Ego functions in epilepsy

Depression in epilepsy: a common but often unrecognized comorbid malady

Depressive disorders (DDs) represent the most frequent psychiatric comorbidity in epilepsy (1-5). Despite their relatively high prevalence, DDs remain unrecognized and untreated in many patients with epilepsy. The purpose of this review is to examine the reasons behind the failure to recognize and treat DDs in epilepsy. We highlight the essential epidemiologic, etiopathogenic, and clinical aspects that need to be considered in the evaluation of every epileptic patient and dedicate the last section of this paper to the review of the most relevant treatment issues. If we are successful in our goals, the reader will be impressed by the significant impact of DDs on the quality of life of these patients, and by the need to investigate treatment modalities with the same scientific rigor used in the assessment of efficacy of antiepileptic drugs in the control of seizures.

Psychopathology and family functioning in mothers with epilepsy

In a prospective comparative study of children born to mothers with epilepsy and to healthy controls, maternal psychopathology, family functioning and the effects of maternal psychopathology and family functioning on child mental status were investigated. The instruments used were the Present State Examination (PSE), the Past History Schedule (PHS), a psychiatric interview for preschool children and a structured interview about family functioning. Interviewers were blind to the clinical status of the mother. The group of mothers with epilepsy differed from the control group only regarding a higher prevalence of minor psychopathology and in 1 of 4 areas of family functioning. There was no difference between mothers with epilepsy and the control group regarding major psychopathology, and almost no differences regarding family functioning. The effect of maternal psychopathology on child mental status was mediated by disturbed family functioning only in the epilepsy group.

Personality characteristics and epilepsy

Patients with a long history of temporal lobe epilepsy or primary generalized epilepsy entered a questionnaire study of personality characteristics, based on a modification of the Bear-Fedio inventory for temporal lobe behavioural syndrome. Psoriasis patients and healthy volunteers served as controls. Four clinical meaningful dimensions of included personality traits were identified: ixoide, ideational, obsessive-compulsive and affective features. Analyses based on the Rasch model approved of all dimensions except for affective features. The epilepsy group obtained the highest scores on all 3 dimensions, healthy volunteers the lowest, while the psoriasis group repeatedly held an intermediate position in all sets of assessment (subjects, interviewers and relatives). A logistic regression analysis showed ixoide features being most important when the entire epilepsy group was compared with other study groups, while the dimension ideational features was significant when the temporal lobe epilepsy group was entered as target group and opposed to primary generalized epilepsy. The intermediate position of the psoriasis group, however, suggests that in addition to the presence of a cerebral dysfunction in the epilepsy group, the mere presence of a chronic disorder with potential social stigmatization influences personality.