Loughman Amy, Bowden Stephen C, D'Souza Wendyl J
Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC 3010, Australia; School of Health & Biomedical Sciences, RMIT University, PO Box 71, Bundoora, VIC 3083, Australia.
Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC 3010, Australia; Department of Clinical Neurosciences, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC 3065, Australia.
Epilepsy Behav. 2017 Feb;67:13-19. doi: 10.1016/j.yebeh.2016.11.014. Epub 2017 Jan 10.
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.
遗传性全身性癫痫（GGE）的心理后遗症越来越受到研究关注，根据最近的一项系统综述，所有成年GGE患者中多达三分之一患有严重的精神疾病共病。仍有一些未被探索的问题。首先，没有足够的证据来确定GGE综合征之间精神病理学的相对患病率。其次，癫痫成年患者自我报告问卷和知情者报告问卷的一致程度尚不清楚。最后，虽然癫痫严重程度可能是GGE中精神病理学恶化的一个预测因素，但关于癫痫持续时间和抗癫痫药物（AEDs）等其他可能的促成因素的证据一直不明确。亚临床癫痫样放电的潜在影响仍未得到探索。前瞻性地测量了60名成年GGE患者在六个以DSM为导向的子量表上的自我报告精神病理学症状，为47名患者的一个子集提供了知情者报告。我们评估了自我报告和知情者报告的症状负担，以及临床癫痫变量与自我报告症状之间的关系。结果显示，总体样本中近一半的症状有所增加。抑郁和焦虑是最常报告的症状类型。自我报告有更多症状认可的趋势，评分者间的一致性相对适中。注意力缺陷多动障碍（ADHD）症状与目前开具的AEDs数量显著正相关。癫痫持续时间、无癫痫发作持续时间或24小时内癫痫样放电的总持续时间对其他精神病理学症状没有显著预测作用。心理需求的高患病率表明，对精神病理学进行常规筛查和提供心理教育可能对改善患者护理和治疗结果至关重要。需要进一步调查以更好地了解GGE中精神病理学的预测和因果因素。
