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Brett BA, Conroy M, Doshi H, Lowe MX, Kalcheff-Korn S, Jackson H. An observational time-series study on the behavioral effects of adjunctive artisanal cannabidiol use by adults with treatment resistant epilepsies. BMC Neurol 2024; 24:141. [PMID: 38671370 PMCID: PMC11046917 DOI: 10.1186/s12883-024-03646-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND For approximately 30% of people with epilepsy, seizures are not well-controlled by anti-seizure medication (ASM). This condition, called treatment resistant epilepsy (TRE), is associated with increased morbidity and mortality, and substantially impacts the quality of life of both the individual and their family. Non-responsiveness to ASMs leads many people with TRE to seek alternative therapies, such as cannabinoid-based medication, particularly cannabidiol (CBD), with or without medical or professional advice. This is due in part to widespread reporting in the media about the benefits of CBD for seizures in some forms of epilepsy. METHODS Adults with TRE, opting to add CBD to their existing treatment regime, completed this prospective, observational, longitudinal, quasi-experimental, time-series study. We hypothesized that adjunctive CBD use would positively impact participants' quality of life and psychological well-being in comparison to a baseline period without CBD use. Participants were followed for a period of approximately six months - for approximately one month of baseline prior to the initiation of CBD use and approximately five months after the initiation of CBD use. Participants provided urine samples and completed behavioral questionnaires that assessed quality of life, anxiety/depression, and adverse events during baseline and at two times during CBD use. RESULTS Complete case analyses (n = 10) showed a statistically significant improvement in quality of life, a statistically significant decrease in anxiety symptoms, and a statistically significant decrease in the experience of adverse events over time (p < 0.05). Improvements noted in the experience of depression symptoms did not reach statistical significance. Urinalysis revealed the majority of participants had no CBD/metabolites in their system at the beginning of the study, and confirmed the presence of CBD/metabolites in participants' urine after CBD was added to their treatment regime. Analysis of missing data using multiple imputation supported the findings of the complete case analysis. INTERPRETATION For a small group of individuals with TRE of varying etiologies, adjunctive use of artisanal CBD was associated with improvements in the behavioral and psychological symptoms of TRE, as well as improved medication tolerability.
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Affiliation(s)
- Barbara A Brett
- Department of Psychology, Colorado State University-Pueblo, 2200 Bonforte Blvd., Pueblo, CO, 81001, USA.
| | - Matthieu Conroy
- US Army Medical Research Institute of Chemical Defense, Aberdeen, MD, USA
| | - Hardik Doshi
- Cape Fear Valley Medical Center, Fayetteville, NC, USA
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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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Temple J, Gemma Cherry M, Gray V, Jones A, Fisher P. Experience sampling methodology study of anxiety and depression in adolescents with epilepsy: The role of metacognitive beliefs and perseverative thinking. Epilepsy Behav 2024; 151:109599. [PMID: 38160577 DOI: 10.1016/j.yebeh.2023.109599] [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: 10/03/2023] [Revised: 12/10/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
Emotional distress is common in young people with epilepsy (YPwE). According to the Self-Regulatory Executive Function (S-REF) model, maladaptive metacognitive beliefs and perseverative thinking are fundamental in the development and maintenance of emotional distress. As emotional distress and perseverative thinking can highly fluctuate over short intervals in YPwE, it is important to account for this variability when testing the utility of psychological models. Experience sampling methodology (ESM) was therefore used to explore the momentary relationship between metacognitive beliefs, perseverative thinking, and emotional distress in YPwE. Eighteen participants diagnosed with epilepsy (aged 12-17 years) completed the 10-day ESM period. Participants were prompted to complete the ESM assessment five times daily. The ESM assessment assessed participant's momentary levels of metacognitive beliefs, perseverative thinking (i.e., worry and rumination), and emotional distress (i.e., anxiety and depression). A series of multilevel regression analyses indicated that metacognitive beliefs were significantly positively associated with worry, rumination, anxiety and depression. After controlling for worry and rumination, respectively, metacognitive beliefs did not account for additional variance in anxiety or depression. Findings provide preliminary support for the utility of the S-REF model for emotional distress in YPwE. Metacognitive therapy, which is underpinned by the S-REF model, may be an appropriate intervention for emotional distress in YPwE. Future studies should assess the mediational relationship between metacognitive beliefs, perseverative thinking, and emotional distress using time-lagged models.
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Affiliation(s)
- James Temple
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK; Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Mary Gemma Cherry
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK; Clinical Health Psychology Service, Liverpool University NHS Foundation Trust, Liverpool, UK.
| | - Victoria Gray
- Psychological Services (Paediatrics), Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Andrew Jones
- Department of Psychology, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Peter Fisher
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK; Clinical Health Psychology Service, Liverpool University NHS Foundation Trust, Liverpool, UK
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Temple J, Fisher P, Davies C, Millar C, Gemma Cherry M. Psychosocial factors associated with anxiety and depression in adolescents with epilepsy: A systematic review. Epilepsy Behav 2023; 149:109522. [PMID: 38006843 DOI: 10.1016/j.yebeh.2023.109522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/27/2023]
Abstract
Anxiety and depression are common in adolescents with epilepsy. Identifying psychosocial risk factors for anxiety and depression is essential for adolescents with epilepsy to receive appropriate support. This systematic review synthesised findings of studies examining the relationship between psychosocial factors and anxiety and/or depression in adolescents with epilepsy. Outcomes were anxiety, depression, and mixed anxiety & depression. Six electronic databases were searched for studies which: used cross-sectional or prospective designs; quantitatively evaluated the relationship between psychosocial factors and anxiety and/or depression; presented results for adolescents with epilepsy aged 9-18 years; and used validated measures of anxiety and/or depression. Psychosocial factors were categorised as intrapersonal, interpersonal, or parent-specific factors. Sixteen studies (23 articles) were included. All but one were cross-sectional. Regarding intrapersonal factors, alternative mental health difficulties were consistently positively associated with all three outcomes. Negative attitude towards epilepsy, lower seizure self-efficacy, lower self-esteem and stigma were consistently positively associated with depression. Interpersonal factors (i.e., lower family functioning assessed from an adolescent's perspective) and parent-specific factors (i.e., parental stigma, stress, anxiety and psychopathology) were positively associated with at least one outcome. Adolescent epilepsy management should exceed assessment of biological/biomedical factors and incorporate assessment of psychosocial risk factors. Prospective studies examining the interplay between biological/biomedical factors and the psychosocial factors underpinning anxiety and depression in adolescents with epilepsy are needed.
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Affiliation(s)
- James Temple
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK; Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Peter Fisher
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK; Clinical Health Psychology Service, Liverpool University NHS Foundation Trust, Liverpool, UK
| | - Cari Davies
- Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Chris Millar
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK; Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Mary Gemma Cherry
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK; Clinical Health Psychology Service, Liverpool University NHS Foundation Trust, Liverpool, UK.
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Assenza G, Sancetta BM, Lanzone J, Narducci F, Ricci L, Boscarino M, Marrelli A, Ciuffini R, Piccioli M, Di Lazzaro V, Tombini M. Resilience predicts and modulates anxiety severity in people with epilepsy. Epilepsy Behav 2023; 147:109390. [PMID: 37619458 DOI: 10.1016/j.yebeh.2023.109390] [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: 06/11/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Anxiety is one of the most relevant psychiatric comorbidities in people with epilepsy (PwE). The role of resilience (RES) in the development of anxiety is not well understood. We purposed to better characterize RES impact on anxiety severity in PwE. MATERIALS AND METHODS One hundred and seventy-six PwE underwent online surveys including a collection of socio-demographic, seizure-related, and psychological variables. PwE were grouped according to the data collected; anxiety levels were compared through non-parametric statistics. Hierarchical regression analysis (HRA) and logistic regression were performed to characterize RES contribute in predicting the presence and the severity of anxiety. Mediation/moderation analysis was performed to evaluate causal effects among RES, depression, and anxiety. RESULTS Anxiety did not differ according to socio-demographic and seizure-related variables, exemption for the presence of drug-related adverse effects. Depression, RES, and sleep quality provided the major contribute on anxiety variance. The addiction of RES level in HRA and logistic regression provided a significant increase of R-squared value (p-value = 0.02) and of area under the curve (p-value = 0.03), respectively. RES modulated depression/anxiety relationship (p-value < 0.001), whereas depression did not mediate RES/anxiety correlation (p-value = 0.68). CONCLUSIONS We demonstrated that RES is a significant independent predictor of anxiety in PwE and is able to modulate depression impact on anxiety. Moreover, we confirmed the relevance of depression and sleep quality on anxiety severity.
