The purpose of this study was to determine the prevalence of psychiatric disorders in Dutch patients with epilepsy in comparison with epidemiological data on a representative sample of the Dutch population. The Composite International Diagnostic Interview (CIDI) was used to determine the prevalence of psychiatric disorders in 209 epilepsy patients and compared with findings in the general Dutch population. The prevalence in temporal lobe epilepsy (TLE) and extra-temporal lobe epilepsy (extra-TLE) was also compared. Psychiatric disorders most frequently found in patients with epilepsy were anxiety and mood disorders. The last-year prevalence of these disorders was 25% for anxiety disorders and 19% for mood disorders. Compared with the general Dutch population, the prevalence of these disorders was significantly higher in epilepsy. No differences were found between patients with TLE and extra-TLE. It can be concluded that patients with epilepsy admitted to a tertiary epilepsy center suffer more often from mood and anxiety disorders than the general population.
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"Furthermore, in the large epidemiological study by Qin et al., patients with localization related epilepsy were only slightly over-represented among those who were psychotic and this difference fell short of statistical significance . Several studies have failed to confirm the commonly held view that there is a specific association between temporal lobe epilepsy and psychopathology which is in contrast to commonly accepted clinical practice [51-53]. "
[Show abstract][Hide abstract]ABSTRACT: Epilepsy has long been considered to be a risk factor for psychosis. However there is a lack of consistency in findings across studies on the effect size of this risk which reflects methodological differences in studies and changing diagnostic classifications within neurology and psychiatry. The aim of this study was to assess the prevalence of psychosis in epilepsy and to estimate the risk of psychosis among individuals with epilepsy compared with controls.
A systematic review and meta-analysis was conducted of all published literature pertaining to prevalence rates of psychosis in epilepsy using electronic databases PUBMED, OVIDMEDLINE, PsychINFO and Embase from their inception until September 2010 with the following search terms: prevalence, incidence, rate, rates, psychosis, schizophrenia, schizophreniform illness, epilepsy, seizures, temporal lobe epilepsy.
The literature search and search of reference lists yielded 215 papers. Of these, 58 (27%) had data relevant to the review and 157 were excluded following a more detailed assessment. 10% of the included studies were population based studies. The pooled odds ratio for risk of psychosis among people with epilepsy compared with controls was 7.8. The pooled estimate of prevalence of psychosis in epilepsy was found to be 5.6% (95% CI: 4.8-6.4). There was a high level of heterogeneity. The prevalence of psychosis in temporal lobe epilepsy was 7% (95% CI: 4.9-9.1). The prevalence of interictal psychosis in epilepsy was 5.2% (95% CI: 3.3-7.2). The prevalence of postictal psychosis in epilepsy was 2% (95% CI: 1.2-2.8).
Our systematic review found that up to 6% of individuals with epilepsy have a co-morbid psychotic illness and that patients have an almost eight fold increased risk of psychosis. The prevalence rate of psychosis is higher in temporal lobe epilepsy (7%). We suggest that further investigation of this association could give clues to the aetiology of psychosis.
"Epilepsy not only is a neurological disorder and a disorder of consciousness, but also it is associated with a wide range of psychological disorders. Some of them are cognitive, personality and mood disorders (4), and no doubt, depression is the most common psychiatric disorder in patients with epilepsy (5-8). Different mechanisms have been found for depression in epilepsy, and the following problems can cause depression: "
[Show abstract][Hide abstract]ABSTRACT: Background: Depression disorder is the most prevalent neuropsychiatric disorder associated with epilepsy, and a correlation has been
detected between depression and suicide. There is a relationship between suicidal behavior and coping mechanisms; therefore, it is important
to undertake psychoanalytic psychotherapy to reduce depressive symptoms. Objectives: To evaluate the Coping Mechanisms, Depression and Suicidal Risk among Patients Suffering from Idiopathic Epilepsy. Materials and Methods: The present study is a cross-sectional pilot study in which 93 Iranian patients with idiopathic epilepsy were selected
from Qaem hospital and neurological clinics. They answered three questionnaires: BDI, SSI, and a questionnaire of coping mechanisms.
Patients were then interviewed and divided into two groups: patients with depression and suicidal ideation, and patients without depression
and suicidal ideation. The two groups were compared in terms of coping mechanisms. Results: Among the patients who filled the questionnaires, only 74 were selected for the interview. 58.9% of the patients did not have depression
or suicidal ideation and 23.3% of them had either depression or suicidal ideation. Findings of the study showed that the two groups had a
significant difference in terms of repressive coping method efficiency (P = 0.022). However, there was no significant difference between the
two groups in terms of problem-focused coping method (P = 0.25) and the emotion-focused coping method efficacy (P = 0.31). Conclusions: Iranian patients with idiopathic epilepsy and with either depression or suicidal ideation, make significant improvement using
repressive coping method in comparison to patients with idiopathic epilepsy who did not suffer from depression or suicidal ideation. The
effect of other coping mechanisms was not significantly different between the two groups.
Keywords: Suicide; Epilepsy; Depression; Coping Skills
"Numerous studies have reported an increased rate of psychiatric disturbances in patients with TLE, compared with patients with other types of epilepsy [113,114]. Other studies, however, failed to document such an association between TLE and psychiatric symptoms [115,116]. Given the increased emphasis on biopsychosocial models, future studies will need to examine relationships between multiple factors putatively contributing to a kindling effect. "
[Show abstract][Hide abstract]ABSTRACT: It is now broadly accepted that psychological stress may change the internal homeostatic state of an individual. During acute stress, adaptive physiological responses occur, which include hyperactivity of the HPA axis. Whenever there is an acute interruption of this balance, illness may result. The social and physical environments have an enormous impact on our physiology and behavior, and they influence the process of adaptation or 'allostasis'. It is correct to state that at the same time that our experiences change our brain and thoughts, namely, changing our mind, we are changing our neurobiology. Increased adrenocortical secretion of hormones, primarily cortisol in major depression, is one of the most consistent findings in neuropsychiatry. A significant percentage of patients with major depression have been shown to exhibit increased concentrations of cortisol, an exaggerated cortisol response to adrenocorticotropic hormone, and an enlargement of both the pituitary and adrenal glands. The maintenance of the internal homeostatic state of an individual is proposed to be based on the ability of circulating glucocorticoids to exert negative feedback on the secretion of hypothalamic-pituitary-adrenal (HPA) hormones through binding to mineralocorticoid (MR) and glucocorticoid (GR) receptors limiting the vulnerability to diseases related to psychological stress in genetically predisposed individuals. The HPA axis response to stress can be thought of as a mirror of the organism's response to stress: acute responses are generally adaptive, but excessive or prolonged responses can lead to deleterious effects. Evidence indicates that early-life stress can induce persistent changes in the ability of the HPA axis to respond to stress in adulthood. These abnormalities appear to be related to changes in the ability of hormones to bind to GR and MR receptors. First episodes may begin with an environmental stressor, but if the cycles continue or occur unchecked, the brain becomes kindled or sensitized, and future episodes of depression, hypomania, or mania will occur independently of an outside stimulus, with greater frequency and intensity. Generally, HPA axis changes appear in chronic depressive and more severe episodes. Moreover, HPA axis changes appear to be state-dependent, tending to improve upon resolution of the depressive syndrome. Interestingly, persistent HPA dysfunction has been associated with higher rates of relapse and chronicity. This article is part of a Special Issue entitled NEWroscience 2013.
Full-text · Article · Nov 2013 · Epilepsy & Behavior