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Niu C, Li P, Du X, Zhao M, Wang H, Yang D, Wu M, Jing W. Risk factors for anxiety in patients with epilepsy: A meta-analysis. Epilepsy Behav 2024; 153:109665. [PMID: 38368787 DOI: 10.1016/j.yebeh.2024.109665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Epilepsy is a very common neurological disease, and it is important to focus on both controlling seizures and alleviating the psychological problems associated with this disease.Anxiety is an important risk factor for epilepsy and seriously affects the quality of life of patients with epilepsy (PWE). However, several risk factors for anxiety in PWE are relatively controversial and understudied. This meta-analysis was performed to identify potential risk factors for anxiety in PWE with the aim of reducing the incidence of anxiety and improving the quality of life among the individuals. METHOD The PubMed, Embase and Cochrane Library databases were systematically searched up to July 2023 to find eligible original English studies. All the search results were reviewed based on our inclusion and exclusion criteria. We calculated the combined odds ratios (ORs), standard mean differences (SMDs) and their corresponding 95% confidence intervals (CIs) to evaluate the effect of the included risk factors on anxiety in PWE. RESULTS Twenty-four studies involving 5,403 PWE were ultimately included. The pooled results of our meta-analysis showed that female sex (OR = 1.67; 95 % CI: 1.30,2.15; p < 0.001), unmarried/divorced/widowed (OR = 0.83; 95 % CI: 0.72,0.96; p = 0.011), low socioeconomic status (OR = 0.47; 95 % CI: 0.33,0.67; p < 0.001), education levels below high school (OR = 1.74; 95 % CI: 1.36,2.23; p < 0.001), a history of trauma (OR = 2.53; 95 % CI: 1.69,3.78; p < 0.001), monotherapy (OR = 0.49; 95 % CI: 0.39,0.62; p < 0.001), AED-induced psychiatric side effects (OR = 2.45; 95 % CI: 1.20,4.98); p = 0.014), depression (OR = 5.45 95 % CI: 2.49,11.94; p < 0.001), a history of suicide (OR = 3.56; 95 % CI: 1.72,7.38; p = 0.001), and illness-related shame (OR = 2.76; 95 % CI: 2.17,3.52; p < 0.001) were risk factors for anxiety. CONCLUSION This meta-analysis showed that female, unmarried, low socioeconomic status, education level below senior high school, a history of trauma, monotherapy, AED-induced psychiatric side effects, depression, a history of suicide, and shame were risk factors for anxiety in PWE. However, further research is needed to determine the effect of other potential risk factors on anxiety in PWE. In addition, most of the studies included in this meta-analysis were not uniform in scale, and the risk factors were not comprehensive; therefore, larger prospective studies in different countries are needed to further investigate these risk factors.
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Affiliation(s)
- Cailang Niu
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China.
| | - Penghong Li
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China.
| | - Xueqing Du
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China.
| | - Mina Zhao
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China.
| | - Haobo Wang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China.
| | - Debo Yang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China.
| | - Maolin Wu
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China.
| | - Wei Jing
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China.
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Pugh R, Vaughan DN, Jackson GD, Ponsford J, Tailby C. Cognitive and psychological dysfunction is present after a first seizure, prior to epilepsy diagnosis and treatment at a First Seizure Clinic. Epilepsia Open 2024; 9:717-726. [PMID: 38319041 PMCID: PMC10984291 DOI: 10.1002/epi4.12909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE Neuropsychological comorbidities found in chronic epilepsy have also been reported earlier in the disease course. However, recurrent seizures, antiseizure medication (ASM), and adjustment to a chronic diagnosis remain potential confounds of this literature. It thus remains unclear whether these comorbidities are primary or secondary attributes of epilepsy. To capture individuals as close to disease onset as possible, we studied the cognitive and psychological functioning in adults after their first seizure, yet prior to epilepsy diagnosis and treatment. METHODS Using a telehealth-based prospective design, we screened cognition, mood, and anxiety symptoms in adult patients referred to a First Seizure Clinic (FSC), who were over 18 years, English-speaking and not taking ASM. We screened cognition via telephone, and psychological symptoms via online questionnaires, all prior to the patients' diagnostic evaluation. Data were collected on 32 individuals subsequently diagnosed with epilepsy at the FSC, and 30 healthy controls from the community, who were matched to the epilepsy group for age, gender, and education. RESULTS A multivariate analysis of variance revealed that the groups differed significantly on combined cognitive measures with a large effect size (F[1,56] = 5.75, p < 0.001, η2 = 0.45). Post-hoc analyses showed that performances on measures of verbal memory, working memory, and executive functions were significantly worse for the newly diagnosed epilepsy group than controls. The epilepsy group also exhibited higher rates of clinically significant depressive and anxiety symptoms. SIGNIFICANCE Cognitive and psychological dysfunction is prevalent in people with epilepsy as early as the first seizure event, before the influence of diagnosis, ASM and recurrent seizures. Their neuropsychological profile parallels that seen in chronic epilepsy, showing that this dysfunction is already present at the very onset of the disease. The current study demonstrates the viability of telehealth neuropsychological screening for all new epilepsy cases. PLAIN LANGUAGE STATEMENT The results of this study show, using telephone-based cognitive assessment and online questionnaires, that people with newly diagnosed epilepsy can experience problems with their thinking and memory skills, and low mood and anxiety, as early as after their first seizure. These issues are apparent at the very beginning of the disease, before an epilepsy diagnosis is made and before antiseizure medication is commenced, which suggests that they are due to the underlying brain disturbance, rather than the secondary effects of seizures, treatment, or lifestyle changes. Telehealth-screening of thinking skills and mental health for all new epilepsy cases is recommended to promote early management of such problems.
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Affiliation(s)
- Remy Pugh
- School of Psychological SciencesMonash UniversityMelbourneVictoriaAustralia
- Florey Institute of Neuroscience and Mental HealthMelbourneVictoriaAustralia
| | - David N. Vaughan
- Florey Institute of Neuroscience and Mental HealthMelbourneVictoriaAustralia
- Department of NeurologyAustin HealthMelbourneVictoriaAustralia
| | - Graeme D. Jackson
- Florey Institute of Neuroscience and Mental HealthMelbourneVictoriaAustralia
- Department of NeurologyAustin HealthMelbourneVictoriaAustralia
| | - Jennie Ponsford
- School of Psychological SciencesMonash UniversityMelbourneVictoriaAustralia
- Monash Epworth Rehabilitation Research CentreEpworth HealthcareMelbourneVictoriaAustralia
| | - Chris Tailby
- School of Psychological SciencesMonash UniversityMelbourneVictoriaAustralia
- Florey Institute of Neuroscience and Mental HealthMelbourneVictoriaAustralia
- Department of Clinical NeuropsychologyAustin HealthMelbourneVictoriaAustralia
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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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Chen X, Chen Y, Zhou L, Tong J. The role of self-esteem as moderator of the relationship between experienced stigma and anxiety and depression among tuberculosis patients. Sci Rep 2023; 13:6889. [PMID: 37105982 PMCID: PMC10134698 DOI: 10.1038/s41598-023-34129-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/25/2023] [Indexed: 04/29/2023] Open
Abstract
Anxiety and depression are very common in tuberculosis (TB) patients and can adversely affect TB treatment adherence, ultimately leading to higher morbidity, mortality and drug resistance. Therefore, the aim of this study was to identify the association among experienced stigma, self-esteem and anxiety and depression, and to further explore whether self-esteem could be a moderator in the association between experienced stigma and anxiety and depression in TB patients. A total of 473 TB patients from Dalian, Liaoning Province, Northeast China participated in a cross-sectional survey. A structured questionnaire was developed to collect data. Hierarchical multiple regression was used to analyze the association among experienced stigma, self-esteem and experienced stigma × self-esteem interaction with anxiety and depression. Simple slope analysis was applied to visualize the interaction. Experienced stigma was positively associated with anxiety (B = 0.307, P < 0.01) and depression (B = 0.277, P < 0.01), and self-esteem was negatively associated with anxiety (B = - 0.215, P < 0.01) and depression (B = - 0.351, P < 0.01) in TB patients. The association between experienced stigma and anxiety was different in the low (1 standard deviation (SD) below the mean, B = 0.376, standard error (SE) = 0.056, P < 0.01) and high (1 SD above the mean, B = 0.228, SE = 0.060, P < 0.01) groups of self-esteem. Additionally, the association between experienced stigma and depression was also different in the low (1 SD below the mean, B = 0.363, SE = 0.053, P < 0.01) and high (1 SD above the mean, B = 0.179, SE = 0.056, P < 0.01) groups of self-esteem. Self-esteem could moderate the association between experienced stigma and anxiety and depression. In addition to reducing experienced stigma, enhancing self-esteem as a way to reduce the impact of experienced stigma on anxiety and depression can also help improve the mental health of TB patients.