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Affiliation(s)
- G Assenza
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - B M Sancetta
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy.
| | - J Lanzone
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| | - F Narducci
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - L Ricci
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - M Boscarino
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy
| | - A Marrelli
- UOC Neurophysiopathology, Ospedale San Salvatore, L'Aquila, Italy
| | - R Ciuffini
- Department of MeSVA, Università degli Studi dell'Aquila, L'Aquila, Italy
| | - M Piccioli
- UOC Neurology, PO San Filippo Neri, ASL Roma 1, Rome, Italy
| | - V Di Lazzaro
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - M Tombini
- UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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Catalán-Aguilar J, González-Bono E, Lozano-García A, Tormos-Pons P, Hampel KG, Villanueva V, Cano-López I. Stress phenotypes in epilepsy: impact on cognitive functioning and quality of life. Front Psychol 2023; 14:1100101. [PMID: 37388654 PMCID: PMC10300421 DOI: 10.3389/fpsyg.2023.1100101] [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: 11/16/2022] [Accepted: 05/22/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction Drug-resistant epilepsy has been proposed as a chronic stress model. Stress can be measured in terms of chronicity (epilepsy duration) and intensity (comorbidities), with depression and anxiety among the most important comorbidities in epilepsy due to its prevalence and its relationship with cognitive functioning and quality of life. This study aims to establish phenotypes according to how patients face a stressful condition (epilepsy) and examine differences in cognition and quality of life depending on these phenotypes. We hypothesize that there will be an interrelationship between epilepsy duration and negative affectivity, and these variables will influence cognition and quality of life. Methods 170 patients (82 men and 88 women) underwent a neuropsychological evaluation in which trait anxiety, depression, attention and executive function, verbal and visual memory, language, emotional recognition, and quality of life were assessed. Hierarchical clustering was performed using z-scores for three variables: trait anxiety; depression; and epilepsy duration. Results Three clusters were found: vulnerable (high negative affectivity and short duration); resilient (moderate negative affectivity and long duration); and low-impact group (low negative affectivity and short duration). Results show that the vulnerable group had poorer cognitive functioning and quality of life than the other groups. Specifically, the vulnerable group had poorer scores than the low-impact group on verbal memory, visual confrontation naming, and quality of life (except seizure worry). Furthermore, resilient patients had better scores than the low-impact group on cognitive flexibility variables, but lower scores on some quality-of-life subscales (i.e., overall quality of life, emotional well-being, and energy). Finally, the vulnerable group had poorer scores than the resilient group in executive functioning, naming, and quality of life. Discussion These results suggest that dealing with stress in patients with epilepsy is related to cognitive performance and quality of life. These findings underline the relevance of considering comorbidities in epilepsy and may be useful for detecting vulnerable or resilient profiles as risk or protective factors for cognitive and quality of life decline.
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Affiliation(s)
- Judit Catalán-Aguilar
- Institut d’Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (Idocal)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
| | - Esperanza González-Bono
- Institut d’Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (Idocal)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
| | - Alejandro Lozano-García
- Institut d’Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (Idocal)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
| | - Paula Tormos-Pons
- Institut d’Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (Idocal)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
| | - Kevin G. Hampel
- Refractory Epilepsy Unit, Neurology Service Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Irene Cano-López
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
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Munger Clary HM, Giambarberi L, Floyd WN, Hamberger MJ. Afraid to go out: Poor quality of life with phobic anxiety in a large cross-sectional adult epilepsy center sample. Epilepsy Res 2023; 190:107092. [PMID: 36701931 PMCID: PMC10167591 DOI: 10.1016/j.eplepsyres.2023.107092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/05/2022] [Accepted: 01/13/2023] [Indexed: 01/18/2023]
Abstract
PURPOSE People with epilepsy (PWE) have unmet healthcare needs, especially in the context of mental health. Although the current literature has established increased incidence of anxiety and depression in PWE and their contribution to poor quality of life, little is known regarding the presence and impact of specific phobia and agoraphobia. Our aim was to assess factors associated with high phobic/agoraphobic symptoms in a large, single tertiary epilepsy center sample, and to assess their impact on quality of life. METHODS In a diverse sample of 420 adults with epilepsy, cross-sectional association of demographic, epilepsy and cognitive factors with high phobic symptoms were assessed using multiple logistic regression. Symptoms were measured with the SCL-90R validated self-report subscale (T-score ≥ 60 considered high phobic symptom group). Multiple logistic regression modeling was used to assess for independent association of demographic and clinical variables with presence of high phobic symptoms, and multiple linear regression modeling was used to evaluate for independent cross-sectional associations with epilepsy-specific quality of life (QOLIE-89). RESULTS Lower education (adjusted OR 3.38), non-White race/ethnicity (adjusted OR 2.34), and generalized anxiety symptoms (adjusted OR 1.91) were independently associated with high phobic/agoraphobic symptoms, all p < 0.005. Phobic/agoraphobic symptoms were independently associated with poor quality of life as were depression symptoms, older age, and non-White race/ethnicity. Generalized anxiety did not demonstrate a significant independent association with quality of life in the multivariable model. CONCLUSION In this study sample, phobic/agoraphobic symptoms were independently associated with poor quality of life. Clinicians should consider using more global symptom screening instruments with particular attention to susceptible populations, as these impactful symptoms may be overlooked using generalized-anxiety focused screening paradigms.
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Affiliation(s)
- Heidi M Munger Clary
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
| | - Luciana Giambarberi
- Department of Psychiatry, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
| | - Whitney N Floyd
- Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
| | - Marla J Hamberger
- Department of Neurology, Columbia University Medical Center, New York, NY 10032, USA.
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Ali Arazeem A, Tahirah Adedolapo I, Joseph Alabi O. Shame, stigma, and social exclusion: The lived experiences of epileptic patients in a health facility in Ilorin, Nigeria. Glob Public Health 2022; 17:3839-3852. [PMID: 35748774 DOI: 10.1080/17441692.2022.2092174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The highest number of persons living with epilepsy (PLWE) are in Africa and the majority live in deplorable conditions, while dealing with varying layers of stigma, social exclusion, and discrimination. OBJECTIVE This study explored the lived experiences of PLWE in Ilorin. METHODS Adopting a qualitative design and a phenomenological lens, 10 PLWE between the ages of 18 and 60 were purposively selected from the University of Ilorin Teaching Hospital (UITH) for in-depth interviews. RESULTS Findings suggest that PLWE bear multiple and intersecting burdens, including physical injuries; institutional, cultural, and economic constraints; psychological strain; social exclusion; and stigma. These disadvantages are often sustained and reproduced by various assumptions about epilepsy; as such, PLWE conceal their condition, and this implicatively reinforce stigma. Difficulty sustaining intimate relationships, overt physical scars, and inferiority complexes are recurrent challenges for PLWE. The study showed that adherence to drugs, self-management, personal precautions towards seizure signs, and family support are important coping strategies. CONCLUSION The study recommends that it is imperative to enhance and sustain systems, processes, and attitudes that prioritise the physical, social, and emotional needs of PLWE, because this is significant for their enhanced quality of life (QoL).
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Affiliation(s)
- Abdullahi Ali Arazeem
- Department of Sociology, University of Johannesburg, Gauteng, South Africa.,Department of Democracy and Governance, National Institute for Legislative and Democratic Studies, Abuja, Nigeria
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Hagemann A, Lahr D, May TW, Speicher P, Hausfeld H, Coban I, Müffelmann B, Bien CG, Specht U. Efficacy of a specialized inpatient rehabilitation program in patients with early versus chronic epilepsy. Epilepsy Behav 2022; 142:108999. [PMID: 36446667 DOI: 10.1016/j.yebeh.2022.108999] [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: 06/08/2022] [Revised: 11/03/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a specialized inpatient rehabilitation program in patients with early in comparison with chronic epilepsy. METHODS We performed a prospective, open pre/post study using a parallel group design. Patients with early epilepsy (EE, treatment with anti-seizure medication [ASM] ≤ 1 year) or with chronic epilepsy (CE, ASM treatment > 5 years) completed questionnaires at the time of their admission to the rehabilitation program and at discharge. Outcome measures comprised scales from the PESOS questionnaire (PErformance, SOciodemographic aspects, Subjective estimation; e.g., emotional adaptation to epilepsy) as well as screening instruments for depression (Neurological Disorders Depression Inventory for Epilepsy, NDDI-E) and anxiety (Generalized Anxiety Disorder Scale, GAD-7). Linear mixed models (LMMs) were used to determine the effects of the program in the total group and to compare the effects between patients with EE and CE. RESULTS The analyses included 79 patients with EE and 157 patients with CE. Baseline comparisons revealed differences in disease-related and sociodemographic variables (e.g., patients with EE were older, those with CE had a higher seizure frequency and a higher rate of unemployment; all p < .01). LMMs showed significant improvements in emotional adaptation to epilepsy, depression, anxiety, overall quality of life and overall health as well as in perceived overall restrictions because of epilepsy and the subjective level of information about epilepsy (all p < .001). Despite the different duration of epilepsy, baseline levels as well as improvements did not differ between patients with EE and CE (all p > .05) except for the perceived level of information, which was significantly lower in patients with EE at admission and improved to a higher extent in this group (both p < .001). CONCLUSION Both patients with EE and patients with CE who are referred to a specialized comprehensive rehabilitation program benefit from the participation in this program with respect to emotional adaptation to epilepsy, aspects of quality of life, and level of information about epilepsy.
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Affiliation(s)
- Anne Hagemann
- Society for Epilepsy Research, Maraweg 21, 33617 Bielefeld, Germany.
| | - Denise Lahr
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Theodor W May
- Society for Epilepsy Research, Maraweg 21, 33617 Bielefeld, Germany.
| | - Pascal Speicher
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Heiko Hausfeld
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Ingrid Coban
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Birgitt Müffelmann
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Christian G Bien
- Society for Epilepsy Research, Maraweg 21, 33617 Bielefeld, Germany; Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Ulrich Specht
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
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Karia S, Gupta G, Kesri R, Goyal S. Comorbid depression and anxiety in patients of epilepsy. ANNALS OF INDIAN PSYCHIATRY 2022. [DOI: 10.4103/aip.aip_97_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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11
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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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12
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Kohek SRB, Foresti ML, Blanco MM, Cavarsan CF, da Silva CS, Mello LE. Anxious Profile Influences Behavioral and Immunohistological Findings in the Pilocarpine Model of Epilepsy. Front Pharmacol 2021; 12:640715. [PMID: 34025410 PMCID: PMC8132119 DOI: 10.3389/fphar.2021.640715] [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: 12/11/2020] [Accepted: 03/22/2021] [Indexed: 12/01/2022] Open
Abstract
Anxiety and epilepsy have a complex bidirectional relationship, where a depressive/anxious condition is a factor that can trigger seizures which in turn can aggravate the depressive/anxious condition. In addition, brain structures such as the hippocampus and amygdala might have a critical relevance in both epilepsy and anxiety. The aim of the present work was to investigate the influence of different anxious profiles to epileptogenesis. Initially, animals were screened through the elevated plus-maze anxiety test, and then seizure development was evaluated using the pilocarpine model of epilepsy. There were no differences in the susceptibility to status epilepticus, mortality rate or frequency of spontaneous recurrent seizures between animals characterized as anxious as compared to the non-anxious animals. Next, we evaluated immunohistological patterns related to seizures and anxiety in various related brain areas. Despite a decrease in the density of neuropeptide Y and parvalbumin expression in epileptic animals, those presenting greater neuropeptide Y immunoreactivity in various brain regions, also showed higher spontaneous recurrent seizures frequency. Differences on the anxious profile showed to interfere with some of these findings in some regions. In addition, animals that were injected with pilocarpine, but did not develop status epilepticus, had behavioral and neuroanatomical alterations as compared to control animals, indicating its importance as an additional tool for investigating the heterogeneity of the epileptogenic response after an initial insult. This study allowed to better understand the association between anxiety and temporal lobe epilepsy and might allow for therapeutic targets to be developed to minimize the negative impacts associated with it.
