Elsevier

Epilepsy & Behavior

Volume 67, February 2017, Pages 13-19
Epilepsy & Behavior

Self and informant report ratings of psychopathology in genetic generalized epilepsy

https://doi.org/10.1016/j.yebeh.2016.11.014Get rights and content

Highlights

  • Elevated psychopathology symptoms in up to 50% of adults with GGE

  • Greater symptom report by patients than their nominated family member

  • No contribution of epilepsy duration, seizure freedom or epileptiform discharges to symptoms

Abstract

The psychological sequelae of genetic generalized epilepsies (GGE) is of growing research interest, with up to a third of all adults with GGE experiencing significant psychiatric comorbidity according to a recent systematic review. A number of unexplored questions remain. Firstly, there is insufficient evidence to determine relative prevalence of psychopathology between GGE syndromes. Secondly, the degree to which self-report and informant-report questionnaires accord in adults with epilepsy is unknown. Finally, while epilepsy severity is one likely predictor of worse psychopathology in GGE, evidence regarding other possible contributing factors such as epilepsy duration and antiepileptic drugs (AEDs) has been equivocal. The potential impact of subclinical epileptiform discharges remains unexplored.

Self-report psychopathology symptoms across six DSM-Oriented Subscales were prospectively measured in 60 adults with GGE, with informant-report provided for a subset of 47. We assessed the burden of symptoms from both self- and informant-report, and the relationship between clinical epilepsy variables and self-reported symptoms.

Results showed elevated symptoms in almost half of the sample overall. Depression and anxiety were the most commonly reported types of symptoms. There was a trend towards greater symptoms endorsement by self-report, and relatively modest interrater agreement. Symptoms of ADHD were significantly positively associated with number of AEDs currently prescribed. Other psychopathology symptoms were not significantly predicted by epilepsy duration, seizure-free duration or total duration of epileptiform discharges over a 24-hour period.

The high prevalence of psychological needs suggests that routine screening of psychopathology and provision of psychoeducation may be essential to improving patient care and outcomes. Further investigation is required to better understand predictive and causal factors for psychopathology in GGE.

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.

References (33)

  • G.M. de Araujo Filho et al.

    Juvenile myoclonic epilepsy: psychiatric comorbidity and impact on outcome

    Epilepsy Behav

    (2013)
  • O. Devinsky

    Psychiatric comorbidity in patients with epilepsy: implications for diagnosis and treatment

    Epilepsy Behav

    (2003)
  • S. Cutting et al.

    Adult-onset idiopathic generalized epilepsy: clinical and behavioral features

    Epilepsia

    (2001)
  • A. Loughman et al.

    A systematic review of psychiatric and associated comorbidities of idiopathic generalized epilepsies

    Neuropsychol Rev

    (2016)
  • T.P.B.M. Suurmeijer et al.

    Social functioning, psychological functioning, and quality of life in epilepsy

    Epilepsia

    (2001)
  • J.I. Tracy et al.

    The association of mood with quality of life ratings in epilepsy

    Neurology

    (2007)
  • Cited by (4)

    • The burden of disease of idiopathic/genetic generalized epilepsy – A nationwide online survey

      2021, Epilepsy and Behavior
      Citation Excerpt :

      In addition, the majority of questionnaires were completed when most relevant COVID-19-related restrictions were paused or only recently started; thus, a putative COVID-19 effect hardly explains the results. Previous studies found more psychiatric comorbidities among patients with IGE than among healthy controls [5,34,35]. We found similar results in our psychiatric scores, where BIS-8, SAPAS-AV, and MDI all were higher in our patients compared to those of healthy populations from other studies [23,26,27].

    • Default mode network dysfunction in idiopathic generalised epilepsy

      2020, Epilepsy Research
      Citation Excerpt :

      The primary distinction between these syndromes however, is the age of onset, where juvenile myoclonic epilepsy has a later age of onset, and is the most common form of IGE, charicterised by myoclonic jerks, tonic-clonic and absence seizures (Dong et al., 2016; Koepp et al., 2014). There is still debate however as to the overlap and separation of IGE subtypes (Berkovic et al., 1987; Loughman et al., 2017a, 2017b). Idiopathic generalised epilepsy was previously considered benign until recently, however recent functional MRI studies have shown abnormalities in resting state networks of those with IGE, thought to explain comorbid deficits found in multiple cognitive domains across IGE subtypes (Li et al., 2015, 2017; Loughman et al., 2016; Maxwell, 2004).

    View full text