The relationship between the Neuro-Quality of Life Depression and Anxiety Measures and the Personality Assessment Inventory in persons with epilepsy

Comparison of psychiatric comorbidities and impact on quality of life in patients with epilepsy or psychogenic nonepileptic spells

OBJECTIVES

Psychiatric comorbidity is common in people with epilepsy (PWE) and psychogenic nonepileptic spells (PNES). These comorbidities can be detrimental to quality of life (QOL) and are often underdiagnosed and undertreated. Some types of epilepsy, such as focal temporal lobe epilepsy (TLE), have been associated with higher rates of psychiatric comorbidity. This study examined the impact of psychiatric comorbidity on QOL in patients admitted to two level 4 epilepsy monitoring units (EMUs).

METHODS

In this prospective observational study, 200 patients admitted to two level 4 EMUs completed standardized surveys including the Quality of Life in Epilepsy (QOLIE-31-P), Generalized Anxiety Disorder 7-item (GAD-7), Patient Health Questionnaire (PHQ-9), and Beck Depression Inventory-II (BDI-II). Hierarchal multiple regression was performed to assess impact on QOL.

RESULTS

Of the 200 participants, 113 had a diagnosis of epilepsy, 36 had a diagnosis of PNES, and 51 were excluded for nondiagnostic evaluation or dual diagnosis. Of those with epilepsy, 65 had TLE, 28 had focal extratemporal lobe epilepsy (ETLE), and 20 had nonfocal epilepsy. Patients with PNES had higher self-reported anxiety and depression levels (GAD-7: p = 0.04, PHQ-9: p < 0.01; BDI-II: p < 0.01) but similar QOL to PWE (p = 0.78). Using hierarchal multiple regression, symptoms of anxiety and depression were significant predictors of lower QOL in PWE but not in patients with PNES. There was no difference in QOL in those with ETLE and TLE.

CONCLUSIONS

Our findings suggest that self-reported anxiety and depression symptoms are common in patients admitted to level 4 EMUs regardless of diagnosis and play an important role in predicting QOL in PWE. Our findings emphasize the importance of routinely screening all EMU patients for psychiatric comorbidity.

Anxiety screening tools in people with epilepsy: A systematic review of validated tools

OBJECTIVE

Anxiety is a common neurological condition often comorbid with epilepsy, with approximately 20% of patients with epilepsy exhibiting symptoms of anxiety. Despite this prevalence, accurate and efficacious tools designed to screen for anxiety specifically in patients with epilepsy have not yet been developed. The purpose of this study is to systematically review the literature and better understand this relationship.

METHODS

Ovid MEDLINE, EMBASE, and PsyclNFO were searched until April 22nd, 2019 without language restrictions. We extracted abstracts, data abstraction, and full-text reviews in duplicate and chose the studies that included measures for anxiety screening in patients with epilepsy. The Quality Assessment of Diagnostic Accuracy Studies Version was used to assess study quality. We used the medians and ranges to calculate the accuracy of the tools.

RESULTS

We screened 4758 abstracts and selected 11 articles dealing with anxiety. The most common validated anxiety screening tools were the Generalized Anxiety Disorder (GAD-7) and Hospital Anxiety and Depression Scale-A (HADS-A). The Mini International Neuropsychiatric Interview (MINI) was the most common reference standard used.

SIGNIFICANCE

Many studies have validated depression screening tools rather than anxiety. This lack of data has left much uncertainty about the relationship of epilepsy to anxiety, as well as diagnostic inconsistencies. The effectiveness of these assessments in practice may be overestimating the prevalence, as the cutpoints are usually chosen after the fact, based on the study sample.