Gender and psychiatric disorders in children with epilepsy. A meta-analysis.

OBJECTIVE: The objective of the study was to assess the influence of gender on psychiatric disorders in children with epilepsy (CWE). METHOD: A systematic review of the literature on risk factors for psychiatric disorder in CWE published between 2004 and June 2018 was undertaken. Studies including data on gender that permitted the calculation of a risk ratio (RR) were included in the meta-analysis. A meta-regression was conducted to examine the contribution of setting of the survey and the inclusion of learning disabilities. RESULTS: Thirty-nine papers were included in the review. The male/female RR in CWE for Attention Deficit Hyperactivity Disorder (ADHD) was 1.49 (Confidence Interval (CI): 1.24-1.79), autistic spectrum disorder (ASD) 1.67 (CI: 1.47 to 1.90), anxiety 1.00 (CI: 0.90-1.12), and depression 0.93 (CI 0.41-2.09). More boys than girls had ADHD and ASD, but in relative terms, the RR male/female was lower in CWE than the RR in the general population reported in other studies. Meta-regression indicated that the inclusion of children with intellectual disability (mental retardation) or the setting (community vs hospital) did not have a significant impact. CONCLUSION: Compared with girls in the general population, girls with epilepsy seem to be at a higher risk of being diagnosed with ADHD/ASD as the gender ratio is more equal. This could be related to differences in the assessment of CWE and/or a shared pathogenesis between psychiatric conditions and epilepsy.

Family function and its relationship to injury severity and psychiatric outcome in children with acquired brain injury: a systematized review.

AIM: The psychological and psychiatric outcome of children with acquired brain injury is influenced by many variables. A review was undertaken to clarify the contribution of family function, how it relates to injury severity, and what particular aspects of family function influence psychological outcome in this group. METHOD: A systematized review of the literature of studies published between 1970 and 2012 from OvidMedline, PsychoInfo, PsycARTICLES, and Cochrane was undertaken focusing on family function, injury severity, and psychiatric outcome. RESULTS: Thirty-six papers met the inclusion criteria. Injury severity was linked to the development of organic personality change. Family function before injury, measured by the Family Assessment Device or the Clinical Rating Scale, had a statistically significant effect on general psychological functioning in six out of eight studies. Family function had a significant effect for oppositional defiant disorder and secondary attention-deficit-hyperactivity disorder. The effects of family function may differ depending on the age of the child and the severity of the injury. Some styles of parenting moderated recovery. After injury, family function was related to the child's contemporaneous psychiatric symptoms. The level of evidence for these papers was 3 or 4 (Oxford Centre for Evidence-based Medicine criteria). INTERPRETATION: Screening for some aspects of family functioning before injury and family function during the rehabilitation phase may identify children at risk of psychiatric disorders.