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Affiliation(s)
- Xu Chen
- Lianyungang Maternal and Child Health Hospital, NO. 669 Qindongmen Street, Haizhou District, Lianyungang, 222000, Jiangsu, People's Republic of China
| | - Yunting Chen
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, 116044, Liaoning, People's Republic of China
| | - Ling Zhou
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, 116044, Liaoning, People's Republic of China.
| | - Jiao Tong
- Lianyungang Maternal and Child Health Hospital, NO. 669 Qindongmen Street, Haizhou District, Lianyungang, 222000, Jiangsu, People's Republic of China.
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Charfi N, Abid S, Farhat N, Elleuch O, Daoud S, Dammak M, Omri S, Thabet JB, Bouali MM, Mhiri C, Maâlej M. Psychiatric comorbidities in epilepsy patients: results of a Tunisian study. PROGRESS IN NEUROLOGY AND PSYCHIATRY 2023. [DOI: 10.1002/pnp.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Nada Charfi
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Salma Abid
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Nouha Farhat
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Oumayma Elleuch
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Saoussen Daoud
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Mariem Dammak
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Sana Omri
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Jihène Ben Thabet
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Manel Maâlej Bouali
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Chokri Mhiri
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
| | - Mohamed Maâlej
- Dr Charfi is a Professor of Psychiatry, Dr Elleuch is a Medical Resident of Psychiatry, Dr Omri is an Associate Professor of Psychiatry, Dr Ben Thabet is a Professor of Psychiatry, Dr Maâlej Bouali is an Associate Professor of Psychiatry and Dr Maâlej is a Professor of Psychiatry, all in the Psychiatry C Department in Hedi Chaker University Hospital of Sfax, Tunisia; Dr Farhat is an Associate Professor of Neurology, Dr Daoud is an Assistant of Neurology, Dr Dammark is a Professor of Neurology, Dr
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Tang WZ, Yusuf A, Jia K, Iskandar YHP, Mangantig E, Mo XS, Wei TF, Cheng SL. Correlates of stigma for patients with breast cancer: a systematic review and meta-analysis. Support Care Cancer 2022; 31:55. [PMID: 36526859 DOI: 10.1007/s00520-022-07506-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study was conducted to examine the factors associated with stigma in breast cancer women. METHODS PubMed, Embase, the Cochrane Library, Web of Science, and two Chinese electronic databases were electronically searched to identify eligible studies that reported the correlates of stigma for patients with breast cancer from inception to July 2022. Two researchers independently performed literature screening, data extraction, and risk of bias assessment. R4.1.1 software was used for statistical analysis. RESULTS Twenty articles including 4161 patients were included in the systematic review and meta-analysis. Results showed that breast cancer stigma was positively correlated with working status, type of surgery, resignation coping, depression, ambivalence over emotional expression, and delayed help-seeking behavior and negatively correlated with age, education, income, quality of life, social support, confrontation coping, psychological adaptation, self-efficacy, and self-esteem. Descriptive analysis showed that breast cancer stigma was positively correlated with intrusive thoughts, body image, anxiety, and self-perceived burden but negatively correlated with a sense of coherence, personal acceptance of the disease, sleep quality, cancer screening attendance and doctor's empathy. CONCLUSION Many demographic, disease-related, and psychosocial variables are related to breast cancer stigma. Our view can serve as a basis for health care professionals to develop health promotion and prevention strategies for patients with breast cancer.
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Affiliation(s)
- Wen-Zhen Tang
- School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Azlina Yusuf
- School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.
| | - Kui Jia
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China.
| | | | - Ernest Mangantig
- School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Xin-Shao Mo
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Tian-Fu Wei
- The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Shi-Li Cheng
- School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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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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Dual burdens of felt stigma and depressive symptoms in patients with epilepsy: Their association with social anxiety, marriage, and employment. Epilepsy Behav 2022; 134:108782. [PMID: 35914436 DOI: 10.1016/j.yebeh.2022.108782] [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: 03/10/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE The present study evaluated whether patients with epilepsy with dual conditions of felt stigma and depressive symptoms are more strongly associated with social anxiety, being unmarried, and being unemployed than those with depressive symptoms or felt stigma alone. METHODS This multicenter, cross-sectional study evaluated subjects using the Stigma Scale-Revised, the Patient Health Questionnaire-9, and the six-item versions of the Social Interaction Anxiety Scale, and the companion Social Phobia Scale. Subjects were grouped by depressive symptoms and felt stigma into four groups. Multivariate logistic regression analyses were performed. RESULTS The 298 subjects included 173 men and 125 women. Of these subjects, 35 (11.7%) had depressive symptoms alone, 33 (11.1%) had stigma alone, and 27 (9.1%) had both depressive symptoms and felt stigma. Multivariate logistic regression analyses showed that, compared with the control group having neither depressive symptoms nor felt stigma, the odds ratios (ORs) for social interaction anxiety and social phobia were highest in the group of dual conditions (OR 18.7 and 13.5, respectively), followed by the depression-alone (OR 7.7 and 4.6, respectively) and stigma-alone (OR 5.0 and 2.8, respectively) groups. Similarly, the ORs for being unmarried (OR 29.2) and unemployed (OR 3.1) were significant only in the group of dual conditions. In addition, male sex and younger age were independently associated with being unmarried whereas seizures recurring ≥1 per month were independently associated with being unemployed. CONCLUSIONS Dual conditions of felt stigma and depressive symptoms may be more strongly associated with social anxiety, being unmarried, and being unemployed than depressive symptoms or felt stigma alone in patients with epilepsy.