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Affiliation(s)
| | | | | | - Clarissa Fantin Cavarsan
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI, United States.,George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, United States
| | | | - Luiz E Mello
- Physiology Department, Universidade Federal de São Paulo, São Paulo, Brazil.,Instituto D' Or de Pesquisa e Ensino, Rio de Janeiro, Brazil
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13
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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: 9] [Impact Index Per Article: 3.0] [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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14
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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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15
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Ertan D, Hubert-Jacquot C, Maillard L, Sanchez S, Jansen C, Fracomme L, Schwan R, Hopes L, Javelot H, Tyvaert L, Vignal JP, El-Hage W, Hingray C. Anticipatory anxiety of epileptic seizures: An overlooked dimension linked to trauma history. Seizure 2020; 85:64-69. [PMID: 33444881 DOI: 10.1016/j.seizure.2020.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/10/2020] [Accepted: 12/12/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Fear of having a seizure called anticipatory anxiety of epileptic seizure (AAS), constitutes a daily life burden but has been rarely studied. Our aim was to assess the prevalence and the determining factors of AAS in patients with drug-resistant focal epilepsy, a dimension that has not been thoroughly investigated before. METHODS We conducted an observational, prospective study enrolling patients with drug-resistant focal epilepsy. The psychiatric assessment aimed to evaluate psychiatric comorbidities, trauma history, and quality of life using hetero-evaluation and self-assessment tools. Dimensions of anxiety specifically related to epilepsy (peri-and-inter-ictal) were explored as exhaustively as possible. RESULTS AAS was found in 53 % of the 87 patients. We compared the two groups of patients: with or without AAS. Patients with AAS had a significantly shorter duration of epilepsy (p = 0.04). There was no difference between groups with respect to psychiatric disorders, except for cannabis dependence, more frequent in patients with AAS (p = 0.02). Compared to patients without AAS, those with AAS presented more subjective ictal anxiety (p = 0.0003) and postictal anxiety (p = 0.02), were more likely to avoid outdoor social situations due to seizure fear (p = 0.001), and had a poorer quality of life (QOLIE emotional well-being; p = 0.03). Additionally, they had experienced more traumatic events in their lifetime (p = 0.005) and reported more frequently a feeling of being unsafe during their seizures (p = 0.00002). SIGNIFICANCE AAS is a specific dimension of anxiety, possibly linked to trauma history. AAS is strongly linked to subjective ictal anxiety but not to the objective severity of seizures or frequency.
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Affiliation(s)
- Deniz Ertan
- Centre Médical de la Teppe, Tain-l'Hermitage, France; Université de Lorraine, CNRS, CRAN, UMR 7039, Nancy, France; CHRU de Nancy, Département de Neurologie, Nancy, France
| | - Caroline Hubert-Jacquot
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France; Université de Lorraine, Faculté de Médecine, Vandœuvre-lès-Nancy, France
| | - Louis Maillard
- Université de Lorraine, CNRS, CRAN, UMR 7039, Nancy, France; CHRU de Nancy, Département de Neurologie, Nancy, France; Université de Lorraine, Faculté de Médecine, Vandœuvre-lès-Nancy, France
| | - Stéphane Sanchez
- Pôle Information médicale évaluation performance, CH de Troyes, Troyes, France
| | - Claire Jansen
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France; Université de Lorraine, Faculté de Médecine, Vandœuvre-lès-Nancy, France
| | - Léa Fracomme
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France; Université de Lorraine, Faculté de Médecine, Vandœuvre-lès-Nancy, France
| | - Raymund Schwan
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France; Université de Lorraine, Faculté de Médecine, Vandœuvre-lès-Nancy, France; INSERM U1114, Université de Strasbourg, Strasbourg, France
| | - Lucie Hopes
- CHRU de Nancy, Département de Neurologie, Nancy, France
| | - Hervé Javelot
- Etablissement Public de Santé Alsace Nord, Brumath, France
| | - Louise Tyvaert
- Université de Lorraine, CNRS, CRAN, UMR 7039, Nancy, France; CHRU de Nancy, Département de Neurologie, Nancy, France; Université de Lorraine, Faculté de Médecine, Vandœuvre-lès-Nancy, France
| | - Jean-Pierre Vignal
- Université de Lorraine, CNRS, CRAN, UMR 7039, Nancy, France; CHRU de Nancy, Département de Neurologie, Nancy, France
| | - Wissam El-Hage
- UMR 1253, iBrain, Université de Tours, INSERM, Tours, France; CHU de Tours, Tours, France
| | - Coraline Hingray
- Université de Lorraine, CNRS, CRAN, UMR 7039, Nancy, France; CHRU de Nancy, Département de Neurologie, Nancy, France; Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France.
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16
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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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Ridsdale L, McKinlay A, Wojewodka G, Robinson EJ, Mosweu I, Feehan SJ, Noble AJ, Morgan M, Taylor SJ, McCrone P, Landau S, Richardson M, Baker G, Goldstein LH. Self-Management education for adults with poorly controlled epILEpsy [SMILE (UK)]: a randomised controlled trial. Health Technol Assess 2019; 22:1-142. [PMID: 29717699 DOI: 10.3310/hta22210] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Epilepsy is a common neurological condition resulting in recurrent seizures. Research evidence in long-term conditions suggests that patients benefit from self-management education and that this may improve quality of life (QoL). Epilepsy self-management education has yet to be tested in a UK setting. OBJECTIVES To determine the effectiveness and cost-effectiveness of Self-Management education for people with poorly controlled epILEpsy [SMILE (UK)]. DESIGN A parallel pragmatic randomised controlled trial. SETTING Participants were recruited from eight hospitals in London and south-east England. PARTICIPANTS Adults aged ≥ 16 years with epilepsy and two or more epileptic seizures in the past year, who were currently being prescribed antiepileptic drugs. INTERVENTION A 2-day group self-management course alongside treatment as usual (TAU). The control group received TAU. MAIN OUTCOME MEASURES The primary outcome is QoL in people with epilepsy at 12-month follow-up using the Quality Of Life In Epilepsy 31-P (QOLIE-31-P) scale. Other outcomes were seizure control, impact of epilepsy, medication adverse effects, psychological distress, perceived stigma, self-mastery and medication adherence. Cost-effectiveness analyses and a process evaluation were undertaken. RANDOMISATION A 1 : 1 ratio between trial arms using fixed block sizes of two. BLINDING Participants were not blinded to their group allocation because of the nature of the study. Researchers involved in data collection and analysis remained blinded throughout. RESULTS The trial completed successfully. A total of 404 participants were enrolled in the study [SMILE (UK), n = 205; TAU, n = 199] with 331 completing the final follow-up at 12 months [SMILE (UK), n = 163; TAU, n = 168]. In the intervention group, 61.5% completed all sessions of the course. No adverse events were found to be related to the intervention. At baseline, participants had a mean age of 41.7 years [standard deviation (SD) 14.1 years], and had epilepsy for a median of 18 years. The mean QOLIE-31-P score for the whole group at baseline was 66.0 out of 100.0 (SD 14.2). Clinically relevant levels of anxiety symptoms were reported in 53.6% of the group and depression symptoms in 28.0%. The results following an intention-to-treat analysis showed no change in any measures at the 12-month follow-up [QOLIE-31-P: SMILE (UK) mean: 67.4, SD 13.5; TAU mean: 69.5, SD 14.8]. The cost-effectiveness study showed that SMILE (UK) was possibly cost-effective but was also associated with lower QoL. The process evaluation with 20 participants revealed that a group course increased confidence by sharing with others and improved self-management behaviours. CONCLUSIONS For people with epilepsy and persistent seizures, a 2-day self-management education course is cost-saving, but does not improve QoL after 12-months or reduce anxiety or depression symptoms. A psychological intervention may help with anxiety and depression. Interviewed participants reported attending a group course increased their confidence and helped them improve their self-management. FUTURE WORK More research is needed on self-management courses, with psychological components and integration with routine monitoring. TRIAL REGISTRATION Current Controlled Trials ISRCTN57937389. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 21. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Leone Ridsdale
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alison McKinlay
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gabriella Wojewodka
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emily J Robinson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iris Mosweu
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sarah J Feehan
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adam J Noble
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Stephanie Jc Taylor
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Centre for Primary Care and Public Health, London, UK
| | - Paul McCrone
- King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark Richardson
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gus Baker
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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18
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Cano-López I, Hidalgo V, Hampel KG, Garcés M, Salvador A, González-Bono E, Villanueva V. Cortisol and trait anxiety as relevant factors involved in memory performance in people with drug-resistant epilepsy. Epilepsy Behav 2019; 92:125-134. [PMID: 30658320 DOI: 10.1016/j.yebeh.2018.12.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/19/2018] [Accepted: 12/22/2018] [Indexed: 11/15/2022]
Abstract
People with drug-resistant epilepsy are exposed to unpredictable and uncontrollable seizures, which can be considered as a chronic stress condition. Additionally, these patients present memory deficits and a high prevalence of depression and anxiety. Cortisol, the main stress hormone, has a modulatory role on memory in healthy individuals and patients with emotional disorders, but its role in memory and emotional processes remains unclear in people with epilepsy. This study analyzes the differences in cortisol levels in people with epilepsy with high and low memory performance, and the relationships among cortisol levels, epilepsy-related factors, memory, anxiety, and depression. Fifty-two adults with drug-resistant epilepsy underwent a neuropsychological evaluation, in which nine saliva samples were collected to analyze the ability of the hypothalamic-pituitary-adrenal axis to descend in accordance with the circadian rhythm. Cortisol area under the curve (AUC) was computed to study the global cortisol changes. Patients with low immediate and delayed memory performance and left-hemisphere focus showed higher cortisol levels. Additionally, patients with low memory scores had higher cortisol AUC, and therefore slower declining levels in the afternoon. Memory performance was negatively related to the cortisol AUC and trait anxiety, being both reliable predictors of memory performance, especially in patients with left-hemisphere focus. These results suggest that memory deficits in people with drug-resistant epilepsy may be influenced by exposure to cortisol derived from chronic stress. Additionally, trait anxiety could contribute to increasing the vulnerability to stress.
