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Hungwe MM, Lowton K. Assessing the prevalence of psychotic symptoms in epileptic patients at a tertiary clinic. S Afr J Psychiatr 2023; 29:2062. [PMID: 37795460 PMCID: PMC10546253 DOI: 10.4102/sajpsychiatry.v29i0.2062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/25/2023] [Indexed: 10/06/2023] Open
Abstract
Background The International League against Epilepsy (ILAE) defines epilepsy as a brain disorder characterised by an enduring risk to generate seizures with neurobiological, cognitive, psychological and social consequences. Psychotic disorders in epilepsy are a serious psychiatric complication affecting the prognosis, morbidity and mortality of patients. There is a paucity in literature with regard to the prevalence of psychotic symptoms in epileptic patients in low- to middle-income countries. Aim This study aimed to look at the prevalence of psychotic symptoms in epileptic patients at an outpatient clinic using the prodromal questionnaire 16 (PQ-16). Setting The study was conducted at the epilepsy clinic at Charlotte Maxeke Academic Hospital (CMJAH), a tertiary hospital located in Johannesburg, South Africa. Method The PQ-16 was distributed to patients at the epilepsy clinic at CMJAH. Results The study consisted of 121 participants. The prevalence of patients found to be at high risk of psychosis (i.e., PQ-16 score > 6) was 61.2% (95% lower confidence interval (LCI): 0.53, upper confidence interval (UCI): 0.70). None of the demographic variables showed significant associations in the percentage of patients found to be at high risk. No association was found between any antiepileptic drug and high risk of psychosis. Conclusion The high prevalence of psychotic like experiences found suggests it is imperative to screen for psychotic disorders in epileptic patients and if required to involve neuropsychiatrists in their management. Contribution This study highlights the importance of assessing psychotic symptoms in epileptic patients and the importance of a multidisciplinary approach in managing these complex patients.
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Affiliation(s)
- Michelle M Hungwe
- Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karishma Lowton
- Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Guo X, Lin W, Zhong R, Han Y, Yu J, Yan K, Zhang X, Liang J. Factors related to the severity of obsessive-compulsive symptoms and their impact on suicide risk in epileptic patients. Epilepsy Behav 2023; 146:109362. [PMID: 37499582 DOI: 10.1016/j.yebeh.2023.109362] [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: 06/14/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To explore relevant factors for the severity of obsessive-compulsive symptoms (OCSs) in adult epileptic patients and investigate whether the severity of OCSs is a mediator in the relationship between depressive/anxiety symptoms and suicide risk in epileptic patients. METHODS This was a cross-sectional study from a hospital in Northeast China. Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Neurological Disorders Depression Inventory for Epilepsy (NDDIE), Generalized Anxiety Disorder (GAD-7), and Nurses' Global Assessment of Suicide Risk (NGASR) were used to assess the severity of OCSs, depressive symptoms, anxiety symptoms, and suicide risk in epileptic patients, respectively. The independent factors of the severity of OCSs and their mediating effects in the relationship between depressive/anxiety symptoms and suicide risk were evaluated by regression analyses and mediator models, respectively. RESULTS NDDIE scores (β = 0.404, p < 0.001), GAD-7 scores (β = 0.247, p = 0.009), and polytherapy (β = 0.119, p = 0.032) were the independent factors of Y-BOCS scores. The Y-BOCS scores partially mediated the relationship between GAD-7 scores and NGASR scores (standardized coefficients of indirect effect = 0.109, Bootstrap 95% CI = 0.024 to 0.214). Still, they did not mediate the relationship between NDDIE scores and NGASR scores (standardized coefficients of indirect effect = 0.062, Bootstrap 95% CI = -0.024 to 0.169). CONCLUSIONS Depressive symptoms, anxiety symptoms, and polytherapy are independently associated with the severity of OCSs in epileptic patients. Depressive and anxiety symptoms mediate the effect of the severity of OCSs on suicide risk in epileptic patients completely.
