Clinical and psychopathological definition of the interictal dysphoric disorder of epilepsy

Abstract

SUMMARYDespite an extensive literature indicating that mood disorders are a frequent psychiatric complication of epilepsy, reports continue to indicate that depression often goes unrecognized or untreated (Schmitz, 2005). The underdiagnosis of affective comorbidity in epilepsy is likely to have many sources: an insufficient sensitivity among epileptol-

The interictal dysphoric disorder of epilepsy: Legend or reality?

“…That up to 50% of patients with epilepsy and mood disorders do not meet DSM criteria do not necessarily mean that all of them have IDD. A cross sectional study aimed at validating IDD against DSM criteria showed that patients with IDD fulfill criteria for a specific DSM diagnosis [20] and this has been replicated by other studies other centres [39,40]. In addition, IDD was shown also inb patients with migraine with a fairly similar prevalence [20] suggesting that it is not disease-specific.…”

“…A cross sectional study aimed at validating IDD against DSM criteria showed that patients with IDD fulfill criteria for a specific DSM diagnosis [20] and this has been replicated by other studies other centres [39,40]. In addition, IDD was shown also inb patients with migraine with a fairly similar prevalence [20] suggesting that it is not disease-specific. However, studies aimed at investigating the impact of IDD on quality of life clearly showed that IDD and DSM depressive disorders have a different impact [39][40][41].…”

“…In fact, IDD seems to be closer to bipolar depression rather than to unipolar one [20,28,29] and psychoses of epilepsy are characterized by a preserved personality and prominent mood symptoms [30] suggesting that psychoses of epilepsy belong to the mood spectrum rather than to the psychotic spectrum. However, the symptom cluster described in patients with IDD and epilepsy is quite peculiar and is rarely reported in psychiatric practice even in rapid cycling bipolar disorders or cyclothymia [28].…”

“…A number of authors agree that up to 50% of patients with epilepsy and depression present psychiatric symptoms that are not captured by standardized classificatory systems such as DSM or ICD [16][17][18][19][20]. This observation might explain the high variability in epidemiological data on mood disorders in epilepsy.…”

“…In fact, post-ictal mania seems to be associated with frontal, non-dominant involvement [37,38] and is associated with a poor prognosis after surgery identifying temporal lobe "plus" patients [38]. In this regard, a specific clinical instrument for the evaluation of IDD and PDS has been developed, namely the Interictal Dysphoric Disorder Inventory (IDDI) [20]. The IDDI is a 38 items, self-report questionnaire exploring a timeinterval of 12 months.…”