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Affiliation(s)
- Irene Cano-López
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Avda. Blasco Ibañez, 21, 46010, Valencia, Spain.
| | - Vanesa Hidalgo
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Avda. Blasco Ibañez, 21, 46010, Valencia, Spain; Department of Psychology and Sociology, Area of Psychobiology, Social and Human Sciences Center, University of Zaragoza, Campus Ciudad Escolar, 44003, Teruel, Spain
| | - Kevin G Hampel
- Multidisciplinary Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Bulevar sur, s/n Carretera de Malilla, 46026, Valencia, Spain
| | - Mercedes Garcés
- Multidisciplinary Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Bulevar sur, s/n Carretera de Malilla, 46026, Valencia, Spain
| | - Alicia Salvador
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Avda. Blasco Ibañez, 21, 46010, Valencia, Spain
| | - Esperanza González-Bono
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Avda. Blasco Ibañez, 21, 46010, Valencia, Spain
| | - Vicente Villanueva
- Multidisciplinary Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Bulevar sur, s/n Carretera de Malilla, 46026, Valencia, Spain
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Zingano BDL, Guarnieri R, Diaz AP, Schwarzbold ML, Wolf P, Lin K, Walz R. Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A) and The State-Trait Anxiety Inventory (STAI) accuracy for anxiety disorders detection in drug-resistant mesial temporal lobe epilepsy patients. J Affect Disord 2019; 246:452-457. [PMID: 30599368 DOI: 10.1016/j.jad.2018.12.072] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/18/2018] [Accepted: 12/23/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is the most prevalent type of surgically remediable epilepsy and highly associated with psychiatric comorbidities. This study aimed to evaluate Hospital anxiety and depression scale-anxiety subscale (HADS-A) and The State-Trait Anxiety Inventory - Trait subscale (STAI-T) accuracy for detection of anxiety disorders in patients with drug-resistant MTLE-HS. METHODS One hundred three consecutive patients with drug-resistant MTLE-HS were enrolled. Diagnosis was based on the anamnesis, neurological examination, video-electroencephalogram (VEEG) analyses, and magnetic resonance imaging (MRI). Psychiatric interviews were based on DSM-IV-TR criteria and ILAE Commission of Psychobiology classification as a gold standard; HADS-A and STAI-T were used as psychometric diagnostic tests, and receiver operating characteristic (ROC) curves were used to determine the optimal threshold scores. RESULTS The areas under the curve (AUCs) were higher than 0.7 (0.6-0.8) for both scales. The STAI-T cutoff point of ˃53 and the HADS-A cutoff point of ˃7 showed both around of 80% (44.4-97.7) sensitivity and 80% (66.9-86.9) and 60% (46.5-68.6) of specificity, respectively. In this sample the prevalence of anxiety disorders was 11.7% and both scales showed a high negative predictive value such as 96% (87.1-99.0) but low positive predictive value such as 30% (22.1-45.2) and 20% (15.0-27.2) respectively. LIMITATIONS The small number of cases in the diagnostic population; the results are only applied to drug resistant MTLE-HS; the psychiatric diagnosis were not based on a structured psychiatric interview; possible observer bias in 7 illiterate patients; the antidepressant treatment was not controlled. CONCLUSIONS In MTLE-HS, STAI-T and HADS-A had a similar and low positive predictive value and high negative predictive value. The implications for the HADS-A and STAI-T usefulness for anxiety disorders screening in patients with other epilepsies types deserve further investigations. If replicated in other populations, these findings may have important relevance for the presurgical screening of anxiety disorders in MTLE-HS patients who are candidates to epilepsy surgery.
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Affiliation(s)
- Bianca de Lemos Zingano
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Serviço de Psiquiatria, Hospital Governador Celso Ramos (HGCR), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil.
| | - Ricardo Guarnieri
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil; Serviço de Psiquiatria, HU-UFSC, Florianópolis, SC, Brazil
| | - Alexandre Paim Diaz
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil; Serviço de Psiquiatria, HU-UFSC, Florianópolis, SC, Brazil; Programa de Pós-Graduação em Ciências da Saúde, Universidade do Sul de Santa Catarina (UNISUL), Palhoça, SC, Brazil
| | - Marcelo Libório Schwarzbold
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil; Serviço de Psiquiatria, HU-UFSC, Florianópolis, SC, Brazil
| | - Peter Wolf
- Serviço de Neurologia, HU-UFSC, Florianópolis, SC, Brazil; Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil; Danish Epilepsy Center, Dianalund, Denmark
| | - Katia Lin
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil; Serviço de Neurologia, HU-UFSC, Florianópolis, SC, Brazil; Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil
| | - Roger Walz
- Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), HU, UFSC, Florianópolis, SC, Brazil; Serviço de Neurologia, HU-UFSC, Florianópolis, SC, Brazil; Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil
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20
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Avedisova AS, Lebedeva AV, Pashnin EV, Kustov GV, Akzhigitov RG, Guekht AB. [Anxiety disorders in epilepsy]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 118:37-44. [PMID: 30698542 DOI: 10.17116/jnevro201811810237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This review is devoted to the place of anxiety disorders in the spectrum of psychiatric comorbidity in patients with epilepsy. The authors present general characteristics of anxiety manifestations and current views on the classification and qualification of anxiety disorders in such patients. Recent data show the relationship of anxiety with different forms of epilepsy, demographic and gender characteristics, localization of epileptic focus. The problem of bidirectional relationship of anxiety and epilepsy as well as the temporal relationship between anxiety and epileptic states are considered.
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Affiliation(s)
- A S Avedisova
- Serbsky National Medical Research Centre for Psychiatry and Narcology, Moscow, Russia; Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia
| | - A V Lebedeva
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - E V Pashnin
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia
| | - G V Kustov
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia
| | - R G Akzhigitov
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia
| | - A B Guekht
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
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21
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Baker DA, Caswell HL, Eccles FJR. Self-compassion and depression, anxiety, and resilience in adults with epilepsy. Epilepsy Behav 2019; 90:154-161. [PMID: 30557784 DOI: 10.1016/j.yebeh.2018.11.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Research suggests that people with epilepsy (PWE) are more likely to experience depression and anxiety than the general population. Given the adversity associated with the condition, resilience may also be important. However, to date, resilience has been largely overlooked in the epilepsy literature. Self-compassion has been widely associated with improved psychological wellbeing and, to a lesser extent, resilience. However, the relationship between self-compassion and depression, anxiety, and resilience in PWE has not been examined. OBJECTIVES Using a quantitative cross-sectional survey design, the aim of the present study was to examine the extent to which self-compassion predicted depression, anxiety, and resilience when controlling for demographic and illness-related variables. METHODS Adults with epilepsy were invited to take part in a survey online or in epilepsy or neurology clinics. Two-hundred and seventy participants completed the survey, and data were analyzed using hierarchical multiple regression models. RESULTS In this sample of PWE, self-compassion significantly predicted lower depression and anxiety and higher resilience when other significant sociodemographic and illness-related variables had been taken into account. CONCLUSIONS The findings of the present study indicate that self-compassion could be an important factor in determining psychological outcomes for adults with epilepsy, and its role is worthy of further exploration to help improve psychological outcomes for PWE.
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Affiliation(s)
- David A Baker
- Division of Health Research, Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster LA1 4YG, UK
| | - Helen L Caswell
- Department of Clinical Neuropsychology, Clinical Sciences Building, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK
| | - Fiona J R Eccles
- Division of Health Research, Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster LA1 4YG, UK.
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22
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Cano-López I, Hampel KG, Garcés M, Villanueva V, González-Bono E. Quality of life in drug-resistant epilepsy: relationships with negative affectivity, memory, somatic symptoms and social support. J Psychosom Res 2018; 114:31-37. [PMID: 30314576 DOI: 10.1016/j.jpsychores.2018.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the relative contribution of factors non-directly related to seizures such as negative affectivity, social support, somatic symptoms and memory performance on quality of life (QOL) in patients with drug-resistant epilepsy. METHODS This is a cross-sectional study. Seventy patients with drug-resistant epilepsy were consecutively recruited from the inpatient Epilepsy Unit, Hospital Universitario y Politécnico La Fe, between April 2015 and October 2017. Medical history provided demographic characteristics of the patients (sex, age, and educational level), and clinical data (age at epilepsy onset, duration of epilepsy in years, frequency of seizures per month, type of seizures and number of AEDs). Pre-surgical assessment included diagnosis of the type of epilepsy and the lateralization of the epileptogenic area. All the patients underwent a neuropsychological assessment in which QOL (QOLIE-31), negative affectivity, social support, somatic symptoms, and memory were evaluated. RESULTS Negative affectivity (including anxiety-trait and depression), social support, neurosensory symptoms, and long-term verbal memory were significantly related to QOL composite score (for all, p < .009), subscales of QOL showing different sensitivities to them. Even after controlling for negative affectivity, neurosensory symptoms and long-term verbal memory significantly contribute to QOL composite score (p = .0001). CONCLUSION Results suggest that clinical management of patients with drug-resistant epilepsy should consider the treatment of verbal memory impairments at an early stage. Recognition of negative affectivity, poor social support and high somatic symptoms would also lead health professionals to develop different strategies to improve the QOL of patients with drug-resistant epilepsy.
