Castro Sayra Catalina Coral, Baroni Gislaine Verginia, Martins William Alves, Palmini André Luis Fernandes, Bisol Luísa Weber
Services of Psychiatry, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil.
Neurology & Porto Alegre Epilepsy Surgery Program, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil; Medicine and Health Sciences Post-Graduated Program, PUCRS, Brazil.
Epilepsy Behav. 2018 Mar;80:254-258. doi: 10.1016/j.yebeh.2018.01.022. Epub 2018 Feb 9.
The objective of the study was to access the suicide risk (SR) in patients with refractory epilepsy and its association with temperament and sleep quality.
A total of 50 consecutive patients referred for epilepsy surgery evaluation in the Porto Alegre Epilepsy Surgery Program were included. All patients had a detailed neurologic and psychiatric evaluation, including video-electroencephalogram (VEEG), high-resolution magnetic ressonance imaging (MRI), and neuropsychologic assessment. In addition, structured questionnaires were applied: module C of the MINI-plus (International Neuropsychiatric Interview-Brazilian version 5.0.0), Affective and Emotional Composite Temperament Scale (AFECTS), and Pittsburgh Sleep Quality Index (PSQI).
Ten patients (20.0%) showed an increased SR. The most frequent location of the epileptic focus was in the temporal lobe (50%; n=25). Final diagnosis on VEEG comprised epilepsy in 74.0% (n=37), psychogenic nonepileptic seizures (PNES) in 8.0% (n=4), and both in 12%. Thirty patients (60.0%) received surgery indication. Mood disorders were the main psychiatric diagnosis, found in 19 subjects (70.4%), with major depressive disorder (MDD) encountered in 15 patients (55.6%). In the group, SR was more frequent in patients with sleep disorders (p=0.001) and elevated scores of high emotional sensitivity (p=0.003).
In this cohort of patients with highly refractory epilepsy, there was a significant association between SR, sleep disorders, and high emotional sensitivity. Careful evaluation of these factors should be performed in these patients to fully access SR.
本研究旨在评估难治性癫痫患者的自杀风险（SR）及其与气质和睡眠质量的关系。
纳入了在阿雷格里港癫痫手术项目中连续转诊进行癫痫手术评估的50例患者。所有患者均接受了详细的神经和精神评估，包括视频脑电图（VEEG）、高分辨率磁共振成像（MRI）和神经心理学评估。此外，还应用了结构化问卷：MINI-plus的C模块（国际神经精神访谈-巴西版5.0.0）、情感和情绪综合气质量表（AFECTS）以及匹兹堡睡眠质量指数（PSQI）。
10例患者（20.0%）显示自杀风险增加。癫痫病灶最常见的位置是颞叶（50%；n = 25）。VEEG的最终诊断包括74.0%（n = 37）为癫痫，8.0%（n = 4）为精神性非癫痫发作（PNES），12%为两者皆有。30例患者（60.0%）获得手术指征。情绪障碍是主要的精神诊断，在19名受试者（70.4%）中发现，15例患者（55.6%）患有重度抑郁症（MDD）。在该组中，睡眠障碍患者（p = 0.001）和高情绪敏感性得分升高的患者（p = 0.003）的自杀风险更高。
在这一队列的高度难治性癫痫患者中，自杀风险、睡眠障碍和高情绪敏感性之间存在显著关联。应对这些患者的这些因素进行仔细评估，以全面评估自杀风险。