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Lee SA, Im K, Choi EJ. Felt stigma may potentiate the relationship between perceived stress and depressive symptoms in persons with epilepsy. Epilepsy Behav 2022; 134:108765. [PMID: 35908417 DOI: 10.1016/j.yebeh.2022.108765] [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: 02/10/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This study assessed the strengths of association among perceived stress, felt stigma, and depression in adults with epilepsy, and evaluated whether felt stigma altered the association between perceived stress and depression. METHODS This multicenter, cross-sectional study included adults with epilepsy. Depression was assessed using the Beck Depression Inventory (BDI), and perceived stress was evaluated using the 10-item Perceived Stress Scale. Felt stigma was determined using the three-item Stigma Scale for Epilepsy, with individuals categorized as positive for felt stigma if they answered "yes" to at least one of these items. A hierarchical linear regression analysis and an analysis of covariance with interaction terms were performed. RESULTS The 316 adults with epilepsy included 171 men and 145 women; of these, 109 (34.5%) reported felt stigma. A hierarchical linear regression analysis showed that perceived stress was the most important correlate of depressive symptoms, followed by felt stigma, being unemployed, recurrence of generalized or focal to bilateral tonic-clonic seizures, and being married. The model explained 54.0% of the variance of BDI scores. Significant interactions between felt stigma and perceived stress on BDI scores was identified in both crude and adjusted models (p < 0.05 each). Specifically, in an adjusted model, BDI scores were more strongly associated with perceived stress in persons with (p < 0.001, partial eta2 = 0.225) than without (p < 0.001, partial eta2 = 0.205) felt stigma. CONCLUSIONS Perceived stress was the most significant correlate of depressive symptoms in adults with epilepsy, followed by felt stigma. The interaction between perceived stress and felt stigma on depressive symptoms was significant. These findings may help in developing cognitive behavioral therapy for stigma and stress management in persons with epilepsy.
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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.
| | - Kayeong Im
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Ju Choi
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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10
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Mei X, Wang H, Wang X, Wu X, Wu J, Ye Z. Associations among neuroticism, self-efficacy, resilience and psychological distress in freshman nursing students: a cross-sectional study in China. BMJ Open 2022; 12:e059704. [PMID: 35697443 PMCID: PMC9196198 DOI: 10.1136/bmjopen-2021-059704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The current study examines the mediating roles of resilience and self-efficacy and the moderating role of gender in the association between neuroticism and psychological distress in Chinese freshman nursing students (FNSs). METHODS A total of 1220 FNSs were enrolled from the Be Resilient to Nursing Career (ChiCTR2000038693) Programme and the following instruments were administered to them: NEO Five-Factor Inventory, General Self-Efficacy Scale, Connor-Davidson Resilience Scale and Kessler Psychological Distress Scale. A moderated mediation analysis and a generalised additive model analysis were performed. RESULTS The direct and indirect effects of neuroticism on psychological distress were significantly mediated by self-efficacy (B = 0.200, 95% CI 0.001 to 0.039), resilience (B = 0.021, 95% CI 0.007 to 0.038) and the interaction between self-efficacy and resilience (B = 0.016, 95% CI 0.005 to 0.028). The interactions between neuroticism and gender (β = 0.102, 95% CI 0.001 to 0.203, p<0.05) and between resilience and gender were significant (β = 0.160, 95% CI 0.045 to 0.275, p<0.01). A non-linear and positive association was confirmed between neuroticism and psychological distress. CONCLUSIONS Self-efficacy and resilience significantly mediate the relationship between neuroticism and psychological distress. Gender moderates the relationships between neuroticism and resilience and between resilience and psychological distress.
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Affiliation(s)
- Xiaoxiao Mei
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Huiyuan Wang
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xinqin Wang
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xiaona Wu
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jieyi Wu
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zengjie Ye
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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11
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Sheikh-Wu SF, Gerber KS, Pinto MD, Downs CA. Mechanisms and Methods to Understand Depressive Symptoms. Issues Ment Health Nurs 2022; 43:434-446. [PMID: 34752200 DOI: 10.1080/01612840.2021.1998261] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Depressive symptoms, feelings of sadness, anger, and loss that interfere with a person's daily life, are prevalent health concerns across populations that significantly result in adverse health outcomes with direct and indirect economic burdens at a national and global level. This article aims to synthesize known mechanisms of depressive symptoms and the established and emerging methodologies used to understand depressive symptoms; implications and directions for future nursing research are discussed. A comprehensive search was performed by Cumulative Index to Nursing and Allied Health Literature, MEDLINE, and PUBMED databases between 2000-2021 to examine contributing factors of depressive symptoms. Many environmental, psychological, and physiological factors are associated with the development or increased severity of depressive symptoms (anhedonia, fatigue, sleep and appetite disturbances to depressed mood). This paper discusses biological and psychological theories that guide our understanding of depressive symptoms, as well as known biomarkers (gut microbiome, specific genes, multi-cytokine, and hormones) and established and emerging methods. Disruptions within the nervous system, hormonal and neurotransmitters levels, brain structure, gut-brain axis, leaky-gut syndrome, immune and inflammatory process, and genetic variations are significant mediating mechanisms in depressive symptomology. Nursing research and practice are at the forefront of furthering depressive symptoms' mechanisms and methods. Utilizing advanced technology and measurement tools (big data, machine learning/artificial intelligence, and multi-omic approaches) can provide insight into the psychological and biological mechanisms leading to effective intervention development. Thus, understanding depressive symptomology provides a pathway to improve patients' health outcomes, leading to reduced morbidity and mortality and the overall nation-wide economic burden.Supplemental data for this article is available online at https://doi.org/10.1080/01612840.2021.1998261 .
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Affiliation(s)
- Sameena F Sheikh-Wu
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| | - Kathryn S Gerber
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| | - Melissa D Pinto
- Sue and Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Charles A Downs
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
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12
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Lin H, Lin WH, Lin F, Liu CY, Che CH, Huang HP. Potential Pleiotropic Genes and Shared Biological Pathways in Epilepsy and Depression Based on GWAS Summary Statistics. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:6799285. [PMID: 35463244 PMCID: PMC9019309 DOI: 10.1155/2022/6799285] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022]
Abstract
Current epidemiological and experimental studies have indicated the overlapping genetic foundation of epilepsy and depression. However, the detailed pleiotropic genetic etiology and neurobiological pathways have not been well understood, and there are many variants with underestimated effect on the comorbidity of the two diseases. Utilizing genome-wide association study (GWAS) summary statistics of epilepsy (15,212 cases and 29,677 controls) and depression (170,756 cases and 329,443 controls) from large consortia, we assessed the integrated gene-based association with both diseases by Multimarker Analysis of Genomic Annotation (MAGMA) and Fisher's meta-analysis. On the one hand, shared genes with significantly altered transcripts in Gene Expression Omnibus (GEO) data sets were considered as possible pleiotropic genes. On the other hand, the pathway enrichment analysis was conducted based on the gene lists with nominal significance in the gene-based association test of each disease. We identified a total of two pleiotropic genes (CD3G and SLCO3A1) with gene expression analysis validated and interpreted twenty-five common biological process supported with literature mining. This study indicates the potentially shared genes associated with both epilepsy and depression based on gene expression, meta-data analysis, and pathway enrichment strategy along with traditional GWAS and provides insights into the possible intersecting pathways that were not previously reported.
