alterations reported are depression, anxiety, psychosis and personality disorders. The inclusion of psychiatric evaluations in the pre- and post-surgical protocols can lead to an improvement in the prognosis of the neurological and mental outcomes of the patients undergoing the intervention.
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Affiliation(s)
- Loida Camargo Camargo
- Fundación Centro Colombiano de Epilepsia y Enfermedades Neurológicas-FIRE, Cartagena, Colombia.
| | | | | | - Jaime Fandiño Franky
- Fundación Centro Colombiano de Epilepsia y Enfermedades Neurológicas-FIRE, Cartagena, Colombia
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Personality changes in patients with refractory epilepsy after surgical treatment: A systematic review. Seizure 2021; 85:95-101. [PMID: 33453594 DOI: 10.1016/j.seizure.2020.12.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/01/2020] [Accepted: 12/31/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE We aimed to conduct a systematic review to evaluate the personality changes in adult patients with drug-resistant epilepsy following surgical treatment. METHODS A systematic review was conducted using the Preferred Reporting Items of Systematic Reviews and MetaAnalyses (PRISMA) statement. We searched PubMed, Medline databases, and the Cochrane Controlled Trials Register, with search terms 'personality', 'epilepsy', and 'surgery'. RESULTS Eleven studies were selected. In 7 out of 11 studies, personality changes were more adaptive, with patients experiencing decreased neuroticism, impulsivity, hypochondriasis, psychasthenia. One study showed increased emotional lability. The remainder of the studies showed no changes in personality dimensions. Changes in personality differed according to the localization of the epileptogenic area, depended on seizure status after treatment and duration of follow-up. Seizure freedom as an outcome of surgical treatment influenced the existence of personality changes, and their severity. Adaptive personality changes could be seen from early follow-up assessments even in patients who were not seizure-free, though further follow-ups showed that improvements after 1-2 years were specific to seizure-free patients. LIMITATIONS The main limitation of our research is the heterogeneity of approaches used to evaluate personality in the included studies. Furthermore, the included studies also had different sample sizes and comparison groups, different designs, and different follow-up durations. We only included studies that were written in English. CONCLUSIONS The majority of studies reported changes in personality dimensions in patients suffering from refractory epilepsy.
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Camargo Camargo L, Tejada Angarita KS, Suarez Marin MM, Fandiño Franky J. Psychiatric Alterations after Previous Temporal Lobectomy: Report of Cases and Review. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 50:S0034-7450(20)30066-4. [PMID: 33735060 DOI: 10.1016/j.rcp.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 02/05/2020] [Accepted: 05/25/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Anterior temporal lobectomy (LTA) is a surgical procedure commonly used for the treatment of temporal lobe epilepsy refractory to medical management, with high success rates in the control of seizures. However, an important association with psychiatric illnesses has been described that can alter the postoperative outcome in these patients. METHODS A series of 2 cases of patients who, despite successful crisis control, developed psychiatric complications in the postoperative period of anterior temporal lobectomy. RESULTS The cases included a male patient with no history of previous mental illness, who developed a major depressive episode in the postoperative period, and a female patient with previous psychosis who presented as a surgical complication exacerbation of psychosis, diagnosed with paranoid schizophrenia. CONCLUSIONS Psychiatric disorders can occur in postoperative temporal lobe epilepsy patients with or without a history of mental illness. The most frequent alterations reported are depression, anxiety, psychosis and personality disorders. The inclusion of psychiatric evaluations in the pre- and post-surgical protocols can lead to an improvement in the prognosis of the neurological and mental outcomes of the patients undergoing the intervention.
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Affiliation(s)
- Loida Camargo Camargo
- Fundación Centro Colombiano de Epilepsia y Enfermedades Neurológicas-FIRE, Cartagena, Colombia.
