Psychiatric Manifestations Of Epilepsy Flashcards
What is proportion of people with epilepsy have a lifetime history of psychiatric disorder?
1 in 3
What are the most common psychiatric disorders found in PWE?
Depression
Mood disorders
Psychiatric disorders
Personality disorders
What is the prevalence of ADHD comorbidity with epilepsy? (Wang et al 2023)
ADHD in epilepsy 22.3%
Epilepsy in ADHD 3.4%
(Epilepsy in general population is 0.5-1%)
What were the rates of suicide-related experiences in Wang et al 2023?
Suicidal ideation 19.3% (OR 2.7)
Suicide attempts 5.96% (OR 2.74)
Completed suicide 0.24% (OR 2.36)
What is the rate of major depression in people with epilepsy?
17.4% (10.7% in general population)
What is the rate of mood disorder in people with epilepsy?
34.2% (19.6% in general population)
What psychiatric conditions are predisposing factors for epilepsy?
ADHD
Depression
Suicidality
Psychosis
Schizophrenia
What are the overlapping risks of epilepsy and schizophrenia?
Risk of developing schizophrenia in epilepsy - 7x
Risks of developing epilepsy in primary schizophrenia - 6x
What are the most frequently diagnosed disorders in adults with epilepsy?
Mental retardation
Bipolar disorder
Alcohol or drug psychosis
What positive effects might ASMs have on neuropsychiatric disorders?
Mood stabilising (valproate, carbamazepine, lamotrigine)
Antidepressant (lamotrigine)
Anxiolytic (pregabalin, gabapentin)
Withdrawal may lead to reemergence of symptoms
What are associated with increased risk of psychiatric disorders in epilepsy?
Generalised seizures
High seizure frequency
High number of A&E/outoatient visits
Hospitalisation
Older age
What ASMs might cause adverse psychiatric effects?
Barbiturates
Topiramate
Levetiracetam
Benzodiazepines
Vigabatrin
Zonisamide
What kind of surgery is most associated with worsening anxiety and depression in PWE?
Temporal lobe resection
How does depression affect post-surgery prognosis?
Reduces chance of becoming seizure free in two years after surgery
What is the NDDI-E used for?
To screen for depression in people with epilepsy
Which sub groups of PWE are more susceptible to depression?
Temporal lobe epilepsy
Drug refractory epilepsy
Neurological comorbidity
Female patients
Which ASMs are associated with depression?
Levetiracetam (Keppra)
What are the implications of using TCAs in PWE?
May have a pro convulsant effect
High plasma levels are associated with increased seizure risk but not at therapeutic levels or below
What particular antidepressant is associated with increased seizure risk?
Clomipramine
What non drug avenues may be used for depression in epilepsy
Psychotherapy
Online self treatment
How do sertraline and CBT compare for MDD in epilepsy?
After 16 weeks
53% reduction with sertraline
60% reduction with CBT
What are ILAE clinical guidelines for depression in epilepsy?
Supportive psychotherapy for new diagnoses
SSRIs as first line
Expedite treatment for sll
What effect may SSRIs have on seizures
Protective possibly
535 vs 1502 per 100k in placebo
How long after recovery from depression should antidepressants be used?
6 months after first episode
2 years after subsequent episodes