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Affiliation(s)
- Han Lin
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Wan-Hui Lin
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Intensive Care Unit, Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Fujian Key Laboratory of Molecular Neurology, Fuzhou 350001, China
| | - Feng Lin
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Chang-Yun Liu
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Chun-Hui Che
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Hua-Pin Huang
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Intensive Care Unit, Department of Neurology, Fujian Medical University Union Hospital, Fuzhou 350001, China
- Fujian Key Laboratory of Molecular Neurology, Fuzhou 350001, China
- Department of Geriatrics, Fujian Medical University Union Hospital, Fuzhou 350001, China
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13
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Rashid H, Upadhyay AD, Pandey RM, Katyal J. Point prevalence of depression in persons with active epilepsy and impact of methodological moderators: A systematic review and meta-analysis. Epilepsy Behav 2021; 125:108394. [PMID: 34794012 DOI: 10.1016/j.yebeh.2021.108394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/06/2021] [Accepted: 10/21/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to determine the pooled prevalence of depression in persons with epilepsy and assess the methodological moderators affecting the prevalence estimates. METHODS Five electronic databases PubMed, The Cochrane Library, EMBASE, WHO Global Index Medicus, and Clinicaltrial.gov were searched for studies reporting prevalence of depression in PWE ≥ 18 years of age in any setting. RESULTS Out of 13,873 studies, after deduplication and screening, 56 studies with 10,527 PWE met the eligibility criteria. The overall pooled prevalence of depression in PWE was 32% (95%confidence interval [CI] 28-35%) and significant heterogeneity (Chi-square = 1171.53, p = 0.00; τ2 = 0.02; I2 = 94.36%). Prevalence has doubled in the recent years (16% in 2000-2005 vs. 35% in 2016-2020), was higher in Asia than in Europe (coefficient 0.899, 95%CI: 0.809-0.999; p = 0.049). Among assessment methods, prevalence was highest in HAM-D scale (54%, 95%CI: 27-82%) and lowest in MINI (22%, 95%CI: 19-26%). Sensitivity analysis also corroborated findings when MINI was excluded (35%, 95%CI: 31-38%). CONCLUSIONS A significant proportion of PWE have depression. Though there is substantial heterogeneity due to various methodological moderators, it is unlikely to affect the routine screening of PWE for depression. Use of a screening tool should be based on ease of administration, and cutoff selection should ensure identification of minimal depression as well.
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Affiliation(s)
- Haroon Rashid
- Neuropharmacology Laboratory, Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ashish D Upadhyay
- Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra M Pandey
- Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Jatinder Katyal
- Neuropharmacology Laboratory, Department of Pharmacology, All India Institute of Medical Sciences, New Delhi 110029, India.
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14
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Zhong R, Lin W, Chen Q, Zhang X, Li G. Predictors of Comorbid Anxiety Symptoms After a New Diagnosis of Epilepsy: A Prospective 12-Month Follow-Up Observation. Front Neurol 2021; 12:743251. [PMID: 34795629 PMCID: PMC8592910 DOI: 10.3389/fneur.2021.743251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/05/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: We aimed to identify the factors contributing to comorbid anxiety symptoms over a 12-month follow-up period in Chinese adults with newly diagnosed epilepsy. Methods: Adult patients with newly diagnosed epilepsy (PWNDE) were recruited from First Hospital, Jilin University. Anxiety symptoms were assessed using the Generalized Anxiety Disorder-7 questionnaire (GAD-7; Chinese version) at 12 months. Multivariate stepwise logistic regression analysis was employed to identify the predictors for anxiety symptoms at 12 months. Results: A total of 157 PWNDE completed the study and were included in the final analysis. The percentage of participants with anxiety symptoms significantly decreased from 31.2% at baseline to 23.6% at 12 months (p = 0.027). Multivariate stepwise logistic regression analysis indicated that depressive symptoms at baseline [odds ratio (OR) 3.877 (95% confidence interval (CI) 1.683-8.933); P = 0.001] and the number of antiseizure medications (ASMs) during the follow-up period [OR 2.814 (95% CI 1.365-5.803); P = 0.005] were independent factors contributing to comorbid anxiety symptoms at 12 months. Conclusion: Depressive symptoms at baseline and the number of ASMs during the follow-up period were significant predictors of comorbid anxiety symptoms 12 months after a diagnosis of epilepsy.
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Affiliation(s)
- Rui Zhong
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Weihong Lin
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Qingling Chen
- Department of Hepatology, Second People's Clinical College of Tianjin Medical University, Tianjin, China
| | - Xinyue Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Guangjian Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
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15
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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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16
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Forthoffer N, Tarrada A, Brissart H, Maillard L, Hingray C. Anxiety and Depression in Newly Diagnosed Epilepsy: A Matter of Psychological History? Front Neurol 2021; 12:744377. [PMID: 34675875 PMCID: PMC8525707 DOI: 10.3389/fneur.2021.744377] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/25/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose: Anxiety and depression are highly prevalent in patients with epilepsy (PWE), and these symptoms can even precede the onset of the pathology. We aimed to define the prevalence of anxiety and depressive symptoms at the time of the epilepsy diagnosis and the factors related to their presence in newly diagnosed adult patients. Methods: One hundred and twelve newly diagnosed patients were assessed, usually in the week after diagnosis. Patients were untreated at this time. We used the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E, cut-off ≥15) and the Generalized Anxiety Disorder 7-Item scale (GAD-7, cut-off >7). A semi-structured interview was conducted to collect sociodemographic and epilepsy data and patients' psychiatric history. We first compared patients with and without anxiety symptoms, then patients with and without depressive symptoms. Results: According to the GAD-7 scale, the prevalence of anxiety symptoms at the time of diagnosis was 35%. Patients with anxiety symptoms had significantly more psychiatric history (26%, p = 0.001) and more history of psychological trauma (51%, p = 0.003) than patients with no anxiety symptoms. According to the NDDI-E scores, the prevalence of depressive symptoms at the time of the diagnosis was 11%. Patients with depressive symptoms had significantly more psychiatric history (43%, p < 0.001) and more history of psychological trauma (65%, p = 0.007) than patients with no depressive symptoms. No difference between groups was found for other sociodemographic variables (age and gender), epilepsy characteristics (number of seizures prior to diagnosis, time from first seizure to diagnosis, type of epilepsy, and localization in focal epilepsy), or neurological comorbidities. Conclusions: Anxiety symptoms are common whereas depressive symptoms are less prevalent at the time of diagnosis. It appears essential to be aware of anxiety and depression in newly diagnosed epileptic patients. They should be screened and routinely monitored, especially those patients with a history of psychological trauma and/or psychiatric disorders. Longitudinal follow-up is required to identify whether these factors and anxiety and depression themselves have an impact on the future course of care.