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Affiliation(s)
- Irene Cano-López
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Avda. Blasco Ibañez, 21, 46010 Valencia, Spain.
| | - Kevin G Hampel
- Multidisciplinary Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Bulevar sur, s/n Carretera de Malilla, 46026, Valencia, Spain
| | - Mercedes Garcés
- Multidisciplinary Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Bulevar sur, s/n Carretera de Malilla, 46026, Valencia, Spain
| | - Vicente Villanueva
- Multidisciplinary Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Bulevar sur, s/n Carretera de Malilla, 46026, Valencia, Spain
| | - Esperanza González-Bono
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Avda. Blasco Ibañez, 21, 46010 Valencia, Spain
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23
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Fisher PL, Reilly J, Noble A. Metacognitive beliefs and illness perceptions are associated with emotional distress in people with epilepsy. Epilepsy Behav 2018; 86:9-14. [PMID: 30036766 DOI: 10.1016/j.yebeh.2018.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/05/2018] [Accepted: 07/08/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Emotional distress is common in people with epilepsy (PWE) for which efficacious interventions are required. Developing evidence-based treatments should be based on testable models of the psychological mechanisms maintaining psychopathology. The Self-Regulatory Executive Function (S-REF) model proposes that maladaptive metacognitive beliefs and processes are central to the development and maintenance of emotional distress. Although preliminary support exists for the role of metacognitive beliefs in emotional distress in PWE, their role has yet to be tested when controlling for the contribution made by illness perceptions. METHODS Four hundred and fifty-seven PWE completed an online survey, which assessed anxiety, depression, metacognitive beliefs, illness perceptions, general demographic factors, and epilepsy characteristics. RESULTS Hierarchical regression analyses demonstrated that metacognitive beliefs and illness perceptions were both associated with anxiety and depression when controlling for the influence of demographic variables and epilepsy characteristics. However, metacognitive beliefs accounted for more variance in anxiety and depression than illness perceptions. CONCLUSION Metacognitive beliefs appear to make a greater contribution to anxiety and depression in PWE than illness perceptions. Prospective studies are now needed to establish the causal role of metacognitive beliefs in both the development and persistence of emotional distress.
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Affiliation(s)
- Peter L Fisher
- Psychological Sciences, University of Liverpool, Liverpool, United Kingdom.
| | - James Reilly
- Psychological Sciences, University of Liverpool, Liverpool, United Kingdom.
| | - Adam Noble
- Psychological Sciences, University of Liverpool, Liverpool, United Kingdom.
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24
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Munger Clary HM, Snively BM, Hamberger MJ. Anxiety is common and independently associated with clinical features of epilepsy. Epilepsy Behav 2018; 85:64-71. [PMID: 29908386 PMCID: PMC6093217 DOI: 10.1016/j.yebeh.2018.05.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/12/2018] [Accepted: 05/12/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to assess for independent association of anxiety symptoms with epilepsy localization and other epilepsy-related and demographic factors in a large tertiary care adult epilepsy population. METHODS Among 540 adults, anxiety was measured by the Symptom Checklist 90-R (SCL-90R) anxiety subscale, and detailed demographics, epilepsy localization, and depression scores (SCL-90R) were collected. High anxiety was defined by SCL-90R anxiety T-score ≥ 60. Stepwise multiple logistic regression was carried out to assess for independent association of high anxiety scores with demographic and clinical factors. RESULTS High anxiety symptoms were present in 46.1% of participants (N = 250). Focal or unknown epilepsy type and depression scores were independently associated with high anxiety (adjusted odds ratios (OR): 2.89 (95% confidence interval [CI] = 1.33-6.29, p = 0.007) and 2.12 (95% CI = 1.83-2.45, p < 0.001), respectively; depression odds per 5-point increase in scale). Among the focal epilepsy subpopulation, mesial temporal sclerosis was also independently associated with high anxiety, with adjusted OR: 2.12 (95% CI = 1.11-4.04, p = 0.023). Lower education, non-white race/ethnicity, Spanish native language, prior head trauma, antiseizure drug polytherapy, and left focus or bilateral foci (in focal epilepsy) were associated with high anxiety in simple logistic regression, but these associations were not independent. A total of 46 individuals (18.4% of those with high anxiety) scored high for anxiety but not depression. Only 26% of those with high anxiety symptoms were taking a potentially anxiolytic medication. CONCLUSION Anxiety symptoms, often without concomitant depression, were highly prevalent in this epilepsy sample and independently associated with focal/unknown epilepsy and mesial temporal sclerosis. These results strongly support the value of screening specifically for anxiety in the epilepsy clinic, to direct patients to appropriate treatment.
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Affiliation(s)
- Heidi M. Munger Clary
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Beverly M. Snively
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Marla J. Hamberger
- Department of Neurology, Columbia University Medical Center, New York, New York, U.S.A
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25
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Abstract
SummaryEpilepsy is a common neurological condition with wide-ranging neuropsychiatric manifestations. The relationship between epilepsy and psychiatry has been recognised for centuries. However, the wide range of neuropsychiatric comorbidities and their extent is only now beginning to be appreciated. The impact of these comorbidities on patients' help-seeking behaviour, seizure control and quality of life suggests that early detection and treatment are of paramount importance. Clinical issues in relation to accurate recognition and appropriate management of neuropsychiatric conditions in epilepsy are discussed.
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26
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Dehn LB, Pfäfflin M, Brückner S, Lutz MT, Steinhoff BJ, Mayer T, Bien CG, Nussbeck FW, May TW. Relationships of depression and anxiety symptoms with seizure frequency: Results from a multicenter follow-up study. Seizure 2017; 53:103-109. [DOI: 10.1016/j.seizure.2017.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/11/2017] [Accepted: 11/13/2017] [Indexed: 02/07/2023] Open
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27
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Pham T, Sauro KM, Patten SB, Wiebe S, Fiest KM, Bulloch AGM, Jetté N. The prevalence of anxiety and associated factors in persons with epilepsy. Epilepsia 2017; 58:e107-e110. [PMID: 28597927 DOI: 10.1111/epi.13817] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 11/27/2022]
Abstract
The objectives of this study were to estimate the prevalence of, and factors associated with, anxiety in epilepsy. We conducted a cross-sectional analysis using data from the Neurological Disease and Depression Study. The prevalence of anxiety and associated factors were assessed using descriptive statistics and logistic regression. Of the total sample (n = 250 patients), nearly 40.0% of participants had anxiety according to the Hospital Anxiety and Depression Scale. The most prevalent symptom of anxiety was "worrying thoughts" (35.6%). After adjustment for age and sex, depression (odds ratio [OR] = 8.97, 95% confidence interval [CI] = 4.38-18.40), medication side effects (OR = 1.79, 95% CI = 1.04-3.05), smoking (OR = 4.35, 95% CI = 2.27-8.31), and illicit substance use (OR = 2.42, 95% CI = 1.18-4.96) were significantly associated with higher odds of anxiety, whereas higher education (OR = 0.47, 95% CI = 0.28-0.80) was associated with lower odds of anxiety. Furthermore, participants with anxiety reported more severe epilepsy, debilitating seizures, and overall lower quality of life. Evidence from our study reveals a high prevalence of anxiety in persons with epilepsy and that anxiety is associated with a variety of negative outcomes. These findings further emphasize the need for more studies to understand the impact of anxiety and its relationship with various sociodemographic and clinical factors.
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Affiliation(s)
- Tram Pham
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Khara M Sauro
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Scott B Patten
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew G M Bulloch
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nathalie Jetté
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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28
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Labudda K, Illies D, Herzig C, Schröder K, Bien CG, Neuner F. Current psychiatric disorders in patients with epilepsy are predicted by maltreatment experiences during childhood. Epilepsy Res 2017. [PMID: 28622538 DOI: 10.1016/j.eplepsyres.2017.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Childhood maltreatment has been shown to be a risk factor for the development of psychiatric disorders. Although the prevalence of psychiatric disorders is high in epilepsy patients, it is unknown if childhood maltreatment experiences are elevated compared to the normal population and if early maltreatment is a risk factor for current psychiatric comorbidities in epilepsy patients. This is the main purpose of this study. METHODS Structured interviews were used to assess current Axis I diagnoses in 120 epilepsy patients from a tertiary Epilepsy Center (34 TLE patients, 86 non-TLE patients). Childhood maltreatment in the family and peer victimization were assessed with validated questionnaires. Patients' maltreatment scores were compared with those of a representative matched control group. Logistic regression analysis was conducted to assess the potential impact of childhood maltreatment on current psychiatric comorbidity in epilepsy patients. RESULTS Compared to a matched control group, epilepsy patients had higher emotional and sexual maltreatment scores. Patients with a current psychiatric diagnosis reported more family and peer maltreatment than patients without a psychiatric disorder. Family maltreatment scores predicted the likelihood of a current psychiatric disorder. TLE patients did not differ from non-TLE patients according to maltreatment experiences and rates of current psychiatric disorders. CONCLUSION Our findings suggest that in epilepsy patients emotional and sexual childhood maltreatment is experienced more often than in the normal population and that early maltreatment is a general risk factor for psychiatric comorbidities in this group.
