Prevalence of psychiatric comorbidities in temporal lobe epilepsy: the value of structured psychiatric interviews

Abstract

Background Although many studies have demonstrated a high prevalence of psychiatric disorders in epileptic patients, most have used unstructured psychiatric interviews for diagnosis, which may lead to significant differences in results. Here we present a study evaluating the prevalence of major psychiatric comorbidities in a cohort of South Brazilian patients with temporal lobe epilepsy using a structured clinical interview. Methods Neuropsychiatric symptoms were analyzed in 98 patients (39 men and 59 women) with temporal lobe epilepsy. Patient mean age was 43 years old, and mean duration of epilepsy was 25 years. Patients were diagnosed according to the ILAE Classification of Epileptic Syndromes using clinical, EEG, and neuroimaging criteria. All patients participated in the Structured Clinical Interview for DSM‐IV (SCID). Results Fifty‐three patients (54.1%) presented major psychiatric comorbidities. Mood disorders were observed in 42 patients (42.9%), the most common being neuropsychiatric disorders. Anxiety disorders were the second most frequent disorders, observed in 18 patients (18.4%). Psychotic disorders and substance abuse were each observed in six patients (6.1%). There were no clinical variables regarding epilepsy characteristics (age of onset, duration, response to antiepileptic drugs) and no MRI features associated with psychiatric disorders. A seven‐fold increased risk of mood disorders was identified in patients with inter‐ictal EEG abnormalities associated with the left hemisphere. Conclusion Relative to previous reports, we identify a high prevalence of psychiatric disorders in TLE patients, although our data is similar to that observed in other studies which have used similar structured interviews in populations of epileptic patients attending tertiary centres. The wide variation in percentages is probably attributable to the different patient groups investigated and to the even greater variety of diagnostic methods. Structured psychiatric interviews may contribute to a better evaluation of the true prevalence of psychiatric comorbidities in temporal lobe epilepsy.

Screening for common mental disorders in people with epilepsy in Goma, in the Democratic Republic of the Congo: a cross-sectional study

“…Several previous studies have reported comparable prevalences to that found in this study, such as 35-35.8% in Ethiopia [16, 20], 35.5% in Iceland [21], 36.5% in the United States [12], and 37% in Europe [22]. However, some studies found signi cantly higher prevalence rates ranging from 45-80% [15,[23][24][25][26][27][28][29][30],…”

“…Differences in sample size, assessment instruments used, and epilepsy patterns may explain the variation in prevalence across studies. Unlike other studies that focused only on temporal lobe epilepsy, which has a higher risk of CMD [25], this study assessed all types of epilepsy.…”

Optimization of Therapy in Patients with Epilepsy and Psychiatric Comorbidities: Key Points

“…One out of three PWE has a diagnosis of a psychiatric disorder over lifetime [ 4 ]. The risk is higher in patients affected by specific forms of epilepsy, and prevalence values of 52% and 54% have been reported in patients with drug-resistant epilepsy and TLE, respectively [ 3 , 6 , 30 ]. Considering the type of epilepsy, personality and anxiety disorders have been reported to be more frequent in patients with idiopathic generalized epilepsy (IGE), while depressive and psychotic disorders appear to be more frequent in those with focal-onset seizures and drug-resistant epilepsy [ 2 , 31 ].…”

Cognitive comorbidities in the rat pilocarpine model of epilepsy

“…However, there is a notable rise of the awareness for neuropsychiatric comorbidities of epilepsy and the number of clinical ( 1 , 2 ) and preclinical studies ( 3 , 4 ) of comorbidities in epilepsy seems to grow over the years. Many clinical reports indicate that mental disorders are more common in patients with epilepsy than in the general population ( 5 – 8 ). In this regard, mood disorders are the most common, anxiety disorders the second most frequent and psychotic disorders the least frequent in people with temporal lobe epilepsy ( 5 ), psychoses being a little more widespread than personality disorders ( 6 ).…”

“…Many clinical reports indicate that mental disorders are more common in patients with epilepsy than in the general population ( 5 – 8 ). In this regard, mood disorders are the most common, anxiety disorders the second most frequent and psychotic disorders the least frequent in people with temporal lobe epilepsy ( 5 ), psychoses being a little more widespread than personality disorders ( 6 ). Such high prevalence of psychiatric disorders is frequently demonstrated among patients with epilepsy when compared them with the general population or with individuals presenting non-epileptic neurological conditions ( 7 ), even if it may vary a lot due to differences in study methods and heterogeneity of epilepsy syndromes ( 8 ).…”