| | | | | | - Jaime Fandiño Franky
- Fundación Centro Colombiano de Epilepsia y Enfermedades Neurológicas-FIRE, Cartagena, Colombia
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Alonso NB, de Albuquerque M, Vidal-Dourado M, Cavicchioli LH, Mazetto L, de Araújo Filho GM, de Figueiredo Ferreira Guilhoto LM, Centeno RS, Yacubian EMT. Revisiting personality in epilepsy: Differentiation of personality in two epilepsies starting in adolescence. Epilepsy Behav 2019; 97:75-82. [PMID: 31195327 DOI: 10.1016/j.yebeh.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/20/2019] [Accepted: 05/08/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this study was to investigate personality characteristics and clinical parameters in two well-defined epilepsies: mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE/HS) and juvenile myoclonic epilepsy (JME) through NEO Revised Personality Inventory (NEO-PI-R) and Neurobehavior Inventory (NBI) standardized instruments. METHODS One hundred patients undergoing corticoamygdalohippocampectomy (CAH), 100 patients with JME, and 100 control subjects answered the personality measures. Clinical parameters such as psychiatric symptoms, seizure frequency, duration of epilepsy, and side of the lesion in MTLE/HS group were investigated. Statistical analysis consisted of the mean and standard deviation (SD) of each variable. Student's t-test or Fisher exact test were used according to the variable studied. RESULTS The three groups were within the average range of NEO-PI-R and NBI, although 'tendencies' and differences were demonstrated. The MTLE/HS and control subjects had a similar profile: low scores in Neuroticism and high in Conscientiousness (r = -0.330; p < 0.001/r = -0.567; p < 0.001, respectively) in opposition to what occurred in JME, low in Conscientiousness and high in Neuroticism (r = -0.509; p = 0.005). The NBI 'sense of personal destiny' trait was higher (3.15; p = 0.003) in MTLE/HS than in JME and controls. The JME 'law and order' scores were lower than in other groups (p = 0.024). A tendency towards specific NBI traits differentiates MTLE/HS (Factor 3) from JME (Factor 1) groups. Psychiatric symptoms and seizure frequency were correlated with worse scores in NBI and, especially, in Neuroticism domain of NEO-PI-R. CONCLUSION Specific personality features were linked to each epileptic disease. These findings highlight the importance of considering unique features linked to epilepsy conditions in daily clinical observation to develop support programmes.
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Affiliation(s)
- Neide Barreira Alonso
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina/UNIFESP, São Paulo, Brazil.
| | - Marly de Albuquerque
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina/UNIFESP, São Paulo, Brazil
| | - Marcos Vidal-Dourado
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina/UNIFESP, São Paulo, Brazil
| | | | - Lenon Mazetto
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina/UNIFESP, São Paulo, Brazil
| | | | | | - Ricardo Silva Centeno
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina/UNIFESP, São Paulo, Brazil
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Ramos-Perdigués S, Baillés E, Mané A, Carreño M, Donaire A, Rumià J, Bargalló N, Boget T, Setoain X, Valdés M, Pintor L. Psychiatric Symptoms in Refractory Epilepsy During the First Year After Surgery. Neurotherapeutics 2018; 15:1082-1092. [PMID: 30066084 PMCID: PMC6277301 DOI: 10.1007/s13311-018-0652-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Psychiatric morbidity in drug-resistant epilepsy is frequent. Surgery is the best therapeutic alternative for treating seizures, but the current evidence concerning the effects of surgery on psychiatric disorders (PDs) is inconclusive. We aim to clarify surgery's role in long-term PDs. Using a prospective controlled study, we analyzed the psychopathologic outcomes of patients with drug-resistant epilepsy, comparing those who underwent surgery to those who did not due to not being suitable. Surgical candidates were paired (n = 84) with the immediately following nonsurgical candidates (n = 68). Both groups continued their usual medical treatment. We studied psychiatric changes for each group and analyzed de novo and remission cases. The assessments were made during the presurgical evaluation, and at 6 months (6-M) and 12 months (12-M) after surgery. Finally, we determined associated factors for postsurgical PDs. At 12 months, using the Hospital Anxiety and Depression Scale (HADS), anxiety improved in both groups (p = 0.000), while depression improved only in the surgical group (p = 0.016). Moreover, all symptom dimensions on the Symptom Checklist-90-R (SCL-90), as well as severity, distress, and total symptoms, decreased only in the surgical group. These ameliorations reached not only statistical significance but also clinical significance for depression (HADS) (p = 0.014) and the interictal dysphoric disorder (p = 0.013). The main predictors for PDs after surgery were as follows: the presurgical and 6-month psychiatric symptoms, the absence of surgery, seizure outcomes, and some antiepileptic and psychiatric drugs. This study provides evidence that surgery for epilepsy could have a role in improving some symptoms of psychiatric disorders 12-M after the surgery.
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Affiliation(s)
- Sònia Ramos-Perdigués
- Sant Joan de Déu Terres de Lleida Hospital, Avinguda de la Canadiense, 28, 25001, Lleida, Catalonia, Spain.
- Nostra Senyora de Meritxell Hospital, Escaldes-Engordany, AD700, Andorra.