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Affiliation(s)
- Kirsten Labudda
- Bielefeld University, Department of Psychology, Bielefeld, Germany; Epilepsy Center Bethel, Krankenhaus Mara, Bielefeld, Germany.
| | - Dominik Illies
- Bielefeld University, Department of Psychology, Bielefeld, Germany; Epilepsy Center Bethel, Krankenhaus Mara, Bielefeld, Germany
| | - Cornelia Herzig
- Bielefeld University, Department of Psychology, Bielefeld, Germany
| | | | | | - Frank Neuner
- Bielefeld University, Department of Psychology, Bielefeld, Germany
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29
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Kotwas I, McGonigal A, Bastien-Toniazzo M, Bartolomei F, Micoulaud-Franchi JA. Stress regulation in drug-resistant epilepsy. Epilepsy Behav 2017; 71:39-50. [PMID: 28494323 DOI: 10.1016/j.yebeh.2017.01.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/29/2016] [Accepted: 01/25/2017] [Indexed: 12/17/2022]
Abstract
The prevalence of psychological distress, especially depressive and anxiety disorders, is higher in epilepsy than in other chronic health conditions. These comorbid conditions contribute even more than epileptic seizures themselves to impaired quality of life in patients with epilepsy (PWE). The link between these comorbidities and epilepsy appears to have a neurobiological basis, which is at least partly mediated by stress through psychological and pathophysiological pathways. The impact of stress in PWE is also particularly important because it is the most frequently reported seizure trigger. It is therefore crucial for clinicians to take stress-related conditions and psychiatric comorbidities into account when managing PWE and to propose clinical support to enhance self-control of stress. Screening tools have been specially designed and validated in PWE for depressive disorders and anxiety disorders (e.g. NDDI-E, GAD-7). Other instruments are useful for measuring stress-related variables (e.g. SRRS, PSS, SCS, MHLCS, DSR-15, ERP-R, QOLIE-31) in order to help characterize the individual "stress profile" and thus orientate patients towards the most appropriate treatment. Management includes both pharmacological treatment and nonpharmacological methods for enhancing self-management of stress (e.g. mindfulness-based therapies, yoga, cognitive-behavioral therapies, biofeedback), which may not only protect against psychiatric comorbidities but also reduce seizure frequency.
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Affiliation(s)
- Iliana Kotwas
- Laboratoire Parole et Langage UMR 7309, Aix-Marseille Université, Marseille, France.
| | - Aileen McGonigal
- Service de Neurophysiologie Clinique, Centre Hospitalo Universitaire de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France; Unité mixte INSERM Epilepsie et Cognition UMR 751, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France
| | | | - Fabrice Bartolomei
- Service de Neurophysiologie Clinique, Centre Hospitalo Universitaire de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France; Unité mixte INSERM Epilepsie et Cognition UMR 751, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France
| | - Jean-Arthur Micoulaud-Franchi
- Service d'explorations fonctionnelles du système nerveux, Clinique du sommeil, CHU de, Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France; USR CNRS 3413 SANPSY, CHU Pellegrin, Université de Bordeaux, France
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30
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Garcia-Cairasco N, Umeoka EHL, Cortes de Oliveira JA. The Wistar Audiogenic Rat (WAR) strain and its contributions to epileptology and related comorbidities: History and perspectives. Epilepsy Behav 2017; 71:250-273. [PMID: 28506440 DOI: 10.1016/j.yebeh.2017.04.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In the context of modeling epilepsy and neuropsychiatric comorbidities, we review the Wistar Audiogenic Rat (WAR), first introduced to the neuroscience international community more than 25years ago. The WAR strain is a genetically selected reflex model susceptible to audiogenic seizures (AS), acutely mimicking brainstem-dependent tonic-clonic seizures and chronically (by audiogenic kindling), temporal lobe epilepsy (TLE). Seminal neuroethological, electrophysiological, cellular, and molecular protocols support the WAR strain as a suitable and reliable animal model to study the complexity and emergent functions typical of epileptogenic networks. Furthermore, since epilepsy comorbidities have emerged as a hot topic in epilepsy research, we discuss the use of WARs in fields such as neuropsychiatry, memory and learning, neuroplasticity, neuroendocrinology, and cardio-respiratory autonomic regulation. Last, but not least, we propose that this strain be used in "omics" studies, as well as with the most advanced molecular and computational modeling techniques. Collectively, pioneering and recent findings reinforce the complexity associated with WAR alterations, consequent to the combination of their genetically-dependent background and seizure profile. To add to previous studies, we are currently developing more powerful behavioral, EEG, and molecular methods, combined with computational neuroscience/network modeling tools, to further increase the WAR strain's contributions to contemporary neuroscience in addition to increasing knowledge in a wide array of neuropsychiatric and other comorbidities, given shared neural networks. During the many years that the WAR strain has been studied, a constantly expanding network of multidisciplinary collaborators has generated a growing research and knowledge network. Our current and major wish is to make the WARs available internationally to share our knowledge and to facilitate the planning and execution of multi-institutional projects, eagerly needed to contribute to paradigm shifts in epileptology. This article is part of a Special Issue entitled "Genetic and Reflex Epilepsies, Audiogenic Seizures and Strains: From Experimental Models to the Clinic".
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Affiliation(s)
- Norberto Garcia-Cairasco
- Physiology Department, Ribeirão Preto School of Medicine, University of São Paulo, Brazil; Neuroscience and Behavioral Sciences Department, Ribeirão Preto School of Medicine, University of São Paulo, Brazil.
| | - Eduardo H L Umeoka
- Physiology Department, Ribeirão Preto School of Medicine, University of São Paulo, Brazil; Neuroscience and Behavioral Sciences Department, Ribeirão Preto School of Medicine, University of São Paulo, Brazil
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Marry Mhlari R, Sodi T. Understanding and management of epilepsy in a rural community in South Africa: An exploratory study. JOURNAL OF PSYCHOLOGY IN AFRICA 2017. [DOI: 10.1080/14330237.2016.1268296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Tholene Sodi
- Department of Psychology, University of Limpopo, South Africa
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Abstract
Anxiety disorders are frequent, though probably underdiagnosed, comorbidities in epilepsy. Epilepsy and anxiety may share common neurobiological correlates as shown in animal models and suggested by studies demonstrating anxiety disorders before the manifestation of epilepsy. Comorbid anxiety disorders have a major impact on the affected patients' quality of life and may increase the risk for suicidality. Successful treatment of the epilepsy may alleviate anxiety symptoms. Treatment of anxiety is based on selective serotonin reuptake inhibitors, benzodiazepines (although only as second-line choices), and psychotherapy. Specific AEDs (especially pregabalin) have been shown to have anxiolytic properties. This paper is aimed at reviewing anxiety disorders in patients with epilepsy discussing current scientific evidence about pathophysiology, clinical aspects, and treatment strategies.
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Affiliation(s)
- Christian Brandt
- Department of General Epileptology, Bethel Epilepsy Centre, Mara Hospital, Maraweg 21, D-33617 Bielefeld, Germany.
| | - Marco Mula
- Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals NHS Foundation Trust, London, UK; Institute of Medical and Biomedical Sciences, St George's University of London, London, UK.
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Micoulaud-Franchi JA, Lagarde S, Barkate G, Dufournet B, Besancon C, Trébuchon-Da Fonseca A, Gavaret M, Bartolomei F, Bonini F, McGonigal A. Rapid detection of generalized anxiety disorder and major depression in epilepsy: Validation of the GAD-7 as a complementary tool to the NDDI-E in a French sample. Epilepsy Behav 2016; 57:211-216. [PMID: 26994447 DOI: 10.1016/j.yebeh.2016.02.015] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/09/2016] [Accepted: 02/10/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Generalized anxiety disorder (GAD) in people with epilepsy (PWE) is underdiagnosed and undertreated. The GAD-7 is a screening questionnaire to detect GAD. However, the usefulness of the GAD-7 as a screening tool in PWE remains to be validated. Thus, we aimed to: (1) validate the GAD-7 in French PWE and (2) assess its complementarity with regard to the previously validated screening tool for depression, the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). METHODS This study was performed under the auspices of the ILAE Commission on Neuropsychiatry. People with epilepsy >18 years of age were recruited from the specialist epilepsy unit in Marseille, France. The Mini-International Neuropsychiatric Interview (MINI) was performed as gold standard, and the Penn State Worry Questionnaire (PSWQ) and the NDDI-E were performed for external validity. Data were compared between PWE with/without GAD using Chi(2) test and Student's t-test. Internal structural validity, external validity, and receiver operator characteristics were analyzed. A principal component factor analysis with Varimax rotation was performed on the 13 items of the GAD-7 (7 items) plus the NDDI-E (6 items). RESULTS Testing was performed on 145 PWE: mean age = 39.38 years old (SD=14.01, range: 18-75); 63.4% (92) women; 75.9% with focal epilepsy. Using the MINI, 49 (33.8%) patients had current GAD. Cronbach's alpha coefficient was 0.898, indicating satisfactory internal consistency. Correlation between GAD-7 and the PSQW scores was high (r (145)=.549, P<.0001), indicating good external validity. Factor analysis shows that the anxiety investigated with the GAD-7 and depression investigated with the NDDI-E reflect distinct factors. Receiver operator characteristic analysis showed area under the curve of 0.899 (95% CI 0.838-0.943, P < 0.0001) indicating good capacity of the GAD-7 to detect GAD (defined by MINI). Cutoff for maximal sensitivity and specificity was 7. Mean GAD-7 score in PWE with GAD was 13.22 (SD = 3.99), and that without GAD was 5.17 (SD = 4.66). SIGNIFICANCE This study validates the French language version of the GAD-7 screening tool for generalized anxiety in PWE, with a cutoff score of 7/21 for GAD, and also confirms that the GAD-7 is a short and easily administered test. Factor analysis shows that the GAD-7 (screening for generalized anxiety disorder) and the NDDI-E (screening for major depression) provide complementary information. The routine use of both GAD-7 and NDDI-E should be considered in clinical evaluation of patients with epilepsy.