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Affiliation(s)
- Natacha Forthoffer
- Laboratoire de Neurosciences Cognitives et Adaptatives (LNCA), Centre National de la Recherche Scientifique (CNRS), Université de Strasbourg, Strasbourg, France.,Département de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Alexis Tarrada
- Département de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France.,Unité de Formation et de Recherche (UFR) Médecine Paris Centre, Université de Paris, Paris, France
| | - Hélène Brissart
- Département de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France.,Centre de Recherche en Automatique de Nancy (CRAN), Centre National de la Recherche Scientifique (CNRS), Université de Lorraine, Nancy, France
| | - Louis Maillard
- Département de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France.,Centre de Recherche en Automatique de Nancy (CRAN), Centre National de la Recherche Scientifique (CNRS), Université de Lorraine, Nancy, France
| | - Coraline Hingray
- Département de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France.,Centre de Recherche en Automatique de Nancy (CRAN), Centre National de la Recherche Scientifique (CNRS), Université de Lorraine, Nancy, France
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17
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Kolli SS, Snyder SN, Cardwell LA, Cline AE, Unrue EL, Feldman SR, O Donovan CA. Adherence to levetiracetam for management of epilepsy: Assessment with electronic monitors. Seizure 2021; 93:51-57. [PMID: 34687986 DOI: 10.1016/j.seizure.2021.10.008] [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: 06/25/2021] [Revised: 09/15/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Anti-seizure medications are used to manage epilepsy and require long-term adherence to maintain therapeutic drug levels. We assessed adherence to levetiracetam and the use of a digital intervention to improve adherence in patients with epilepsy. METHODS 30 participants with epilepsy were randomized 1:1 either to a digital email adherence intervention or control group. All patients were provided levetiracetam equipped with electronic monitoring caps to assess patient adherence to medication. Patients were followed for 6 months, with return visits at 1 month, 3 months, and 6 months. RESULTS Subjects randomized to the control arm (n = 15) took 66% of the prescribed doses compared to the intervention group, who took 65% of prescribed doses (n = 15). Nine participants did not complete the study. Of the twenty-one participants that completed the study, the overall rate of adherence was 72% of prescribed doses taken. Two subjects in the control group and three subjects in the intervention group were adherent every month of the study-taking at least 80% of prescribed doses. Those randomized to the control group took the correct number of doses 44% of days in the study, and those in the intervention group took the correct number of doses 37% of days. DISCUSSION Poor adherence to levetiracetam is common. An internet-based email survey intervention did not improve adherence to levetiracetam in epilepsy patients. Further advances in adherence are needed to help patients receive the maximum benefit of their medical treatments.
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Affiliation(s)
- Sree S Kolli
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem 27157-1071, NC, United States
| | - Stephanie N Snyder
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem 27157-1071, NC, United States.
| | - Leah A Cardwell
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem 27157-1071, NC, United States
| | - Abigail E Cline
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem 27157-1071, NC, United States
| | - Emily L Unrue
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem 27157-1071, NC, United States
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem 27157-1071, NC, United States; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, United States; Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, United States; Department of Dermatology, University of Southern Denmark, Odense, Denmark
| | - Cormac A O Donovan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, United States
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18
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Zhong R, Chen Q, Li M, Lu Y, Zhao Q, Zhang X, Lin W. Factors contributing to comorbid depressive symptoms in adult people with newly diagnosed epilepsy: A 12-month longitudinal study. Epilepsy Behav 2021; 124:108326. [PMID: 34619545 DOI: 10.1016/j.yebeh.2021.108326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/04/2021] [Accepted: 09/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We aimed to investigate the point prevalence of comorbid depressive symptoms from the time of newly diagnosed epilepsy to 12 months and to identify the factors contributing to comorbid depressive symptoms over a 12-month period in patients with newly diagnosed epilepsy (PWNDE). METHODS A consecutive cohort of PWNDE from the First Hospital of Jilin University was recruited. Depressive symptoms were evaluated using the Chinese version of the Neurological Disorders Depression Inventory for Epilepsy scale (C-NDDI-E). Multivariate stepwise logistic regression models were used to confirm the factors contributing to depressive symptoms in patients. RESULTS The point prevalence of depressive symptoms among PWNDE slightly decreased from 24.8% at baseline to 22.3% at 12 months. A MoCA score < 26 was identified as an independent risk factor contributing to depressive symptoms at baseline (OR = 2.419, 95% CI: 1.093-5.350, P = 0.029) and at 12 months (OR = 3.007, 95% CI: 1.223-7.390, P = 0.016). The adjusted OR for depressive symptoms in female patients was 0.365 (95% CI: 0.171-0.779, P = 0.009) compared with male patients. Depressive symptoms at baseline (OR = 4.539, 95% CI: 1.973-10.445, P < 0.001) were identified as significant predictors of depressive symptoms at 12 months. CONCLUSION There was a slight decrease in the prevalence of comorbid depressive symptoms in PWNDE over the 12-month period after epilepsy diagnosis. Cognitive impairment and baseline depressive symptoms were independent risk factors for comorbid depressive symptoms at 12 months.
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Affiliation(s)
- Rui Zhong
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Qingling Chen
- Department of Hepatology, Tianjin Medical University, Tianjin Second People's Hospital, Tianjin, China
| | - Mengmeng Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yingxue Lu
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Qian Zhao
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Xinyue Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Weihong Lin
- Department of Neurology, The First Hospital of Jilin University, Changchun, China.
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19
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Lee SA. Felt stigma in seizure-free persons with epilepsy: Associated factors and its impact on health-related quality of life. Epilepsy Behav 2021; 122:108186. [PMID: 34252827 DOI: 10.1016/j.yebeh.2021.108186] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/15/2021] [Accepted: 06/20/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE We investigated felt stigma in seizure-free persons with epilepsy with regard to associated factors and its impact on health-related quality of life (HRQoL). METHODS This cross-sectional study included 81 patients who had been seizure free for at least 2 years and 52 controls who had only had one seizure in the last 2 years. All patients completed the Stigma Scale, Quality of Life in Epilepsy Inventory-31 (QOLIE-31), short form of the Eysenck Personality Questionnaire-Revised (EPQ-RS), Hospital Anxiety Depression Scale (HADS), Rosenberg Self-esteem Scale, and the enacted stigma questionnaire. RESULTS The proportion of felt stigma was not significantly different between controls (25%) and patients in seizure remission (21%). A stepwise logistic regression analysis revealed that enacted stigma and higher EPQ-RS Neuroticism scores were more likely to be associated with felt stigma of patients in remission. Quality of Life in Epilepsy Inventory-31 scores were significantly higher in patients in seizure remission than in controls. In the stepwise linear regression analysis, felt stigma was not associated with the total QOILE-31 scores. Sobel tests showed that felt stigma had indirect effects on the QOLIE-31 scores through EPQ-RS Neuroticism scores, but its statistical significance was lost after controlling for the presence of enacted stigma, anxiety, and depressive symptoms. CONCLUSION One-fifth of seizure-free patients continued to feel stigmatized, even though they had not had a seizure in more than 2 years. Experience of enacted stigma and a neurotic personality trait were the most important correlates of felt stigma for these patients. Health-related quality of life was significantly better in patients in remission than in patients with rare seizures. Felt stigma was not a significant or independent factor associated with worse HRQoL in patients in remission.
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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.