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Affiliation(s)
- Xin Guo
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Weihong Lin
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Rui Zhong
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yujuan Han
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jieyang Yu
- Department of Pediatric Neurology, the First Hospital of Jilin University, Changchun, China
| | - Kangle Yan
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Xinyue Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| | - Jianmin Liang
- Department of Pediatric Neurology, the First Hospital of Jilin University, Changchun, China.
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Seid J, Gebrehiwot B, Andualem F, Kassaye A, Mohammed J, Akele M. Factors associated with stress-related symptoms among people with epilepsy in Ethiopia, a cross-sectional study. Front Neurol 2023; 14:1218448. [PMID: 37583951 PMCID: PMC10425181 DOI: 10.3389/fneur.2023.1218448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/14/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction Stress is a common psychological problem present in people with epilepsy and has a serious impact on the health-related satisfaction of people with epilepsy and their cohabiters. This study aimed to assess the magnitude and related factors of stress. Methods A hospital-based cross-sectional study was carried out among 301 systematically chosen people with epilepsy. The seven stress-related items of the Depression, Anxiety, and Stress -21 questionnaire was used to measure stress. Data were entered using Epi Info and analyzed by SPSS version 25. Predictors with a p-value < 0.20 in the bivariate logistic regression were transferred into the multivariate model. A p-value of less than 0.05 was viewed as statistically significant. Result The prevalence of stress symptoms in this study was 23.9%. Daily labor occupational status with Adjusted Odds ratio [(AOR) = 0.042, 95% CI: 0.004, 0.469], onset of illness at the age of 18 years and above (AOR = 0.188, 95% CI: 0.046, 0.771), perceived stigma (AOR = 3.320, 95% CI: 1.345, 8.200), the presence of anxiety symptoms (AOR = 8.275, 95% CI: 3.345, 20.471), and belief that the condition is untreatable (AOR = 6.360, 95% CI: 1.647, 24.562) were significantly associated factors. Conclusion The occurrence of stress was high, and it reinforced that there is a requisite for the identification and handling of stress-related symptoms among people with epilepsy.
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Affiliation(s)
- Jemal Seid
- Department of Psychiatric Nursing, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Birhane Gebrehiwot
- Department of Psychiatric Nursing, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Fantahun Andualem
- Department of Psychiatric Nursing, College of Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Abenet Kassaye
- Department of Psychiatric Nursing, College of Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Jemal Mohammed
- Department of Medicine, Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia
| | - Mulugeta Akele
- Department of Psychiatry, College of Medicine and Health Science, Mizan-Tepi University, Mizan, Ethiopia
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Włodarczyk A, Dywel A, Cubała WJ. Safety and Tolerability of the Acute Ketamine Treatment in Treatment-Resistant Depression: Focus on Comorbidities Interplay with Dissociation and Psychomimetic Symptoms. Pharmaceuticals (Basel) 2023; 16:173. [PMID: 37259323 PMCID: PMC9966368 DOI: 10.3390/ph16020173] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 11/25/2023] Open
Abstract
There is evidence for ketamine use in treatment-resistant depression (TRD). Several safety concerns arise regarding adverse drug reactions in specific subpopulations. The aim of this study was to investigate the safety of intravenous ketamine treatment in relation to dissociative and psychotic measures in TRD inpatients with Major Depressive Disorder (MDD) and Bipolar depression (BP) with comorbidities. In total, 49 inpatients with MDD or BP were treated with ketamine following the registered naturalistic observational protocol in a tertiary reference unit for mood disorders (NCT04226963). This dataset represents an intermittent analysis of an observational study performed for interim modeling of observational learning. The observations were applied to the inhomogeneous TRD population in a single site with no blinding and were limited to acute administration. The presence of epilepsy was significantly associated with an elevation in the BPRS over time (p = 0.008). Psychotic symptomatology with BPRS scores for comorbid conditions excluding epilepsy turned out to be insignificant (p = 0.198) regardless of the diagnosis. However, for a subgroup of patients with epilepsy (n = 6), a substantial fluctuation was seen across all administrations in the time course of the study. The study results contribute to the literature on the safety and tolerability profile of CNS adverse drug reactions in short-term treatment with intravenous ketamine as an add-on intervention to current standard-of-care psychotropic medication in TRD-MDD and TRD-BP inpatients with comorbidities. The careful consideration of comorbidities and concomitant medication is needed with ketamine administration along with close-clinical supervision at every visit.