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Affiliation(s)
- Jean-Arthur Micoulaud-Franchi
- Services d'explorations fonctionnelles du système nerveux, Clinique du sommeil, CHU de Bordeaux, Place Amélie Raba-Leon, 33076 Bordeaux, France; USR CNRS 3413 SANPSY, CHU Pellegrin, Université de Bordeaux, France
| | - Stanislas Lagarde
- Service de Neurophysiologie Clinique, APHM, Hôpital de la Timone, 13005 Marseille, France
| | - Gérald Barkate
- Hôpital Henri Gastaut, Etablissement Hospitalier Spécialisé dans le traitement des Epilepsies, 300 Boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Boris Dufournet
- Service de Neurophysiologie Clinique, APHM, Hôpital de la Timone, 13005 Marseille, France
| | - Cyril Besancon
- Hôpital Henri Gastaut, Etablissement Hospitalier Spécialisé dans le traitement des Epilepsies, 300 Boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Agnès Trébuchon-Da Fonseca
- Service de Neurophysiologie Clinique, APHM, Hôpital de la Timone, 13005 Marseille, France; INSERM UMR 1106, INS, 27 Bd Jean Moulin, 13385 Marseille, France; Aix Marseille Université, Faculté de Médecine, Marseille, France
| | - Martine Gavaret
- Service de Neurophysiologie Clinique, APHM, Hôpital de la Timone, 13005 Marseille, France; INSERM UMR 1106, INS, 27 Bd Jean Moulin, 13385 Marseille, France; Aix Marseille Université, Faculté de Médecine, Marseille, France
| | - Fabrice Bartolomei
- Service de Neurophysiologie Clinique, APHM, Hôpital de la Timone, 13005 Marseille, France; INSERM UMR 1106, INS, 27 Bd Jean Moulin, 13385 Marseille, France; Aix Marseille Université, Faculté de Médecine, Marseille, France; Hôpital Henri Gastaut, Etablissement Hospitalier Spécialisé dans le traitement des Epilepsies, 300 Boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Francesca Bonini
- Service de Neurophysiologie Clinique, APHM, Hôpital de la Timone, 13005 Marseille, France; INSERM UMR 1106, INS, 27 Bd Jean Moulin, 13385 Marseille, France; Aix Marseille Université, Faculté de Médecine, Marseille, France
| | - Aileen McGonigal
- Service de Neurophysiologie Clinique, APHM, Hôpital de la Timone, 13005 Marseille, France; INSERM UMR 1106, INS, 27 Bd Jean Moulin, 13385 Marseille, France; Aix Marseille Université, Faculté de Médecine, Marseille, France.
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Tong X, An D, McGonigal A, Park SP, Zhou D. Validation of the Generalized Anxiety Disorder-7 (GAD-7) among Chinese people with epilepsy. Epilepsy Res 2015; 120:31-6. [PMID: 26709880 DOI: 10.1016/j.eplepsyres.2015.11.019] [Citation(s) in RCA: 272] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/25/2015] [Accepted: 11/24/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To validate the Chinese version of the Generalized Anxiety Disorder-7 (GAD-7) in Chinese people with epilepsy (PWE). METHODS A consecutive cohort of PWE from the West China Hospital was recruited. Each patient received a psychiatric evaluation comprising the Mini International Neuropsychiatric Interview (MINI) and the GAD-7. Demographic and clinical characteristics were collected. Cronbach's α coefficient was calculated and receiver operating curve (ROC) analysis was conducted. RESULTS A total of 213 PWE completed the psychiatric evaluation. The GAD-7 was easily understood and quickly completed by all participants. Fifty patients (23.5%) had GAD according to the MINI criteria. Cronbach's α coefficient for the GAD-7 was 0.888. ROC analysis showed an area under the curve of 0.974 (95% CI=0.956-0.993). At a cut-off score of >6, the GAD-7 achieved the largest Youden index of 0.854 with a sensitivity of 94%, a specificity of 91.4%, a positive predictive value of 77% and a negative predictive value of 98%. SIGNIFICANCE The Chinese version of the GAD-7 is a valuable tool for screening for GAD in Chinese PWE.
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Affiliation(s)
- Xin Tong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Dongmei An
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
| | - Aileen McGonigal
- Aix Marseille Université, Inserm, INS UMR_S 1106, CHU Timone, Service de Neurophysiologie Clinique, Assistance Publique des Hôpitaux de Marseille, Marseille 13005, France
| | - Sung-Pa Park
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
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Kalyva E, Melonashi E. Parental Perceptions of Health-Related Quality of Life of Albanian Children with Epilepsy. Health Psychol Res 2015; 3:2244. [PMID: 26973964 PMCID: PMC4768536 DOI: 10.4081/hpr.2015.2244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 11/23/2022] Open
Abstract
Epilepsy adversely affects the health-related quality of life (HRQoL) of children living with it. Even though almost 80% of children with epilepsy live in developing countries very little research has been conducted with the specific population. The present study took place in Albania and aimed to investigate parental perceptions of the HRQoL of their children with epilepsy. Considering the well-defined gender roles in the Albanian traditional family it was expected that mothers and fathers reports of their children's HRQoL would differ. Results showed no differences in maternal and paternal reports; instead there was a moderate correspondence between the reports across all dimensions. Parents also reported the highest scores of HRQoL in the interpersonal dimension and the lowest scores in the intrapersonal dimension. The findings have implications in the context of future research and also medical care for children with epilepsy in Albania.
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Affiliation(s)
- Efrosini Kalyva
- City College, International Faculty of the University of Sheffield, Thessaloniki, Greece
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Multimorbidity and Patient Safety Incidents in Primary Care: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0135947. [PMID: 26317435 PMCID: PMC4552710 DOI: 10.1371/journal.pone.0135947] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 07/29/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Multimorbidity is increasingly prevalent and represents a major challenge in primary care. Patients with multimorbidity are potentially more likely to experience safety incidents due to the complexity of their needs and frequency of their interactions with health services. However, rigorous syntheses of the link between patient safety incidents and multimorbidity are not available. This review examined the relationship between multimorbidity and patient safety incidents in primary care. METHODS We followed our published protocol (PROSPERO registration number: CRD42014007434). Medline, Embase and CINAHL were searched up to May 2015. Study design and quality were assessed. Odds ratios (OR) and 95% confidence intervals (95% CIs) were calculated for the associations between multimorbidity and two categories of patient safety outcomes: 'active patient safety incidents' (such as adverse drug events and medical complications) and 'precursors of safety incidents' (such as prescription errors, medication non-adherence, poor quality of care and diagnostic errors). Meta-analyses using random effects models were undertaken. RESULTS Eighty six relevant comparisons from 75 studies were included in the analysis. Meta-analysis demonstrated that physical-mental multimorbidity was associated with an increased risk for 'active patient safety incidents' (OR = 2.39, 95% CI = 1.40 to 3.38) and 'precursors of safety incidents' (OR = 1.69, 95% CI = 1.36 to 2.03). Physical multimorbidity was associated with an increased risk for active safety incidents (OR = 1.63, 95% CI = 1.45 to 1.80) but was not associated with precursors of safety incidents (OR = 1.02, 95% CI = 0.90 to 1.13). Statistical heterogeneity was high and the methodological quality of the studies was generally low. CONCLUSIONS The association between multimorbidity and patient safety is complex, and varies by type of multimorbidity and type of safety incident. Our analyses suggest that multimorbidity involving mental health may be a key driver of safety incidents, which has important implication for the design and targeting of interventions to improve safety. High quality studies examining the mechanisms of patient safety incidents in patients with multimorbidity are needed, with the goal of promoting effective service delivery and ameliorating threats to safety in this group of patients.
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Gender differences in depression, but not in anxiety in people with epilepsy. Seizure 2015; 32:37-42. [PMID: 26552559 DOI: 10.1016/j.seizure.2015.07.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 07/14/2015] [Accepted: 07/17/2015] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Anxiety and depression are frequent comorbidities in people with epilepsy (PWE), but possible gender differences are often neglected. The aim of the present study was to analyze if men and women with epilepsy differ with regard to anxiety and depressive symptoms and to identify possible predictors. METHODS Adult consecutive PWE (N=302; 53% women) completed self-report questionnaires, including the depression module of the Patient Health Questionnaire (PHQ-9), the anxiety module of the Hospital Anxiety and Depression Scale (HADS-A) and the subscales "medication effects" and "seizure worry" of the Patient-weighted Quality of Life in Epilepsy Inventory-31-P (QOLIE-31-P). RESULTS There was no gender difference in extent of anxiety (p=.532), which was mainly due to higher anxiety levels in men compared to the general population. The gender difference in depressive symptoms was significant (p=.009), with female patients being more affected. The most important predictors for anxiety and depressive symptoms were detrimental effects of medication (QOL medication effects) and of seizure worry (QOL seizure worry). Moreover, these predictors were more closely associated with anxiety and depressive symptoms in men. CONCLUSION Future intervention studies could show whether providing more information about the illness and medication effects may improve anxiety and depression. Our results suggest that such interventions should be tailored to the different needs of men and women.
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Jacoby A, Snape D, Lane S, Baker GA. Self-reported anxiety and sleep problems in people with epilepsy and their association with quality of life. Epilepsy Behav 2015; 43:149-58. [PMID: 25599986 DOI: 10.1016/j.yebeh.2014.09.071] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 09/25/2014] [Accepted: 09/26/2014] [Indexed: 11/28/2022]
Abstract
Comorbidities are common in epilepsy, and their role in quality of life (QOL) is receiving increasing scrutiny. Considerable attention has been focused on the role of depression, the most common comorbidity, with rather less attention paid to its frequent concomitant, anxiety, and other conditions known to be at increased prevalence among people with epilepsy (PWE) when compared to the general population. In this paper, we report findings from a UK-based survey in which we examined self-reporting of two common comorbidities, anxiety and sleep problems, factors associated with them, and their role in QOL in people with and without epilepsy. Data were obtained via mailed questionnaires, supplemented by an internet survey, from PWE and age- and gender-matched controls. Based on self-reported symptoms, PWE were at higher risk of anxiety and sleep problems. Contributory factors for anxiety included poorer general health, worry about seizures, and self-reported antiepileptic drug (AED) side effects. Good social support emerged as protective for anxiety in PWE. Nighttime sleep problems were very common even in controls but were further elevated in PWE. Antiepileptic drug adverse events emerged as an important contributory factor for sleep problems. Trait anxiety emerged as significant for defining overall QOL, and its importance over state anxiety supports the notion of anxiety in PWE as a primarily premorbid condition. In contrast, sleep quality was not consistently predictive of QOL. Our study has important implications for clinical management, emphasizing the need for a holistic approach to address wider patient-reported problems as well as any epilepsy-specific ones.