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- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Neuroticism and extraversion affect health-related quality of life of persons with epilepsy independently from depression and anxiety symptoms. Epilepsy Behav 2021; 117:107858. [PMID: 33640563 DOI: 10.1016/j.yebeh.2021.107858] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 01/31/2023]
Abstract
PURPOSE We determined whether neuroticism and extraversion are associated with health-related quality of life (HRQoL) independently from other psychological factors in persons with epilepsy. METHODS This was a cross-sectional study of 357 adults with epilepsy. The Quality of Life in Epilepsy Inventory-31 (QOLIE-31), short form of the Eysenck Personality Questionnaire-Revised, Hospital Anxiety Depression Scale, Rosenberg Self-esteem Scale, and Stigma Scale for Epilepsy were used. A hierarchical linear regression analysis and Sobel test were performed. RESULTS The final model explained 64.2% of the variance in the QOLIE-31. Demographic factors, entered in step 1 of the hierarchical linear regression, explained <1% of the variance. Social factors entered in step 2 and epilepsy-related factors in step 3 explained an additional 9.3% and 9.6% of the variance, respectively. Psychological factors, entered in the final step, explained 44.7% of the variance. Except for extraversion, all psychological factors assessed were independently associated with QOLIE-31 scores. When entered in step 1 of the regression analysis, neuroticism explained 36.1% of the variance, following only depression (49.0%) and anxiety (44.9%) according to the Hospital Anxiety Depression Scale. Both neuroticism (B = -0.264, p = 0.001) and extraversion (B = 0.189, p = 0.009) had indirect effects on QOLIE-31 scores mediated by depressive symptoms. CONCLUSIONS Neuroticism is the third most important factor for HRQoL of persons with epilepsy, following depressive symptoms and anxiety. Both neuroticism and extraversion indirectly affect HRQoL through depressive symptoms.
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Zhong R, Chen Q, Li M, Li N, Zhang X, Lin W. Sex differences in anxiety in patients with epilepsy: Status and risk factors analysis. Epilepsy Behav 2021; 116:107801. [PMID: 33578225 DOI: 10.1016/j.yebeh.2021.107801] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Evidence has indicated that there may be sex differences in the prevalence of and risk factors for anxiety in patients with epilepsy (PWE). The prevalence and risk factors for anxiety in male and female PWE in Northeast China were investigated. METHODS A consecutive cohort of patients with epilepsy (PWE) from the First Hospital of Jilin University was recruited. Anxiety symptoms were assessed using the 7-item Generalized Anxiety Disorder-7 questionnaire (GAD-7; Chinese version). Multivariate logistic regression analyses were used to confirm independent risk factors for anxiety in male and female patients. RESULTS Anxiety was prevalent in 28.2% (n = 162) of the total sample of patients, in 23.2% (n = 79) of males, and in 35.5% (n = 83) of females. Younger age (P = 0.033), higher seizure frequency over the last year (P = 0.003), and higher C-NDDI-E scores (P = 0.001) were risk factors for anxiety in males with epilepsy. Only higher C-NDDI-E scores (P = 0.001) had an independent effect on the risk of anxiety in females with epilepsy. CONCLUSION Anxiety is a common psychiatric comorbidity among PWE. There were sex differences in the prevalence and risk factors for anxiety in patients.
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Affiliation(s)
- Rui Zhong
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Qingling Chen
- Department of Hepatology, Second People's Clinical College of Tianjin Medical University, Tianjin Second People's Hospital, Tianjin, China
| | - Mengmeng Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Nan Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Xinyue Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Weihong Lin
- Department of Neurology, The First Hospital of Jilin University, Changchun, China.
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Gugała-Iwaniuk M, Sławińska K, Bochyńska A, Konopko M, Rola R, Ryglewicz D, Sienkiewicz-Jarosz H. The prevalence of depressive and anxiety symptoms in Polish epilepsy patients - The context of pharmaco-resistance. Epilepsy Behav 2021; 114:107522. [PMID: 33272895 DOI: 10.1016/j.yebeh.2020.107522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/11/2020] [Accepted: 09/21/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Patients with epilepsy (PWE) are at a higher risk of experiencing depressive and anxiety symptoms than the general population; these symptoms are more prevalent in patients with drug-resistant epilepsy (DRE) compared to those with non-drug-resistant epilepsy (NDRE). The aim of the present study was to compare the level of reported depressive and anxiety symptoms in patients with DRE and patients with NDRE and to examine the relationships between demographic and epilepsy-related variables and severity of depression and anxiety symptoms. MATERIAL AND METHODS A total of 193 adult PWE, divided into a DRE group (n = 87), and an NDRE group (n = 106), completed the Beck Depression Inventory (BDI) and the Stat-Trait Anxiety Inventory (STAI-Sand STAI-T). Data analysis included sociodemographic and disease-related variables such as the type of epilepsy syndrome, age at onset of disease, and duration of the disease. RESULTS The DRE group presented a higher score of BDI than the NDRE group (p = 0.04). Age correlated with the score of STAI-S in the NDRE group (r = 0.22). Sex was the only significant predictor of the score of STAI-T in the NDRE group. Men from the DRE group presented higher scores in BDI, STAI-S, and STA-T compared with the NDRE group. CONCLUSIONS Patients with DRE reported more severe depressive symptoms than patients with NDRE. In NDRE patients, the level of anxiety, considered as a state, was correlated with age. Sex was a significant predictor of the level of anxiety in DRE patients. Pharmaco-resistance was significantly associated with severity of depression and anxiety in male patients.
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Affiliation(s)
- Magdalena Gugała-Iwaniuk
- Ist Department of Neurology, The Institute of Psychiatry and Neurology, Warsaw (I Klinika Neurologiczna, Instytut Psychiatrii I Neurologii, ul.Sobieskiego 9, 02-957 Warszawa, Poland.
| | - Ksenia Sławińska
- Ist Department of Neurology, The Institute of Psychiatry and Neurology, Warsaw (I Klinika Neurologiczna, Instytut Psychiatrii I Neurologii, ul.Sobieskiego 9, 02-957 Warszawa, Poland
| | - Anna Bochyńska
- Ist Department of Neurology, The Institute of Psychiatry and Neurology, Warsaw (I Klinika Neurologiczna, Instytut Psychiatrii I Neurologii, ul.Sobieskiego 9, 02-957 Warszawa, Poland
| | - Magdalena Konopko
- Ist Department of Neurology, The Institute of Psychiatry and Neurology, Warsaw (I Klinika Neurologiczna, Instytut Psychiatrii I Neurologii, ul.Sobieskiego 9, 02-957 Warszawa, Poland
| | - Rafał Rola
- Ist Department of Neurology, The Institute of Psychiatry and Neurology, Warsaw (I Klinika Neurologiczna, Instytut Psychiatrii I Neurologii, ul.Sobieskiego 9, 02-957 Warszawa, Poland; Neurological Department, Military Institute of Aviation Medicine, Warsaw (Klinika Neurologiczna, Wojskowy Instytut Medycyny Lotniczej, ul.Krasińskiego 54/56, 01-755 Warszawa, Poland
| | - Danuta Ryglewicz
- Ist Department of Neurology, The Institute of Psychiatry and Neurology, Warsaw (I Klinika Neurologiczna, Instytut Psychiatrii I Neurologii, ul.Sobieskiego 9, 02-957 Warszawa, Poland
| | - Halina Sienkiewicz-Jarosz
- Ist Department of Neurology, The Institute of Psychiatry and Neurology, Warsaw (I Klinika Neurologiczna, Instytut Psychiatrii I Neurologii, ul.Sobieskiego 9, 02-957 Warszawa, Poland
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Olawa BD, Idemudia ES. The extraversion-neuroticism and geriatric depression relations: do social engagements and social supports have roles to play? Heliyon 2020; 6:e05719. [PMID: 33364493 PMCID: PMC7750367 DOI: 10.1016/j.heliyon.2020.e05719] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/14/2020] [Accepted: 12/09/2020] [Indexed: 02/02/2023] Open
Abstract
Evidence on the social pathways by which personality traits associate with depressive feeling is lacking. This study assessed the mediating roles of social engagements and social supports on the associations of extraversion and neuroticism with depressive symptoms among 465 older adults (Meanage = 74.18 ± 9.42) recruited from the senatorial districts of Ekiti State, Nigeria. Major assumptions were tested in structural equation modelling frame-work. High extraversion influenced both high engagements in social activities and perceived social supports, and then low depressive symptoms. High neuroticism predicted both low social engagements and social supports, and then increased depressive symptoms. While a full mediation was established between extraversion and depression, a partial one was found between neuroticism and depression. The total effect of neuroticism on depression surpassed that of extraversion. Psychotherapeutic interventions targeting depression from high neuroticism may aim frequent social engagements and seeking family and non-family supports.
