Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
Epilepsia. 2012 Jun;53(6):1095-103. doi: 10.1111/j.1528-1167.2012.03500.x. Epub 2012 May 11.
In a nationally representative population-based study in England, we estimated the burden of psychiatric and neurodevelopmental comorbidities in people with epilepsy. We investigated whether any overrepresentation of comorbidities could be explained by epilepsy being a chronic medical or neurologic condition, or by the confounding effect of demographic and socioeconomic factors or other health conditions.
The Adult Psychiatric Morbidity Survey 2007 comprised detailed interviews with 7,403 individuals living in private households in England. Doctor-diagnosed epilepsy (and asthma, diabetes, and migraine, chronic conditions for comparison) was ascertained by self-report, and extensive diagnostic and screening interviews were used to assess psychiatric and neurodevelopmental conditions.
The estimated lifetime prevalence of epilepsy in the adult (≥ 16 years old) population of England was 1.2% (95% confidence interval [CI] 1.0-1.5). Almost one-third of the people with epilepsy had an International Classification of Diseases, Tenth Revision (ICD-10) anxiety or depressive disorder (compared with one in six people without epilepsy). Among these, social phobia and agoraphobia, generalized anxiety disorder, depression, and measures of suicidality had strong associations with epilepsy, which remained robust after accounting for potential confounders. These associations were consistently stronger than those in people with asthma or diabetes, and similar to those in people reporting migraine or chronic headaches. Epilepsy was also strongly associated with autism spectrum disorders (odds ratio [OR] 7.4, 95% CI 1.5-35.5) and possible eating disorders, and these associations were not evident in people with asthma, diabetes, or migraine.
Psychiatric and neurodevelopmental conditions were overrepresented in people with epilepsy. These associations were stronger than with other nonneurologic chronic conditions, and not explained by confounding. Some overlap in the psychopathology observed in epilepsy and migraine cannot rule out the presence of common pathways of psychiatric comorbidity in neurologic conditions. However, associations of epilepsy with conditions such as autism spectrum disorders point to comorbidities specific to epilepsy that may not be shared by other neurologic conditions.
在英格兰进行的一项全国性基于人群的研究中，我们评估了癫痫患者的精神和神经发育合并症负担。我们研究了癫痫是否为慢性医学或神经疾病，或是否因人口统计学和社会经济因素或其他健康状况的混杂效应，导致合并症的发病率升高。
2007 年成人精神疾病发病率调查包括对居住在英格兰私人住宅中的 7403 名个体进行详细访谈。通过自我报告确定癫痫（和哮喘、糖尿病和偏头痛，作为比较的慢性疾病）的诊断，并使用广泛的诊断和筛查访谈评估精神和神经发育疾病。
英格兰成人（≥16 岁）人群中癫痫的终生患病率估计为 1.2%（95%置信区间[CI]1.0-1.5）。近三分之一的癫痫患者患有国际疾病分类第 10 版（ICD-10）焦虑或抑郁障碍（相比之下，无癫痫的患者为六分之一）。在这些患者中，社交恐惧症和广场恐惧症、广泛性焦虑症、抑郁症和自杀倾向测量值与癫痫有很强的关联，在考虑到潜在混杂因素后，这些关联仍然很稳健。这些关联比哮喘或糖尿病患者更强烈，与报告偏头痛或慢性头痛的患者相似。癫痫还与自闭症谱系障碍（比值比[OR]7.4，95%CI1.5-35.5）和可能的进食障碍强烈相关，而在哮喘、糖尿病或偏头痛患者中则没有这些关联。
精神和神经发育合并症在癫痫患者中发病率更高。这些关联比与其他非神经慢性疾病的关联更强，并且不能用混杂因素来解释。在癫痫和偏头痛中观察到的精神病理学之间存在一些重叠，但不能排除神经合并症中存在共同的精神共病途径。然而，癫痫与自闭症谱系障碍等疾病的关联表明，癫痫特有的共病可能与其他神经疾病不同。
