Systematic Literature Review of Psychiatric Comorbidities in Adults with Epilepsy

Abstract

Background and Purpose Mental illness is disproportionately common in people with epilepsy (PWE). This systematic literature review identified original research articles that reported the prevalence of psychiatric comorbidities based upon clinical assessments in a sample of PWE and assessed the clinical features of the populations found in studies included in our review of mental health comorbidity. Methods The included articles were written in English and published from 2008 to 2018, and focused on adults aged ≥18 years who had psychiatric diagnoses determined in clinical assessments, such as those found in medical records, clinician psychiatric evaluations, structured diagnostic interviews, and mental health screening questionnaires specific for a psychiatric disorder. The primary outcome was the prevalence of psychiatric comorbidities as a percentage of the total sample of PWE. Additional data included the overall sample size, mean age, epilepsy type, study design, and method of diagnosis. A modified Newcastle Ottawa Scale was used to assess the quality of the studies. All 23 articles that were consistent with the inclusion criteria were related to observational studies. Results Mood disorders and anxiety disorders were the most common psychiatric comorbidities, with prevalence rates of 35.0% and 25.6%, respectively. Major depressive disorder was the most common mood disorder, with a prevalence of 24.2%. Post-traumatic stress disorder (PTSD) had the highest reported prevalence among anxiety disorders, at 14.2%, followed by general anxiety disorder at 11.1%. Other comorbidities included psychosis (5.7%), obsessivecompulsive disorder (3.8%), schizophrenia (1.7%), bipolar disorder (6.2%), and substance abuse (7.9%). The pooled prevalence of suicidality, as reported for two studies, was 9.3%. Temporal lobe epilepsy (TLE) was associated with higher levels of psychiatric comorbidity. Two (8.7%) of the 23 studies compared psychiatric comorbidities in TLE with that of extratemporal lobe epilepsy (ETLE), and one of these two studies found that depression was more common in TLE (53.8%) than in ETLE (25%). Regarding seizure types, partial seizures were associated with a higher prevalence of depression vs generalized seizures. Conclusions This systematic literature review of recent original research found a relatively high prevalence of mental health comorbidities in PWE. Mood and anxiety disorders are the most common comorbidities, while psychotic spectrum conditions such as schizophrenia and bipolar disorder are much rarer. The prevalence of comorbidity may vary with the epilepsy type and treatment responsiveness. These findings suggest that screening tools for depression and anxiety should be included as part of the training for epilepsy care, while resources for other relatively common conditions such as PTSD and substance abuse disorders should be readily available to neurology specialists who treat PWE.

The impact of one-year COVID-19 containment measures in patients with mesial temporal lobe epilepsy: A longitudinal survey-based study

“…In addition, about 50% of our patients presented a certain stress level. Psychiatric disorders are frequent comorbidities in MTLE, manifesting in about 75% of these patients, compared to lower rated reported in extratemporal and generalized epilepsies [30] . More than half of MTLE patients suffer from depression, and about 40% of them from anxiety, including post-traumatic stress disorder and generalized anxiety disorder.…”

Impact of the COVID-19 pandemic on persons with epilepsy in Uganda: A descriptive cross-sectional study

“…Psychiatric disorders are disproportionally more common in PWE, with mood and anxiety disorders being the most prevalent. A recent meta-analysis of 23 articles among PWE performed between 2008 and 2018 found a prevalence of 24.2% for depressive disorder and 11.1% for anxiety disorder [27] . Our results indicate a slightly lower percentage for depression.…”

Behavioral presentations of focal onset seizures

“…A systematic review revealed that mood and anxiety disorders (35.0% and 25.6%, respectively) are the most common psychiatric comorbidity while disorders belonging to psychotic spectrum like schizophrenia (1.7%) or bipolar disorders (6.2%) are rare. [ 8 ] Hallucinations, illusions, and sensory illusions and distortions, cognitive illusions, time distortion, thought and speech disturbance and motor automatisms have all been reported as ictal phenomena. [ 9 ] Fugue state, also known as a twilight state can be defined as an altered state of consciousness with varying grades of motor activity and amnesia for the event.…”