Department of Neurology, Alfred Health, Prahran, Victoria, Australia.
Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Epilepsia. 2021 May;62(5):1170-1183. doi: 10.1111/epi.16871. Epub 2021 Mar 18.
This study was undertaken to identify factors that predict discordance between the screening instruments Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and Generalized Anxiety Disorder scale (GAD-7), and diagnoses made by qualified psychiatrists among patients with seizure disorders. Importantly, this is not a validation study; rather, it investigates clinicodemographic predictors of discordance between screening tests and psychiatric assessment.
Adult patients admitted for inpatient video-electroencephalographic monitoring completed eight psychometric instruments, including the NDDI-E and GAD-7, and psychiatric assessment. Patients were grouped according to agreement between the screening instrument and psychiatrists' diagnoses. Screening was "discordant" if the outcome differed from the psychiatrist's diagnosis, including both false positive and false negative results. Bayesian statistical analyses were used to identify factors associated with discordance.
A total of 411 patients met inclusion criteria; mean age was 39.6 years, and 55.5% (n = 228) were female. Depression screening was discordant in 33% of cases (n = 136/411), driven by false positives (n = 76/136, 56%) rather than false negatives (n = 60/136, 44%). Likewise, anxiety screening was discordant in one third of cases (n = 121/411, 29%) due to false positives (n = 60/121, 50%) and false negatives (n = 61/121, 50%). Seven clinical factors were predictive of discordant screening for both depression and anxiety: greater dissociative symptoms, greater patient-reported adverse events, subjective cognitive impairment, negative affect, detachment, disinhibition, and psychoticism. When the analyses were restricted to only patients with psychogenic nonepileptic seizures (PNES) or epilepsy, the rate of discordant depression screening was higher in the PNES group (n = 29, 47%) compared to the epilepsy group (n = 70, 30%, Bayes factor for the alternative hypothesis = 4.65).
Patients with seizure disorders who self-report a variety of psychiatric and other symptoms should be evaluated more thoroughly for depression and anxiety, regardless of screening test results, especially if they have PNES and not epilepsy. Clinical assessment by a qualified psychiatrist remains essential in diagnosing depressive and anxiety disorders among such patients.
本研究旨在确定影响癫痫患者神经障碍抑郁量表（NDDI-E）和广泛性焦虑障碍量表（GAD-7）筛查工具与合格精神科医生诊断之间不一致的因素。重要的是，这不是验证研究，而是调查筛查测试与精神评估之间不一致的临床诊断预测因素。
接受住院视频脑电图监测的成年患者完成了八项心理计量学工具，包括 NDDI-E 和 GAD-7 以及精神病评估。根据筛查工具与精神科医生诊断的一致性将患者分为不同组别。如果筛查结果与精神科医生的诊断不同，包括假阳性和假阴性结果，则筛查结果为“不一致”。使用贝叶斯统计分析来确定与不一致相关的因素。
共有 411 名患者符合纳入标准；平均年龄为 39.6 岁，55.5%（n=228）为女性。33%的患者（n=136/411）出现抑郁筛查不一致，主要是假阳性（n=76/136，56%）而非假阴性（n=60/136，44%）所致。同样，焦虑筛查有三分之一的患者（n=121/411，29%）结果不一致，这是由于假阳性（n=60/121，50%）和假阴性（n=61/121，50%）所致。七种临床因素可预测抑郁和焦虑的不一致筛查：分离症状更严重、患者报告的不良事件更多、主观认知障碍、负性情绪、情感分离、抑制障碍和精神病态。当分析仅限于精神性非癫痫性发作（PNES）或癫痫患者时，PNES 组（n=29，47%）的抑郁筛查不一致率高于癫痫组（n=70，30%，替代假设的贝叶斯因子=4.65）。
有各种精神和其他症状的癫痫患者应更彻底地评估抑郁和焦虑，无论筛查测试结果如何，尤其是如果他们患有 PNES 而非癫痫。合格精神科医生的临床评估仍然是诊断此类患者抑郁和焦虑障碍的关键。