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Affiliation(s)
- Ann Jacoby
- Department of Public Health and Policy, University of Liverpool, UK.
| | - Dee Snape
- Department of Public Health and Policy, University of Liverpool, UK
| | - Steven Lane
- Department of Biostatistics, University of Liverpool, UK
| | - Gus A Baker
- Department of Molecular and Clinical Pharmacology, University of Liverpool, UK
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Han SH, Kim B, Lee SA. Contribution of the family environment to depression in Korean adults with epilepsy. Seizure 2015; 25:26-31. [DOI: 10.1016/j.seizure.2014.11.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 10/29/2014] [Accepted: 11/28/2014] [Indexed: 10/24/2022] Open
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Epilepsy and physical exercise. Seizure 2015; 25:87-94. [DOI: 10.1016/j.seizure.2014.09.015] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 09/24/2014] [Accepted: 09/26/2014] [Indexed: 11/22/2022] Open
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Cognitive and Psychosocial Effects of Oxcarbazepine Monotherapy in Newly Diagnosed Partial Epilepsy. Clin Neuropharmacol 2014; 37:100-7. [DOI: 10.1097/wnf.0000000000000038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Verrotti A, Carrozzino D, Milioni M, Minna M, Fulcheri M. Epilepsy and its main psychiatric comorbidities in adults and children. J Neurol Sci 2014; 343:23-9. [PMID: 24929650 DOI: 10.1016/j.jns.2014.05.043] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/08/2014] [Accepted: 05/19/2014] [Indexed: 12/11/2022]
Abstract
Psychiatric disorders seem to be more frequent in patients with epilepsy (PWE) than the general population. Although researchers have documented a strong association between epilepsy and psychiatric comorbidities, the nature of this relationship is poorly understood. According to this, psychiatric diseases are often underdiagnosed and undertreated in PWE with further decrease of the quality of life of patients. The aim of the review was to examine the most frequent psychiatric comorbidities in adults with epilepsy (AWE) and the main psychiatric comorbidities in children with epilepsy (CWE) in order to better understand the relationship between epilepsy and the development of psychiatric disorders.
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Affiliation(s)
- Alberto Verrotti
- Department of Pediatrics, University of Perugia, Piazza Università 1, Perugia 06123, Italy.
| | - Danilo Carrozzino
- Department of Clinical and Experimental Sciences, School of Advanced Studies, "G. D'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, Chieti 66013, Italy
| | - Maddalena Milioni
- Department of Pediatrics, University of Perugia, Piazza Università 1, Perugia 06123, Italy
| | - Maria Minna
- Department of Clinical and Experimental Sciences, School of Advanced Studies, "G. D'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, Chieti 66013, Italy
| | - Mario Fulcheri
- Department of Psychological, Humanistic and Territorial Sciences, University "G. D'Annunzio" of Chieti-Pescara, Via dei Vestini 31, Chieti 66013, Italy
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Seo JG, Cho YW, Lee SJ, Lee JJ, Kim JE, Moon HJ, Park SP. Validation of the generalized anxiety disorder-7 in people with epilepsy: a MEPSY study. Epilepsy Behav 2014; 35:59-63. [PMID: 24798411 DOI: 10.1016/j.yebeh.2014.04.005] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/05/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
Abstract
The Generalized Anxiety Disorder-7 (GAD-7) is a valuable instrument to screen for anxiety in primary care patients. However, it has not been validated in people with epilepsy (PWE). Therefore, we validated the GAD-7 and examined its differential effect from adverse effects of antiepileptic drugs (AEDs) on the detection of anxiety in Korean PWE. Eligible patients who visited outpatient clinics in 4 tertiary care hospitals and 1 secondary care hospital underwent several instruments including the Mini International Neuropsychiatric Interview-Plus Version 5.0.0 (MINI-Plus 5.0.0), the Korean version of the Neurological Disorders Depression Inventory for Epilepsy (K-NDDI-E), the Korean version of the Liverpool Adverse Event Profile (K-LAEP), and the Quality of Life in Epilepsy-10 (QOLIE-10). Two hundred forty-three patients were enrolled in the study, and 51 (21.0%) patients had GAD by the MINI-Plus 5.0.0. Cronbach's α coefficient for the GAD-7 was 0.924. At a cutoff score of 6, the GAD-7 had a sensitivity of 92.2%, a specificity of 89.1%, a positive predictive value of 69.1%, and a negative predictive value of 97.7%. The GAD-7 score was well correlated with the K-NDDI-E score, the K-LAEP score, and the QOLIE-10 overall and subscale scores. The impact of adverse effects of AEDs on the GAD-7 was less than that on the K-NDDI-E. In conclusion, the GAD-7 is a reliable and valid screening tool for detecting GAD in PWE.
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Affiliation(s)
- Jong-Geun Seo
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yong Won Cho
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Se-Jin Lee
- Department of Neurology, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Jang-Joon Lee
- Department of Neurology, Daegu Fatima Hospital, Republic of Korea
| | - Ji-Eun Kim
- Department of Neurology, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Hye-Jin Moon
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Sung-Pa Park
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
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Prevalence and quality of anxiety in patients with epilepsy. Epilepsy Behav 2014; 32:34-7. [PMID: 24463307 DOI: 10.1016/j.yebeh.2013.12.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/16/2013] [Accepted: 12/25/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depression and anxiety are the most frequent psychiatric disorders identified in patients with epilepsy. We aimed to determine the prevalence of state and trait anxiety in patients with epilepsy compared with people without epilepsy. METHODS We recruited patients and healthy controls in the outpatient neurology clinic of Kurdistan University of Medical Sciences, Iran, during 2011. Eighty-four patients with epilepsy and 168 healthy persons from relatives of the patients in the case group were recruited and filled out the inventory. The State-Trait Anxiety Inventory (STAI) was used to measure anxiety. After selection of participants and neurological evaluation, all subjects were clinically interviewed at the outpatient clinic of neurology. Data were analyzed using SPSS software, version 16. Fisher's exact and chi-square tests were used for nominal variables, and the t-test was used for anxiety scores. RESULTS The average ages of the patients in the case and control groups were 28 and 27.5 years, respectively. State anxiety was significantly higher in patients with epilepsy than in the control group (p=0.042). Also, a higher trait anxiety score was reported in the case group compared with the control group (p=0.009). CONCLUSION The rates of both state and trait anxiety were higher in patients in the case group. It appears that anxiety in epilepsy is not just a reaction to a stressful situation, and there may be genetic or temperamental factors that contribute to the relationship between epilepsy and anxiety.
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Depressive syndromes in neurological disorders. Eur Arch Psychiatry Clin Neurosci 2013; 263 Suppl 2:S123-36. [PMID: 24077889 DOI: 10.1007/s00406-013-0448-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 09/16/2013] [Indexed: 12/18/2022]
Abstract
Depressive syndromes represent a common and often characteristic feature in a number of neurological disorders. One prominent example is the development of post-stroke depression, which can be observed in more than one-third of stroke survivors in the aftermath of an ischemic stroke. Thus, post-stroke depression represents one of the most prevalent, disabling, and potentially devastating psychiatric post-stroke complications. On the other hand, depressive syndromes may also be considered as a risk factor for certain neurological disorders, as recently revealed by a meta-analysis of prospective cohort studies, which demonstrated an increased risk for ischemic events in depressed patients. Moreover, depressive syndromes represent common comorbidities in a number of other neurological disorders such as Parkinson's disease, multiple sclerosis, or epilepsy, in which depression has a strong impact on both quality of life and outcome of the primary neurological disorder.
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Abstract
This study investigated (1) the incidence of posttraumatic stress disorder following epileptic seizure (post-epileptic seizure PTSD) and psychiatric co-morbidity and (2) the extent to which alexithymia traits related to the severity of the preceding outcomes. Seventy-one people with epilepsy participated in the study and completed the Posttraumatic Stress Diagnostic Scale, Hospital Anxiety and Depression Scale (HADS), and Toronto Alexithymia Scale. The control group comprised 71 people without epilepsy who completed the HADS. Fifty-one percent met the diagnostic criteria for full-PTSD; 30 % for partial-PTSD and 19 % for no-PTSD. The epilepsy group reported significantly more anxiety and depression than the control with demographic variables controlled for. Difficulty identifying feelings predicted post-epileptic seizure PTSD, anxiety and depression. It was positively correlated with post-epileptic seizure PTSD and depression, while it was negatively correlated with anxiety. People can develop PTSD and psychiatric co-morbid symptoms following epileptic seizures. The severity of these symptoms was related to difficulty in identifying internal feelings and emotions.
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Affiliation(s)
- Man Cheung Chung
- Natural Science and Public Health, Zayed University, PO Box 144534, Abu Dhabi, UAE.
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Abdalla IG, Scorza CA, Cavalheiro EA, de Albuquerque M, de Almeida ACG, Scorza FA. Attitudes of Brazilian epileptologists to discussion about SUDEP with their patients: truth may hurt, but does deceit hurt more? Epilepsy Behav 2013; 27:470-1. [PMID: 23618616 DOI: 10.1016/j.yebeh.2013.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 03/16/2013] [Indexed: 01/12/2023]
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