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Van Hees S, Siewe Fodjo JN, Wijtvliet V, Van den Bergh R, Faria de Moura Villela E, da Silva CF, Weckhuysen S, Colebunders R. Access to healthcare and prevalence of anxiety and depression in persons with epilepsy during the COVID-19 pandemic: A multicountry online survey. Epilepsy Behav 2020; 112:107350. [PMID: 32920373 PMCID: PMC7481834 DOI: 10.1016/j.yebeh.2020.107350] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective of this study was to assess access to healthcare and to estimate the prevalence of depression and anxiety among persons with epilepsy (PWE) during the ongoing coronavirus disease 2019 (COVID-19) pandemic. METHODS We conducted a multicountry online survey among PWE. Persons with epilepsy were invited to participate through various social media channels. The Hospital Anxiety and Depression Scale (HADS) and 9-item Patient Health Questionnaire (PHQ-9) scale were used to score anxiety and depression. Logistic regression modeling was used to investigate factors associated with anxiety and depression. RESULTS Three hundred ninety-nine PWE were included (mean age: 38.22 ± 12.09 years), the majority were female (80.2%) and living in high-income countries (83.2%). Two hundred three PWE reported symptoms of a cold since January 2020. Nine (25%) of the 36 PWE tested for COVID were positive. A total of 72 PWE (19.6%) reported problems to obtain antiseizure medication (ASM), which in 25% of cases was directly COVID-related. Of the 399 PWE, 201 (50.4%) screened positive for anxiety according to the HADS; 159 (39.8%) and 187 (46.9%) PWE screened positive for depression based on the HADS and PHQ-9 scale, respectively. Female gender and financial problems were associated with both depression and anxiety. A planned follow-up consultation with the treating physician was associated with a lower risk of depression, whereas difficulties to access ASM treatment increased the odds of depression. In 65/137 (47.4%) PWE with a planned follow-up visit with the treating physician, this consultation was canceled. CONCLUSIONS Innovative approaches are needed to ensure continuity in access to ASM treatment. Healthcare workers should ensure continued follow-up, either through inperson or telehealth appointments, to timely identify symptoms of anxiety and depression and act accordingly.
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Affiliation(s)
- Stijn Van Hees
- Global Health Institute, University of Antwerp, Belgium; Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Belgium
| | | | - Veerle Wijtvliet
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Belgium
| | | | | | | | - Sarah Weckhuysen
- Department of Neurology, University Hospital Antwerp, Belgium; VIB-Center for Molecular Neurology, University of Antwerp, Belgium
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Abstract
BACKGROUND Epilepsy and mental illness share similar problems in terms of stigma, as a result of centuries of superstition, ignorance and misbeliefs. Stigma leads not only to discrimination and civil and human rights violations but also to poor access to healthcare and non-adherence or decreased adherence to treatment, ultimately increasing morbidity and mortality. Despite continuous efforts in fighting stigma in these conditions, there is very limited knowledge on the phenomenon of double stigma, meaning the impact of having two stigmatised conditions at the same time. AIMS To discuss double stigma in mental health with special reference to epilepsy. METHOD Articles were identified through searches in PubMed up to 31 October 2019 using the search terms 'epilepsy', 'psychiatric disorders', 'stigma' and additional material was identified from the authors' own files and from chosen bibliographies. RESULTS Double stigma is gaining attention for other stigmatised medical conditions, such as HIV, however, the literature on epilepsy is almost non-existent and this is quite astonishing given that one in three people with epilepsy have a lifetime diagnosis of a psychiatric condition. Felt (perceived) stigma and psychiatric disorders, particularly depression, create a vicious circle in epilepsy maintaining both, as depression correlates with stigma and vice versa as well as epilepsy and depression serving as bidirectional risk factors. This phenomenon has no geographical and economic boundaries as similar data have been reported for low-income and high-income countries. CONCLUSIONS Governments and policymakers as well as health services, patients' organisations, families and the general public need to be aware of the phenomenon of double stigma in order to develop campaigns and interventions tailored for these patients.
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Affiliation(s)
- Marco Mula
- Institute of Medical and Biomedical Education, St George's University of London, UK; and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, UK
| | - Kenneth R Kaufman
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, USA; and Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
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Yang Y, Yang M, Shi Q, Wang T, Jiang M. Risk factors for depression in patients with epilepsy: A meta-analysis. Epilepsy Behav 2020; 106:107030. [PMID: 32248060 DOI: 10.1016/j.yebeh.2020.107030] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/04/2020] [Accepted: 03/04/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Depression is common and associated with reduced quality of life (QoL) in people with epilepsy (PWE). Although multiple studies have investigated the relevant predictors, the results have been inconsistent. This meta-analysis aimed to investigate the risk factors that might increase the possibility of depression in this population. METHODS Medline, The Cochrane Library, Web of Science, and Embase were comprehensively searched for cross-sectional studies on the occurrence of depression in PWE. A random effects model was used to calculate the pooled hazard ratios (HRs) and 95% confidence intervals (95% CIs). Heterogeneity between the study results and the probability of publication bias were also assessed. RESULTS Fifty-one cross-sectional studies with sample sizes ranging from 36 to 1763 were included in this meta-analysis. The significant factors associated with an increased risk of depression were older age (odds ratio [OR]: 1.02, 95% CI: 1.00-1.04; p = 0.019), female gender (OR: 1.58, 95% CI: 1.30-1.93; p < 0.001), low education level (OR: 3.38, 95% CI: 2.86-4.00; p < 0.001), not being employed (OR: 1.61, 95% CI: 1.08-2.38; p = 0.019), poor antiepileptic drug (AED) adherence (OR: 2.84, 95% CI: 1.94-4.16; p < 0.001), polytherapy (OR: 2.25, 95% CI: 1.48-3.41; p < 0.001), stigma (OR: 2.22, 95% CI: 1.71-2.88; p < 0.001), and anxiety (OR: 2.21, 95% CI: 1.66-2.94; p < 0.001). A shorter epilepsy duration was significantly associated with a lower risk of depression (OR: 0.99, 95% CI: 0.99-0.99; p < 0.001), whereas marital status (OR: 1.07, 95% CI: 0.90-1.20; p = 0.684), economic level (OR: 1.01, 95% CI: 0.95-1.08; p = 0.684), age at seizure onset (OR: 0.99, 95% CI: 0.75-1.29; p = 0.912), and seizure control (OR: 1.03, 95% CI: 0.65-1.63; p = 0.900) did not increase the risk of depression. CONCLUSION This meta-analysis defined several factors related to an increased risk of depression in PWE and can contribute to better prevention and screening strategies for depression in this group. The mechanisms behind this comorbidity remain to be further investigated to determine individually appropriate and targeted interventions.
