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Cronin W, Kwan P, Foster E. Anxiety and depressive symptoms in adults with new-onset seizures: A scoping review. Epilepsia Open 2023; 8:758-772. [PMID: 37247255 PMCID: PMC10472411 DOI: 10.1002/epi4.12766] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/18/2023] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE Anxiety and depression are common comorbidities in people living with epilepsy. Emerging research suggests that these conditions may even predate epilepsy onset. This review aimed to summarize the prevalence of clinically significant anxiety and depressive symptoms in people with first seizures and newly diagnosed epilepsy, as well as clinicodemographic factors associated with these symptoms. METHODS A scoping literature review was performed. OVID Medline and Embase were searched from January 1, 2000, through May 1, 2022. Articles of interest were selected based on predetermined inclusion and exclusion criteria. RESULTS From 1836 studies identified on screening, 16 met eligibility criteria and were included in the review. Clinically significant anxiety and depressive symptoms, as determined by validated cutoff scores for anxiety and depression screening instruments, were common in people with first seizures (range 13-28%) and newly diagnosed epilepsy (range 11-45%). They were associated with a range of clinicodemographic factors including past psychiatric history and trauma, personality traits, self-esteem, and stigma profiles. SIGNIFICANCE There is substantial evidence that clinically significant anxiety and depressive symptoms are often present at the time and shortly following the first seizure or epilepsy diagnosis. Future research is needed to better understand the complex interactions between these common psychiatric comorbidities, new-onset seizure disorders, and certain clinicodemographic characteristics. This knowledge may inform targeted and holistic treatment approaches.
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Affiliation(s)
- William Cronin
- Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneVictoriaParkvilleAustralia
| | - Patrick Kwan
- Neurology DepartmentAlfred HealthMelbourneVictoriaAustralia
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of Medicine (The Royal Melbourne Hospital)The University of MelbourneParkvilleVictoriaAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Monash Institute for Medical Engineering (MIME)Monash UniversityMelbourneVictoriaAustralia
| | - Emma Foster
- Neurology DepartmentAlfred HealthMelbourneVictoriaAustralia
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
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Concealment behaviors in Korean adults with epilepsy: Their relationships to social anxiety and seizure severity independent of felt stigma. Epilepsy Behav 2022; 129:108647. [PMID: 35299089 DOI: 10.1016/j.yebeh.2022.108647] [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: 01/21/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE This study assessed whether seizure severity and social anxiety were related to self-disclosure or concealment behaviors independent of felt stigma in Korean adults with epilepsy. METHODS This multicenter, cross-sectional study used the Disclosure Management Scale (DMS), the short forms of the Social Phobia Scale (SPS-6) and Social Interaction Anxiety Scale (SIAS-6), and the Stigma Scale-Revised to evaluate Korean adults with epilepsy. Seizure severity was measured as a composite variable, and multivariate linear regression analyses were performed to assess whether seizure severity and social anxiety were related to concealment behaviors. RESULTS The 315 subjects included 132 (41.9%) women and 183 (58.1%) men. Of these subjects, 212 (67.3%) reported rarely or never talking to others about their epilepsy, whereas only 98 (31.1%) stated that they rarely or never kept their epilepsy secret from others. Linear regression analyses showed that concealment behaviors were positively correlated with degree of social anxiety (on separate models using the SIAS-6 and SPS-6) and felt stigma, and negatively associated with level of seizure severity. Both models accounted for about 14% of the variance in DMS scores. CONCLUSIONS The majority of Korean adults with epilepsy choose concealment and selective disclosure strategies. Social anxiety and seizure severity along with felt stigma play significant roles in deciding whether to disclose or conceal a diagnosis of epilepsy. The explanatory power of these models was weak.