| | - Eva Baillés
- Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, 08002, Spain
- Autonomous University of Barcelona, Barcelona, 08193, Spain
| | - Anna Mané
- Institute of Neuropsychiatry and Addictions, Parc de Salut Mar and Foundation IMIM, Barcelona, 08003, Spain
- Center for Biomedical Research in Mental Health Network (CIBERSAM), Madrid, 28029, Spain
| | - Mar Carreño
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Antonio Donaire
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Jordi Rumià
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
| | - Nuria Bargalló
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Teresa Boget
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Xavier Setoain
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Manuel Valdés
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Luís Pintor
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
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Prayson BE, Floden DP, Ferguson L, Kim KH, Jehi L, Busch RM. Effects of surgical side and site on psychological symptoms following epilepsy surgery in adults. Epilepsy Behav 2017; 68:108-114. [PMID: 28142129 PMCID: PMC5373962 DOI: 10.1016/j.yebeh.2016.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/28/2016] [Accepted: 11/03/2016] [Indexed: 11/18/2022]
Abstract
This retrospective study examined the potential role of side and site of surgery in psychological symptom change after epilepsy surgery and determined the base rate of psychological change at the individual level. Two-hundred twenty-eight adults completed the Personality Assessment Inventory (PAI) before and after temporal (TLR; n=190) or frontal lobe resection (FLR; n=38). Repeated measures ANOVAs with bootstrapping examined differences in psychological outcome as a function of surgical site separately in patients who underwent left- versus right-sided resections. Individual's PAI score changes were then used to determine the prevalence of clinically meaningful postoperative symptom change. Following left-sided resections, there were significant group-by-time interactions on Somatic Complaints, Anxiety, and Anxiety Related Disorders. There was also a trend in this direction on the Depression scale. TLR patients endorsed greater preoperative symptoms than FLR patients on all of these scales, except the Somatic Complaints scale. After surgery, TLR patients reported symptom improvement on all four scales, while scores of FLR patients remained relatively stable over time. Endorsement of Mania-related symptoms increased in both TLR and FLR groups from pre-to post-surgical testing. Following right-sided resections, both groups endorsed symptom improvements on Somatic Complaints, Anxiety, and Depression scales following surgery. In addition, the TLR group endorsed more Mania-related symptoms than the FLR group regardless of time. Patterns of meaningful change in individual patients were generally consistent with group findings, with the most frequent improvements observed following TLR. However, there were a small subset of patients who reported symptom exacerbation after surgery. Our results suggest that surgical lateralization and localization are important factors in postoperative psychological outcome and highlight the importance of considering psychological change at the individual patient level. Further research is needed to identify potential risk factors for symptom exacerbation to aid in preoperative counseling and identify those patients most in need of postoperative psychological surveillance.
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Affiliation(s)
- Brigid E Prayson
- Wellesley College, 106 Central Street, Wellesley, MA 02481, United States
| | - Darlene P Floden
- Department of Psychology and Psychiatry, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Center for Neurological Restoration, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Lisa Ferguson
- Department of Psychology and Psychiatry, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Kevin H Kim
- Department of Psychology in Education, University of Pittsburgh, 5918 Wesley W. Posvar Hall, Pittsburgh, PA 15260, United States
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Robyn M Busch
- Department of Psychology and Psychiatry, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
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9
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Ramos-Perdigués S, Baillés E, Mané A, Carreño M, Donaire A, Rumia J, Bargalló N, Boget T, Setoain X, Valdes M, Pintor L. A prospective study contrasting the psychiatric outcome in drug-resistant epilepsy between patients who underwent surgery and a control group. Epilepsia 2016; 57:1680-1690. [PMID: 27562413 DOI: 10.1111/epi.13497] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Psychiatric morbidity in drug-resistant epilepsy is frequent and has a negative influence on quality of life. Surgery is proven to be the best therapeutic alternative for treating seizures. However, it is inconclusive with the current evidence whether surgery, per se, is a risk factor or promotes amelioration of psychiatric disorders. Until now, most studies have been cross-sectional with small or heterogeneous groups. In addition, the few prospective studies did not have an identical control group. The present study aims to clarify the role of surgery in psychopathologic alterations. METHODS We analyzed, through a prospective case-control study, the psychopathologic outcomes of patients with drug-resistant epilepsy, comparing those who underwent surgery and those who continued with pharmacologic treatment due to not being suitable for surgery. The assessments were performed during presurgical evaluation and 6 months after surgery. We studied psychiatric changes for each group, compared differences between groups, and also analyzed de novo and remission cases. Finally, we determined associated factors for postsurgical psychiatric disturbances. RESULTS The surgical group experienced a significant decrease in psychopathologic alterations in comparison with the control group. In addition, distress perception of surgical patients also improved, whereas it did not decrease in the control group. Patients who underwent surgery presented a decrease in depressive and anxiety symptoms, whereas the nonsurgical group increased its anxiety levels. De novo disturbances that appeared after surgery were less frequent than in nonsurgical patients. We observed significant favorable outcomes considering de novo versus remission cases for anxiety, depression, and total symptoms only in the surgical group. The two main predictors for psychiatric disorders after surgery were presurgical psychiatric functioning and surgery. SIGNIFICANCE Provides evidence that surgery improves psychiatric functioning in drug-resistant epilepsy through a prospective controlled study.
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Affiliation(s)
| | - Eva Baillés
- Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain
| | - Anna Mané
- Institute of Neuropsychiatry and Addictions, Parc de Salut Mar and Foundation IMIM, Barcelona, Spain.,Center for Biomedical Research in Mental Health Network (CIBERSAM), Barcelona, Spain
| | - Mar Carreño
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Antonio Donaire
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Jordi Rumia
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Nuria Bargalló
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Teresa Boget
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Xavier Setoain
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Manuel Valdes
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Luís Pintor
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
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