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Affiliation(s)
- Yanhong Yang
- Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Mengyang Yang
- Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Qianling Shi
- The First School of Clinical Medicine, The Cochrane Center of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Tiancheng Wang
- The Epilepsy Center, Department of Neurology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.
| | - Min Jiang
- Beijing Children's Hospital, Capital Medical University, Beijing, China.
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Han SH, Kim KT, Ryu HU, Lee SA, Cho YJ, Kim JH, Kang KW, Shin DJ, Lee GH, Hwang KJ, Kim YS, Kim JB, Kim JE, Lee SY, Seo JG. Factors associated with social anxiety in South Korean adults with epilepsy. Epilepsy Behav 2019; 101:106569. [PMID: 31675602 DOI: 10.1016/j.yebeh.2019.106569] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to examine social anxiety in South Korean adults with epilepsy and to identify associated factors. METHOD This was a cross-sectional, multicenter study in South Korea. Social anxiety was assessed using short forms of the Social Phobia Scale (SPS-6) and Social Interaction Anxiety Scale (SIAS-6). The SPS-6 scores ≥9 and SIAS-6 scores ≥12 were considered indicative of social phobia and social interaction anxiety, respectively. The Patient Health Questionnaire-9 (PHQ-9); Stigma Scale-Revised (SS-R); Disclosure Management Scale; Family Adaptation, Partnership, Growth, Affection, Resolve (F-APGAR) scale; and a questionnaire assessing knowledge about epilepsy were also used. RESULTS Of a total of 219 patients with epilepsy, 21% and 11% had SPS-6 scores ≥9 and SIAS-6 scores ≥12, respectively. In logistic regression analysis, SPS-6 scores ≥9 were independently associated with SS-R scores of 4-9 (odds ratio [OR]: 8.626, 95% confidence interval [CI]: 2.515-29.587, p = .001), SS-R scores 1-3 (OR: 5.496, 95% CI: 1.757-17.197, p = .003), and PHQ-9 scores ≥10 (OR: 4.092, 95% CI: 1.823-9.185, p = .001). In contrast, SIAS-6 scores ≥12 were related only to PHQ-9 scores ≥10 (OR: 8.740, 95% CI: 3.237-23.599, p < .001). Belonging to a dysfunctional family and lack of knowledge about epilepsy tended to be associated with social phobia (p = .071) and social interaction anxiety (p = .090), respectively. Epilepsy-related variables were not related to social anxiety. CONCLUSION Social anxiety is not rare in patients with epilepsy. In this study, social phobia was associated with perceived stigma and depressive symptoms, whereas social interaction anxiety was related only to depressive symptoms in patients with epilepsy.
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Affiliation(s)
- Su-Hyun Han
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Keun Tae Kim
- Department of Neurology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Han Uk Ryu
- Department of Neurology, Chonbuk National University School of Medicine, Jeonju, Republic of Korea
| | - Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Yang-Je Cho
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jee Hyun Kim
- Department Neurology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Kyung-Wook Kang
- Department of Neurology, Chonnam National University Hospital, Kwangju, Republic of Korea
| | - Dong Jin Shin
- Department of Neurology, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Republic of Korea
| | - Gha Hyun Lee
- Departments of Neurology, Pusan National University School of Medicine, Pusan, Republic of Korea
| | - Kyoung Jin Hwang
- Department of Neurology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Young-Soo Kim
- Department of Neurology, Gyeongsang National University School of Medicine, Changwon, Republic of Korea
| | - Jung Bin Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji-Eun Kim
- Department of Neurology, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Seo-Young Lee
- Department of Neurology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Jong-Geun Seo
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Margolis SA, Gonzalez JS, Faria C, Kenney L, Grant AC, Nakhutina L. Anxiety disorders in predominantly African American and Caribbean American adults with intractable epilepsy: The role of perceived epilepsy stigma. Epilepsy Behav 2019; 99:106450. [PMID: 31419635 DOI: 10.1016/j.yebeh.2019.106450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Anxiety disproportionately affects people with epilepsy (PWE) and leads to poor outcomes. Yet, risk factors are not well understood especially among underserved groups. This cross-sectional study aimed to identify epilepsy-specific predictors of anxiety disorders in predominantly African American and Caribbean American PWE. MATERIALS AND METHODS The prevalence of anxiety disorders was established via diagnostic interview (Mini-International Neuropsychiatric Interview (MINI)). We identified the extent to which aspects of seizure burden (seizure frequency, seizure severity, convulsive vs. nonconvulsive seizures), seizure worry, and perceived epilepsy stigma were associated with anxiety disorder diagnosis. Finally, logistic regression assessed the overall and independent contributions of significant risk factors. RESULTS There were 60 participants (62% women, 52% African American, 27% Caribbean American, 20% Hispanic/Latino) with an average of 2 seizures per month. Nearly half of the sample (43%) had ≥1 anxiety disorder, with 62% of affected individuals qualifying for agoraphobia. Those with anxiety disorders tended to have convulsive seizures (p = 0.037) and endorsed greater seizure worry (p = 0.012), more general symptoms of anxiety (p = 0.005), and worse perceived epilepsy stigma (p = 0.003). Logistic regression accounted for 28% to 37.6% of the variance in anxiety disorder diagnostic status and correctly classified 73% of cases; however, only perceived epilepsy stigma made a unique contribution. CONCLUSIONS Anxiety disorders were prevalent in these predominantly African American and Caribbean American PWE. Epilepsy-specific risk factors included convulsive seizures, seizure worry, and perceived epilepsy stigma. Interventions aimed at treating anxiety disorders in diverse PWE may especially benefit from targeting stigma beliefs.
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Affiliation(s)
- Seth A Margolis
- Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA; Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 222 Richmond St., Providence, RI 02903, USA.
| | - Jeffrey S Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave., Bronx, NY 10461, USA; Albert Einstein College of Medicine, Yeshiva University, 1300 Morris Park Ave., Bronx, NY 10461, USA
| | - Caylin Faria
- Bridgewater State University, 131 Summer St., Bridgewater, MA 02324, USA
| | - Lauren Kenney
- Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA
| | - Arthur C Grant
- State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave., Brooklyn, NY 11203, USA
| | - Luba Nakhutina
- State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave., Brooklyn, NY 11203, USA
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Novais F, Loureiro S, Andrea M, Figueira ML, Pimentel J, Câmara Pestana L. May the right-side epileptogenic zone be a predictor of psychiatric comorbidity in people with refractory epilepsy? Laterality 2019; 25:275-284. [DOI: 10.1080/1357650x.2019.1662431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Filipa Novais
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Susana Loureiro
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Mafalda Andrea
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Lisbon, Portugal
| | - Maria Luísa Figueira
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - José Pimentel
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Department of Neurosciences and Mental Health, Neurology Department, Hospital de Santa Maria (CHULN), Lisbon, Portugal
| | - Luís Câmara Pestana
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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