描述男性和女性癫痫伴发和非癫痫性发作性疾病退伍军人在精神科特征方面的差异。
Characterizing differences in psychiatric profiles between male and female veterans with epilepsy and psychogenic non-epileptic seizures.
机构信息
DR Associates of North Texas (Private Researcher), Plano, TX 75093, USA.
Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; Psychology Department, Louisiana State University, Baton Rouge, LA 70803, USA.
出版信息
Epilepsy Res. 2022 Oct;186:106995. doi: 10.1016/j.eplepsyres.2022.106995. Epub 2022 Aug 13.
OBJECTIVE
While previous studies have described psychiatric profiles in patients with psychogenic non-epileptic seizures (PNES) and epileptic seizures (ES), a well-matched comparison between males and females has been lacking. To address this shortcoming, the present study sought to explore sex differences between male and female Veterans with ES and PNES in terms of psychiatric diagnoses, trauma histories, and psychiatric treatment.
METHODS
A male Veteran sample (PNES n = 87, ES n = 28) was identified matching age and seizure diagnosis with our previously-gathered female Veteran sample (PNES n = 90, ES n = 28). Retrospective chart review was used to obtain demographic, psychiatric, and seizure-related variables. Group differences between PNES and ES were first assessed among males followed by differences between males and females.
RESULTS
Males with PNES were more likely to receive psychiatric treatment (82.6 % vs. 60.7 %, p = 0.017), be prescribed more psychotropics (1.6 vs. 0.9, p = 0.003), and more likely to have childhood physical abuse (27.9 % vs. 3.6 %, p = 0.007) than those with ES. Compared to PNES, males with ES presented to the epilepsy monitoring unit (EMU) significantly later (12.8 years vs. 6.1 years, p = 0.009), and were prescribed more anti-seizure medications (ASMs) previously (2.1 vs. 0.8, p = 0.009) and currently (1.6 vs. 1.0, p = 0.001). Between males and females with PNES, females evidenced more depression (76.7 % vs. 26.3 %, p < 0.001), borderline personality disorder (18.9 % vs. 4.7 %, p = 0.004), suicidality (65.6 % vs. 33.7 %, p < 0.001), and childhood sexual abuse (37.8 % vs. 11.6 %, p < 0.001), while males had higher rates of substance use disorders (37.2 % vs. 8.9 %, p < 0.001).
SIGNIFICANCE
A greater psychiatric burden is seen among females compared to males with PNES, especially diagnoses of borderline personality disorder and depression. Higher rates of suicidality and inpatient psychiatric hospitalization may warrant particular consideration in screening and intervention efforts among female Veterans with PNES.
目的
既往研究已经描述了精神性非癫痫性发作（PNES）和癫痫发作（ES）患者的精神科特征，但缺乏男女患者的匹配比较。为了解决这一不足，本研究旨在探讨男女退伍军人 ES 和 PNES 患者在精神科诊断、创伤史和精神科治疗方面的性别差异。
方法
确定了一组男性退伍军人样本（PNES n=87，ES n=28），并与我们之前收集的女性退伍军人样本（PNES n=90，ES n=28）进行年龄和癫痫诊断匹配。回顾性病历审查用于获取人口统计学、精神科和癫痫相关变量。首先评估 PNES 和 ES 男性之间的组间差异，然后评估男性与女性之间的差异。
结果
PNES 男性更有可能接受精神科治疗（82.6%比 60.7%，p=0.017）、接受更多精神药物治疗（1.6 比 0.9，p=0.003），且更有可能经历儿童期躯体虐待（27.9%比 3.6%，p=0.007）。与 PNES 相比，ES 男性到癫痫监测单元（EMU）就诊的时间明显更晚（12.8 年比 6.1 年，p=0.009），且此前（2.1 比 0.8，p=0.009）和目前（1.6 比 1.0，p=0.001）接受的抗癫痫药物治疗更多。PNES 男性和女性之间，女性表现出更多的抑郁（76.7%比 26.3%，p<0.001）、边缘型人格障碍（18.9%比 4.7%，p=0.004）、自杀意念（65.6%比 33.7%，p<0.001）和儿童期性虐待（37.8%比 11.6%，p<0.001），而男性的物质使用障碍发生率更高（37.2%比 8.9%，p<0.001）。
意义
PNES 女性患者的精神负担比男性患者更重，尤其是边缘型人格障碍和抑郁的诊断。更高的自杀意念率和住院精神科治疗率可能需要在对 PNES 女性退伍军人进行筛查和干预时特别考虑。
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