Psychiatric comorbidity in epilepsy.

Many studies on psychiatric comorbidity in epilepsy have been performed using many different patient groups and diagnostic instruments. This methodological heterogeneity complicates comparison of the findings. In this article, psychiatric disorders in epilepsy are reviewed from the perspective of the DSM classification system. The empirical findings of axis I clinical disorders and axis II personality disorders are described separately. Furthermore, the existence and specificity of conditions such as interictal dysphoric disorder, interictal behavior syndrome, and psychosis of epilepsy are discussed. From the many studies that have been performed on this topic it can be learned that there is a need for well-controlled studies using representative patient groups and valid and standardized diagnostic instruments. So far, the majority of the studies have concerned axis I disorders; relatively little research has been performed on axis II personality disorders. More research on personality disorders, as well as on the relative contributions of the different (brain- and non-brain-related) factors to the relationship between epilepsy and psychiatric disorders, is recommended.

Personality disorder traits in patients with epilepsy.

OBJECTIVE AND METHODS: The Questionnaire on Personality Traits (VKP: Vragenlijst voor Kenmerken van de Persoonlijkheid) was used to investigate personality disorder (PD) traits in 203 patients with epilepsy and a control group of 332 subjects from the general population. Furthermore, the association of PD traits with epilepsy-related variables was studied, as well as the association between PD traits and level of psychopathology. RESULTS: The results showed that, compared with the control group, patients with epilepsy had higher dimensional VKP scores for several Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and International Classification of Diseases (ICD-10) PDs. Associations were found between PD traits and age at onset of epilepsy, duration of epilepsy, seizure frequency and number of anti-epileptic drugs. Anxiety and depression were not associated with PD traits. CONCLUSION: It is likely that suffering from epileptic seizures negatively influences personality development and can result in the development of maladaptive PD traits. The results also support the idea that PD traits are not (completely) covered by axis I psychopathology and therefore should be separately investigated.

Psychopathologies in patients with nonepileptic seizures with and without comorbid epilepsy: how different are they?

The underlying psychopathology in patients with nonepileptic seizures (NES) is diverse and poorly understood. The prevalence of epilepsy in NES patients is higher than in the general population, so epilepsy can be understood as a risk factor for NES. The question emerges if psychopathology differs in NES patients with and without epilepsy. Retrospective data concerning psychopathology and personality in both groups show two differences: (1) somatoform disorders are more prevalent in NES-only patients and (2) personality disorders are more typical in NES patients with epilepsy and resemble the pattern of psychopathology found in epilepsy-only patients. If true, then NES in epilepsy patients may be associated with an epilepsy condition. Consequently, in studies of psychopathology in epilepsy patients, patients with comorbid nonepileptic seizures have to be included.

Prevalence of Psychopathology in Dutch Epilepsy Inpatients: A Comparative Study.

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.

Psychosocial impact of epileptic seizures in a Dutch epilepsy population: a comparative Washington Psychosocial Seizure Inventory study.

PURPOSE: The psychosocial functioning of epilepsy patients from the Netherlands was investigated and compared with results from other countries. The impact of epilepsy was also studied in two different groups of Dutch epilepsy patients, inpatients and outpatients. METHODS: The Washington Psychosocial Seizure Inventory (WPSI) was used to study the psychosocial problems of 134 Dutch outpatients and 181 Dutch inpatients. WPSI profiles were compared with those from the former German Democratic Republic (West Germany), Finland, Canada, the United States, Chile, and Japan. RESULTS: For the Dutch epilepsy patients, most of the psychosocial problems were experienced by inpatients; they had serious problems in emotional, interpersonal, and vocational adjustment, adjustment to seizures, and overall psychosocial functioning. Seizure-free outpatients, however, experienced significant problems only in the emotional adjustment area. Comparing the outcomes of various countries, Dutch outpatients and patients from West Germany and Finland experienced the least psychosocial difficulties, whereas epilepsy patients from Chile, Japan, and Canada have serious problems in most areas of psychosocial functioning. CONCLUSIONS: Patients with epilepsy experience psychosocial problems, although the amount of psychosocial difficulties depends on the seizure frequency and the culture that patients live in.

Influence of an evacuation in February 1995 in The Netherlands on the seizure frequency in patients with epilepsy: a controlled study.

PURPOSE: Stress is often noted by patients to be a precipitating factor in causing seizures. No precise data are, however, available. In 1995 for 250,000 inhabitants in The Netherlands, a serious life event occurred within a period of seven days. An extreme high water level in the province of Gelderland, with the possibility of a flood, made the government decide to evacuate people and their livestock. This retrospective study investigated the influence of this forced evacuation on the seizure frequency of patients with epilepsy, compared with patients of the same age and type of epilepsy living outside the evacuation area at the time of the threatening flood. METHODS: Information regarding epilepsy syndrome, seizure type, and frequency was derived from seizure diaries and medical histories of 30 evacuated patients and 30 matched control patients. RESULTS: Of the 30 evacuees, eight showed an increase and one a decrease in seizure frequency during or shortly after the evacuation period, compared with one and zero control patients, respectively. These results proved to be statistically significant (p < 0.05). CONCLUSIONS: Our data support the hypothesis that there is a relation, albeit small, between a stressful life event and seizure frequency.

Response learning of rats in a Morris water maze: involvement of the medical prefrontal cortex.

This study is concerned with the question whether the medial prefrontal cortex mediates spatial navigation requiring the expression of response learning. It consists of two parts. In the first experiment it was investigated whether intact male Wistar rats can learn a spatial response task in a Morris water maze, and, if so, how the learning of this task compares with the learning of a place task, in the same water maze. The data illustrate that rats can indeed learn the response task demands, but also demonstrate that this task is more difficult to learn than the place task. This is evidenced by a slower and more capricious acquisition. Based on these findings a second experiment was conducted, in which sham-operated rats and rats with damage of the medial prefrontal cortex (mPFC) were compared for their acquisition in the response task in the Morris water maze. The results showed that both escape latency and path length of the mPFC-damaged animals were significantly higher than those of the sham-operated animals. A behavioral analysis of the swimming paths demonstrated that the mPFC-damaged rats were more persistent in their use of a place strategy, while the sham-operated animals sooner switched to the more successful taxon-orientation strategy. Taken together with previous findings these data support the hypothesis of a functional dissociation of the mPFC with regard to its involvement in the expression of place and response learning.