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Xu Y, Neuen DR, Glozier N, Nikpour A, Somerville E, Bleasel A, Ireland C, Anderson CS, Hackett ML. Disability patterns over the first year after a diagnosis of epilepsy. Clin Neurol Neurosurg 2019; 179:60-65. [PMID: 30849696 DOI: 10.1016/j.clineuro.2019.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/12/2019] [Accepted: 02/25/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine the patterns and predictors of disability over the first 12 months after a diagnosis of epilepsy. PATIENTS AND METHODS The Sydney Epilepsy Incidence Study to Measure Illness Consequences (SEISMIC) was a prospective, multicenter, community-based study of people with newly diagnosed epilepsy in Sydney, Australia. Disability was assessed using the World Health Organization's, Disability Assessment Schedule (WHODAS) 2.0 12-item version, at baseline (i.e. within 28 days of diagnosis) and 12 months post-diagnosis. Demographic, socioeconomic, clinical and epilepsy-related data, obtained through structured interviews, were entered into multivariable linear regression and shift analysis to determine predictors of greater disability. RESULTS Of 259 adults (≥18 years), 190 (73%) had complete WHODAS at baseline (mean ± SD scores 4 ± 6) and follow-up (4 ± 8). After adjustment for age, sex and co-morbidity, greater overall disability at 12 months was associated with lower education (P = 0.05), economic hardship (P = 0.004), multiple antiepileptic medications (P = 0.02) and greater disability (P < 0.001) at the time of diagnosis; these variables explained 38.3% of the variance. Among the 12 WHODAS items, "being emotionally affected by health problems" was the most frequent disability problem identified at both time points (all P < 0.0001). The proportion of participants without problems in that domain improved over 12 months (from 24% to 50%, P < 0.0001), whereas the other 11 items remained relatively stable. Independent baseline predictors of a worse emotional outcome at 12 months were severe/extreme emotional distress (odds ratio [OR] 4.52, 95% confidence intervals [CI] 1.67-12.24), economic hardship (OR 2.30, 95% CI 1.24-4.25) and perceived stigma (OR 2.02, 95% CI 1.03-3.93). CONCLUSION Most people report problems with emotional health after a diagnosis of epilepsy but many recover over the next 12 months. Services addressing the social and psychological impact of diagnosis may be needed to improve outcome.
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Affiliation(s)
- Ying Xu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, 83-117 Missenden Road, Camperdown, NSW 2050, Australia; School of Public Health, Faculty of Medicine and Health, Edward Ford Building (A27) Fisher Road, University of Sydney, NSW 2006, Australia.
| | - Dennis R Neuen
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, 83-117 Missenden Road, Camperdown, NSW 2050, Australia; Wagga Wagga Rural Clinical School, School of Medicine Sydney, University of Notre Dame Australia, 40 Hardy Avenue, Wagga Wagga, NSW 2650, Australia.
| | - Nick Glozier
- Brain and Mind Centre, University of Sydney, 94 Mallett St, Camperdown, NSW 2050, Australia.
| | - Armin Nikpour
- School of Public Health, Faculty of Medicine and Health, Edward Ford Building (A27) Fisher Road, University of Sydney, NSW 2006, Australia; Neurology Department, Royal Prince Alfred Hospital, Sydney Local Area Health District, 50 Missenden Rd, Camperdown, NSW 2050, Australia.
| | - Ernest Somerville
- Neurology Department, Prince of Wales Clinical School, University of New South Wales, Barker St, Randwick, NSW 2031, Australia.
| | - Andrew Bleasel
- Neurology Department, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW 2145, Australia.
| | - Carol Ireland
- Epilepsy Action Australia, PO Box 879, Epping, NSW 1710, Australia.
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, 83-117 Missenden Road, Camperdown, NSW 2050, Australia; School of Public Health, Faculty of Medicine and Health, Edward Ford Building (A27) Fisher Road, University of Sydney, NSW 2006, Australia; Neurology Department, Royal Prince Alfred Hospital, Sydney Local Area Health District, 50 Missenden Rd, Camperdown, NSW 2050, Australia; The George Institute China at Peking University Health Science Center, Level 18, Tower B, Horizon Tower, No. 6 Zhichun Rd, Haidian District, Beijing 100088, PR China.
| | - Maree L Hackett
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, 83-117 Missenden Road, Camperdown, NSW 2050, Australia; School of Public Health, Faculty of Medicine and Health, Edward Ford Building (A27) Fisher Road, University of Sydney, NSW 2006, Australia; Faculty of Health and Wellbeing, University of Central Lancashire, Preston, PR1 2HE, UK.