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Affiliation(s)
- Adam Włodarczyk
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdansk, 80-214 Gdansk, Poland
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Li J, Ledoux-Hutchinson L, Toffa DH. Prevalence of Bipolar Symptoms or Disorder in Epilepsy: A Systematic Review and Meta-Analysis. Neurology 2022; 98:e1913-e1922. [PMID: 35292556 DOI: 10.1212/wnl.0000000000200186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/26/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This systematic review with meta-analysis (PROSPERO: CRD42021249336) was performed to estimate the pooled lifetime prevalence of bipolar symptoms (BS) and bipolar disorder (BD) in people with epilepsy (PWE). METHODS A search was performed on June 5th, 2021, in four databases (MEDLINE/PubMed, Ovid EMBASE, Ovid APA PsycInfo, and Web of Science) for original research reporting on BS/BD in PWE, with no restriction on language or time of publication. Inclusion criteria were as follows: 1) original research, 2) cross-sectional study design component, 3) reported a lifetime prevalence of BS/BD or enough information to calculate an estimate, and 4) reported the method by which participants were deemed bipolar. Studies based on an exclusively pediatric population were excluded. To calculate pooled lifetime prevalence of BS/BD, two meta-analytic random-effects models were fitted, one for BS, and the other for BD. Risk of bias was assessed using a standardized appraisal tool for studies reporting prevalence. Certainty of evidence was evaluated using the GRADE approach. RESULTS A total of 750 records were screened, and 17 studies were included for analysis: seven provided prevalence estimates for only BS, eight for only BD, and two for both BS and BD. After outlier exclusion and subgroup analysis using screening method as a moderator, the pooled prevalence of BS in PWE was 12.3% [95% CI; 10.6-14.1%] (7,506 PWE). The pooled prevalence of BD in PWE was 4.5% [95% CI; 2.2-7.4%] (48,334 PWE). Considerable heterogeneity was present - more so for BD than for BS - and could be explained through differences in population demographics and study methodology. DISCUSSION This study's main limitation was regarding the certainty of evidence. Notwithstanding, our estimates of prevalence should prompt further research on BS/BD in PWE. Given the significant morbidity associated to BD, clinicians should carefully screen PWE for BS.
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Affiliation(s)
- Jimmy Li
- Neurology Division, University of Sherbrooke Health Centre (CHUS), Sherbrooke, QC, Canada.,University of Montreal Health Centre Research Centre (CRCHUM), Montreal, QC, Canada
| | | | - Dènahin Hinnoutondji Toffa
- University of Montreal Health Centre Research Centre (CRCHUM), Montreal, QC, Canada.,Neurology Division, University of Montreal Health Centre (CHUM), Montreal, QC, Canada
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Seid J, Mebrahtu K, Andualem F. Prevalence and associated factors of anxiety disorder symptoms among people with epilepsy in Mekelle, Ethiopia, 2019: Institutional-based cross-sectional study. Nurs Open 2022; 9:1731-1743. [PMID: 35170244 PMCID: PMC8994931 DOI: 10.1002/nop2.1198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 12/12/2021] [Accepted: 01/30/2022] [Indexed: 11/09/2022] Open
Abstract
Aim Anxiety can have a profound influence on the health‐related quality of life of people with epilepsy and caregivers. The study aimed to assess the prevalence and associated factors of anxiety disorder among people with epilepsy. Design An institutional‐based cross‐sectional study was conducted. Method From 18 April 2019–30 May 2019, systematically selected 300 peoples with epilepsy were recruited. Anxiety was assessed by using the generalized anxiety disorder‐7 (GAD‐7). The data were entered by using Epi Info and analysed by SPSS version 25. Result The prevalence of anxiety was 38.3%. Secondary educational status, medication‐related side effect, substance use history, seizure‐related physical trauma, stress symptoms and a mental illness belief were significantly associated factors. The prevalence of anxiety disorder symptom was high, and it reinforced the need for recognition and treatment of mental disorders in people with epilepsy.
