Scévola Laura, Sarudiansky Mercedes, Lanzillotti Alejandra, Oddo Silvia, Kochen Silvia, D'Alessio Luciana
Epilepsy Center, Ramos Mejía y El Cruce Hospital, EnyS-CONICET, Buenos Aires, Argentina; Mental Health Center, Ramos Mejía Hospital, Buenos Aires, Argentina.
Epilepsy Center, Ramos Mejía y El Cruce Hospital, EnyS-CONICET, Buenos Aires, Argentina.
Epilepsy Behav. 2017 Apr;69:133-138. doi: 10.1016/j.yebeh.2017.01.007. Epub 2017 Mar 1.
Depression is the most frequent psychiatric co-morbidity in patients with epilepsy. Lifetime prevalence of depression is reported more frequently in temporal lobe epilepsy and is estimated at 35%. This co-morbidity appears to be related with various mechanisms. The aim of this study was to determine the quality of life (QoL) of patients with pharmacoresistant epilepsy with and without co-morbid depression in an Argentinean population.
Patients admitted to the video-EEG monitoring unit during the period 2010-2013 went through a standardized psychiatric assessment using SCID-I (Structured Clinical Interview for Axis I diagnoses of DSM-IV), BDI II (Beck Depression Inventory) GAF (Global assessment of functioning), and Q LES Q-SF (for quality of life). Patients were divided in two groups: with and without depression (according to DSM-IV). Sociodemographic data, BDI II scores, GAF, and quality of life (QoL) were compared between the two groups. Comparisons were made using Student's t-test and Mann-Whitney U test. Frequency distributions were compared by Chi-square test. Spearman correlation coefficients were determined.
Seventy-seven patients with pharmacoresistant epilepsy were eligible for this study, 41 patients were included in the group with depression (mean BDI II 15.93), and 36 in the group without depression (mean BDI II 3.36) (p=0.001). The overall QoL was significantly lower in the group with depression compared to the group without depression (p<0.01). The most affected areas were: physical health (p=0.013), mood (p=0.006), course activities (referring to school as well as to hobbies or classes outside of school) (p=0.003), leisure time activities (p=0.011), social activities (p=0.047), general activities (p=0.042), and medication (p=0.022). Severity of depression according to BDI II had a negative correlation with overall QoL (r - 0.339, p<0.01). No correlations were found between seizure frequency, QoL and BDI II.
Patients with pharmacoresistant epilepsy and co-morbid depression reported worst QoL. Depression disrupts daily functioning (leisure, social functioning) and is a negative influence for subjective perception of health and medication. Interdisciplinary treatment should be considered (neurology-psychiatry-psychotherapy).
抑郁症是癫痫患者中最常见的精神共病。据报道，颞叶癫痫患者一生中患抑郁症的比例更高，估计为35%。这种共病似乎与多种机制有关。本研究的目的是确定阿根廷人群中伴有和不伴有共病抑郁症的药物难治性癫痫患者的生活质量（QoL）。
2010年至2013年期间入住视频脑电图监测病房的患者接受了标准化的精神评估，使用SCID-I（DSM-IV轴I诊断的结构化临床访谈）、BDI II（贝克抑郁量表）、GAF（功能总体评估）和QL ES Q-SF（用于生活质量）。患者分为两组：有抑郁症组和无抑郁症组（根据DSM-IV）。比较两组患者的社会人口统计学数据、BDI II评分、GAF和生活质量（QoL）。采用学生t检验和曼-惠特尼U检验进行比较。通过卡方检验比较频率分布。确定斯皮尔曼相关系数。
77例药物难治性癫痫患者符合本研究条件，41例患者纳入抑郁症组（BDI II平均为15.93），36例患者纳入无抑郁症组（BDI II平均为3.36）（p = 0.001）。与无抑郁症组相比，抑郁症组的总体生活质量显著更低（p < 0.01）。受影响最严重的方面包括：身体健康（p = 0.013）、情绪（p = 0.006）、课程活动（指学校以及校外爱好或课程）（p = 0.003）、休闲时间活动（p = 0.011）、社交活动（p = 0.047）、一般活动（p = 0.042）和药物治疗（p = 0.022）。根据BDI II得出的抑郁症严重程度与总体生活质量呈负相关（r = -0.339，p < 0.01）。未发现癫痫发作频率、生活质量和BDI II之间存在相关性。
伴有共病抑郁症的药物难治性癫痫患者报告的生活质量最差。抑郁症会干扰日常功能（休闲、社交功能），并对健康和药物治疗的主观感受产生负面影响。应考虑采用多学科治疗（神经科-精神科-心理治疗）。
