Psychiatric Comorbidities of epilepsy

1. Psychiatric comorbidities of epilepsy موسی عطارزاده

2. 1. depression: • -10% to 20% among patients with controlled seizures • - 20% to 60% among those with refractory epilepsy

3. Bidirectional relationship: • The relationship between seizures and depression is bidirectional, in that the presence of one predicts the other. • Those with depression have a 1.7- to 6-fold higher risk of developing seizures than controls.

4. Prediction of quality of life: • Depression is a better predictor of quality of life in patients with epilepsy than are verbal memory, psychomotor function, cognitive processing speed, mental flexibility, seizure frequency, and seizure severity

5. Negative effects: • Depression has a negative effect and is associated with more disability, greater social difficulties, more drug side effects, lower employment rates, cognitive dysfunction and subjective memory complaints, and greater use of the medical system.

6. Response to treatment: • Those with psychiatric disease are less likely to attain seizure freedom with antiepileptic drugs (AEDs) or anterior temporal lobectomy.

7. Risk factors for depression: • Potential risk factors for depression in patients with epilepsy include frequent seizures (>1 per month), symptomatic focal epilepsy, younger age, psychosocial difficulties with learned helplessness, and polypharmacy.

8. IGE and depression: • Depression ratings negatively correlate with the presence of idiopathic generalized epilepsy (IGE) as opposed to other types of seizures!

9. MTS and depression: • Mesial temporal sclerosis (MTS) is a better predictor of the presence of depression compared to other forms of temporal lobe epilepsy.

10. Female predominance? • Unlike idiopathic depression, female predominance is not a consistent finding.

11. Presentation of depression in epilepsy • 25% to 71%: Atypical presentations • - intermittent irritability • - depressed or euphoric moods • - anergia • - insomnia • - atypical pains • - anxiety, and fears. • Episodes begin and end abruptly

12. Duration and frequency of episodes: • Episodes begin and end abruptly. They may recur every few days to every few months and last from a few hours up to 2 days or more.

13. subictal dysphoric disorder • When limbic lesion is associated with episodic dysphoria like described previously but no seizure.

14. A continuum: • Depression in epilepsy may represent a continuum, perhaps with persistent depressive disorder, intermittent episodes of IDD, and occasional worsening of symptoms meeting criteria for MDD.

15. Lobectomy and depression: • Many patients experience an increase in dysphoria over the 12 to 18 months following temporal lobectomy, after which symptoms resolve.

16. Ictal depression: • Ictal depression may manifest as a simple partial seizure (SPS) in which depression is the sole symptom or as an aura leading to a complex partial seizure (CPS). Psychiatric symptoms occur in 25% of auras, 15% of which involve affective changes.

17. Ictal depression is the second most common, after ictal anxiety or fear, and consists of anhedonia, guilt, and SI. In dacrystic seizures, auras consist of unprovoked and inappropriate crying.

18. The mood alterations with ictal depression are stereotypical and occur out of context. Postictal depression has long been recognized, but its frequency is unknown. In one series, postictal depression was evident in 43% of patients with partial seizures. Postictal symptoms often persist for hours to several days and may be severe, including SI