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Affiliation(s)
- Jemal Seid
- Department of Psychiatric Nursing, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kalayu Mebrahtu
- Department of Psychiatric Nursing, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Fantahun Andualem
- Department of Psychiatric Nursing, College of Health Sciences, Adigrat University, Tigray, Ethiopia
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Grzegorzewska AM, Wiglusz MS, Landowski J, Jakuszkowiak-Wojten K, Cubała WJ, Włodarczyk A, Szarmach J. Multiple Comorbidity Profile of Psychiatric Disorders in Epilepsy. J Clin Med 2021; 10:jcm10184104. [PMID: 34575214 PMCID: PMC8465099 DOI: 10.3390/jcm10184104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022] Open
Abstract
The co-occurrence of psychiatric disorders in people with epilepsy (PWE) is not well documented or studied. Anxiety and depressive disorders are the most frequent comorbid disorders in PWE. In this paper, we characterized the rates of multiple psychiatric disorder comorbidity by reanalyzing data from a study sample of PWE. A total of 96 outpatient PWE completed the self-report symptom scale, and were diagnosed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) Axis I disorders (SCID-I). For analyses, patients were assigned to a comprehensive diagnostic group of anxiety and depressive disorders. In order to determine comorbidity across psychiatric diagnoses for the DSM-IV categories, Pearson's chi-squared test (χ2) was used. In the study sample, eight patients (8.3% of the study sample, n = 96) had comorbid major depressive disorder and anxiety disorder. When looking at comorbidity of each diagnosis separately, it was determined that 50% of individuals with an anxiety disorder had comorbid Major Depressive Disorder (MDD) and 38% patients with MDD had comorbid anxiety disorder. This finding encourages a more systematic reporting of psychiatric prevalence data in epilepsy, especially taking into account the high ratio of multiple comorbid anxiety and depressive disorders in PWE.
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Yang TW, Kim DH, Kim YS, Kim J, Kwon OY. Anxiety disorders in outpatient clinics of epilepsy in tertiary care hospitals: A meta-analysis. Seizure 2020; 75:34-42. [PMID: 31874357 DOI: 10.1016/j.seizure.2019.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/11/2019] [Accepted: 12/15/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND AND PURPOSE Although anxiety disorders (ADs) occur frequently in people with epilepsy (PWE) and impair quality of life and treatment outcomes, current efforts to categorize and investigate AD subtypes in PWE remain insufficient. Thus, the present meta-analysis aimed to determine the current prevalence rates of any AD type and various AD subtypes in PWE managed by outpatient clinics. METHODS MEDLINE, EMBASE, Cochrane Library, Web of Science, and SCOPUS were searched to identify and select studies that assessed the prevalence of ADs or individual AD subtypes in adult PWE under the routine care of outpatient epilepsy clinics in tertiary hospitals. Only studies that used gold-standard diagnostic tools for assessing ADs were included in this meta-analysis. RESULTS The database search ultimately identified 15 studies, of which 9 provided current prevalence rates of any type of AD. The pooled estimated prevalence of any AD was 26.1 %. Of the 15 total studies, 13 provided current prevalence rates of generalized anxiety disorder (GAD), revealing an overall estimated prevalence of 18.2 %. In terms of current prevalence rates, GAD was highest, followed by agoraphobia, social phobia, panic disorder, and obsessive-compulsive disorder. CONCLUSIONS Among PWE managed in the outpatient epilepsy clinics of tertiary care hospitals, the current prevalence of any AD was 26.1 %, and GAD was the most prevalent subtype of AD.
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Affiliation(s)
- Tae-Won Yang
- Department of Neurology and Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Republic of Korea; Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Do-Hyung Kim
- Department of Neurology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Young-Soo Kim
- Department of Neurology and Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Republic of Korea; Department of Neurology, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Juhyeon Kim
- Department of Neurology and Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Republic of Korea; Department of Neurology, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Oh-Young Kwon
- Department of Neurology and Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Republic of Korea; Department of Neurology, Gyeongsang National University Hospital, Jinju, Republic of Korea.
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