Self and informant report ratings of psychopathology in genetic generalized epilepsy
Introduction
The cognitive, psychological, and psychosocial sequelae of the genetic generalized epilepsies (GGE) is a topic of recent research interest, with accumulating evidence suggesting that GGE is not the benign condition as once thought [1], [2]. A recent systematic review found that clinically significant psychiatric comorbidity may occur in up to half of all children and a third of all adults with the condition [3]. As is the case with psychiatric symptoms in the general population, the most common comorbidities in adults with GGE were depression and anxiety, followed by conditions such as addiction, impulse control, and psychotic disorders [3], [4]. It is unclear whether this survey encompasses the full burden of undiagnosed and untreated dimensional psychopathological symptoms or is limited to patients with existing diagnoses, since many studies did not prospectively measure symptoms.
The significance of these outcomes for quality of life in epilepsy is well-recognized, and improving these patient outcomes has become an important clinical goal [5], [6]. Indeed, several authors have posited that psychological and behavioral comorbidities such as mood disorders are intimately related to the epilepsy, and that the relationship is best understood as bidirectional; i.e. epilepsy is a risk factor for mood disorder and mood disorder is a risk factor for epilepsy [7], [8]. While a neurobiological underpinning to psychopathology is considered likely, specific causal relationships are rarely identified, which may be due - at least in part - to the heterogeneity of epilepsy as a condition and that studies have mostly focused on epilepsy-related risk factors [9]. Epilepsy severity has been identified as one likely predictor of poor psychosocial outcomes in adults with GGE, with findings of other factors such as longer epilepsy duration and antiepileptic drug (AED) treatment proving equivocal - both negative and null associations with psychopathological outcome have been reported [3]. Finally, while subclinical epileptiform discharges (ED) are known to disrupt cognitive functioning in epilepsy and bear a relationship to depression in epilepsy [10], [11], their potential role in mood and psychosocial functioning in GGE and other epilepsies remains unexplored.
In a large, prospectively recruited sample of adults with GGE, we aimed to a) assess the burden of psychopathology across different symptom types on the basis of both categorical and dimensional outcomes; b) consider a self- and informant-report version of a comprehensive symptom severity questionnaire; c) examine the relationship between ED and other clinical variables and psychopathological symptom ratings. On the basis of previous research, we anticipated that the questionnaire would identify a 30% prevalence of people with GGE vulnerable to psychopathological comorbidity.
Section snippets
Participants and procedure
As part of a larger study regarding the prognosis and EEG characteristics of GGE [12], adults with EEG-confirmed GGE completed the Adult Self-Report form of the Achenbach System of Empirically Based Assessment. We established the diagnosis of GGE and classified patients into childhood absence epilepsy (CAE), juvenile absence epilepsy (JAE), juvenile myoclonic epilepsy (JME), and generalized epilepsy with generalized tonic-clonic seizures (GTCS) only (GTCSO) according to ILAE criteria [13], [14]
Patient characteristics
Prospective recruitment yielded 60 people with EEG-confirmed GGE (18 males; mean age: 31.6, SD: 11.0). For a subset of 47, a family member or close friend also completed the corresponding Adult Behavior Checklist. The majority of informant-report questionnaires were completed by spouses/partners (43%), and parents or adult children (36%). Smaller proportions were completed by friends (8%), siblings (4%) or were not reported (9%). The group with both self- and informant-report data available
Discussion
The results of this study indicate a high prevalence of self-reported and informant-reported psychopathology across all six DSM-Oriented Subscales. Almost half of our sample endorsed experiencing levels of symptomatology in the borderline-clinical or clinical range on one or more of the Subscales. This contrasted with approximately 18% who had previously or were currently being treated for a psychiatric condition. Depressive symptoms were the most common, with up to 28% of the GGE participants
Conclusion
In summary, these results indicate a high prevalence of psychological needs in patients with GGE. Depressive symptoms were the most common; however anxiety, avoidant personality, and attention deficit problems also occurred frequently. Our results suggest that patients may have more insight into these problems than their families. Antiepileptic drug polytherapy may be a risk factor for attention deficit symptoms. Routine screening of psychopathology and the provision of psychoeducation to
Disclosures
AL, SB and WD state that they have no disclosures relevant to this manuscript.
Study funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Amy Loughman was supported by an Australian National Health and Medical Research Council Public Health Scholarship.
Acknowledgements
The authors gratefully acknowledge data collection assistance from Nicholas Bendrups, Lib Yin Wong, and all of the participants who volunteered their time for this research.
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