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Tan M, Boston R, Cook MJ, D'Souza WJ. Risk factors for injury in a community-treated cohort of patients with epilepsy in Australia. Epilepsia 2019; 60:518-526. [PMID: 30720862 DOI: 10.1111/epi.14659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 01/05/2019] [Accepted: 01/07/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE There remains a paucity of knowledge regarding specific epilepsy-related risk factors for accidents and injuries in people with epilepsy. Injury studies in people with epilepsy are overrepresented, with tertiary based populations that are prone to bias from severe disease. This study aims to assess the contribution of epilepsy-related risk factors to injuries in a community-based cohort. METHODS We performed a retrospective nested case-control study on patients recruited into the Tasmanian Epilepsy Register (TER) from July 1, 2001 to June 30, 2002. The TER is a community-based cohort of patients with epilepsy in Tasmania, Australia, recruited from the national prescription database and interviewed for epilepsy diagnosis, injuries, and risk factors using validated questionnaires with diagnosis made by an epilepsy specialist. The primary outcome measures were lifetime and recent 12-month injury. Multivariate logistic regression with multiple imputation modeling responder nondisclosure was performed, adjusting for age, gender, region, socioeconomic status, seizure frequency, and epilepsy duration. RESULTS A total of 819 patients with epilepsy were included in this study. Ten percent of patients experienced an injury in the preceding year. Before adjusting for seizure frequency, any seizure over the past 12 months was associated with recent injury (adjusted odds ratio [OR] = 7.90, 95% confidence interval [CI] = 4.17-14.96). Impaired awareness, cluster seizures, sleep-only seizures, and convulsive seizure were characteristics found to significantly influence injuries irrespective of seizure frequency. Although a warning appeared initially protective for recent injuries (OR = 0.39, 95% CI = 0.22-0.69), this was entirely explained by seizure frequency, with the effect becoming nonsignificant. SIGNIFICANCE Likely due to their unpredictable nature, seizures expose patients with epilepsy to a high risk of life-threatening injury. These findings emphasize the importance of seizure freedom for maximizing the safety of patients with epilepsy.
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Affiliation(s)
- Michael Tan
- Department of Medicine, University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Ray Boston
- Department of Medicine, University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, Pennsylvania
| | - Mark J Cook
- Department of Medicine, University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Wendyl J D'Souza
- Department of Medicine, University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia
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Lee SA, Jeon JY, No SK, Park H, Kim OJ, Kwon JH, Jo KD. Factors contributing to anxiety and depressive symptoms in adults with new-onset epilepsy. Epilepsy Behav 2018; 88:325-331. [PMID: 30340902 DOI: 10.1016/j.yebeh.2018.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE We investigated factors contributing to anxiety and depressive symptoms over a 1-year period in Korean adults with new-onset epilepsy. METHODS This longitudinal multicenter study included adults diagnosed with epilepsy within 12 months of a first seizure. Using stepwise regression analyses, we determined whether Hospital Anxiety Depression Scale (HADS) scores could be predicted by demographic, clinical, and psychosocial variables at baseline and at 12 months. RESULTS Of 141 patients included at baseline, 63 (44.7%) and 60 (42.6%) had Hospital Anxiety Depression Scale-Anxiety (HADS-A) and Hospital Anxiety Depression Scale-Depression (HADS-D) scores >7, respectively. Of 98 patients who completed the 12-month study, the corresponding figures decreased to 32.7% and 36.7%, respectively. Higher HADS-A scores both at baseline and 12 months were predicted by higher neuroticism, stigma, and lower self-esteem (p < 0.05). Higher HADS-D scores at baseline were predicted by higher neuroticism, lower self-esteem, marital status, and lower extroversion (p < 0.05) whereas those at 12 months were predicted by self-esteem, seizure recurrence, and age at epilepsy onset (p < 0.05). Neuroticism or self-esteem was the strongest predictor of psychological distress. CONCLUSIONS Anxiety and depressive symptoms are common at the time of diagnosis in Korean adults with new-onset epilepsy. While these decrease over time, they remained high 12 months after epilepsy diagnosis. Psychological factors, particularly neuroticism and self-esteem, may be the most important risk factors. Epilepsy variables, such as seizure recurrence and age at onset, may also be important factors for depressed mood at 12 months.
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Affiliation(s)
- Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Ji Ye Jeon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soon-Kee No
- Department of Neurology, Bong-Seng Memorial Hospital, Pusan, Republic of Korea
| | - Hyungkook Park
- Department of Neurology, SoonChunHyang University College of Medicine, Cheonan, Republic of Korea
| | - Ok-Joon Kim
- Department of Neurology, CHA University, Seongnam, Republic of Korea
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan College Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Kwang-Deog Jo
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
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