Research & Development Unit, Dayanand Medical College, Ludhiana, India; Department of Neurology, Dayanand Medical College, Ludhiana, India.
Research & Development Unit, Dayanand Medical College, Ludhiana, India; Department of Neurology, Dayanand Medical College, Ludhiana, India; UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom.
Epilepsy Behav. 2022 Dec;137(Pt A):108965. doi: 10.1016/j.yebeh.2022.108965. Epub 2022 Nov 4.
Psychiatric disorders are frequent among people with epilepsy but often under-recognized. The diagnosis and treatment of these disorders in low- and low-middle-income countries (LMICs) are challenging.
This cross-sectional survey included people recruited during a community epilepsy screening program involving 59,509 individuals from poor communities in Ludhiana in Northwest India. Adults (age ≥18 years) with confirmed epilepsy on antiseizure medications were screened for depression and anxiety using the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and Generalized Anxiety Disorder-7 (GAD-7) twice over two years of follow-up. They were later interviewed for symptoms using the Brief Psychiatric Rating Scale, which was then confirmed by assessments by an experienced psychiatrist.
Of the 240 people with confirmed epilepsy, 167 (70%) were adults, of whom, 116 (70%) eventually participated in the study. The NDDI-E with a cut-off of 15 identified depression in 14 (12%) of 116 people after one year of follow-up and 17 (15%) at two years. The GAD-7 using a cut-off of 6 identified 22 (19%) at one year and 32 (28%) with anxiety at two years. The area under the curves for NDDI-E was estimated as 0.62 (CI, 0.51-0.73; SE: 0.06; p = 0.04) and for GAD-7 as 0.62 (CI, 0.46-0.78; SE: 0.08; p = 0.12). Brief Psychiatric Rating Scale identified 63 (54%) people with psychiatric symptoms, for whom, a psychiatric diagnosis was confirmed in 60 (52%). A psychiatric diagnosis was associated with education below high school [Odds Ratio (OR): 2.59, CI, 1.12-5.1; p = 0.03], later age of seizure onset (OR, 1.05, CI: 1.0-1.10; p = 0.04), seizure frequency of at least one/year at enrolment (OR, 2.36, CI: 1.0-5.58; p = 0.05) and the use of clobazam (OR, 5.09, CI, 1.40-18.42; p = 0.01).
Depression and anxiety are common in people with epilepsy. Our findings underscore the low yields of screening instruments, NDDI-E and GAD-7, and comparatively better professionally-administered diagnostic assessments in resource-limited settings in LMICs. Moreover, previously established cut-offs do not apply to the community studied.
精神障碍在癫痫患者中很常见，但往往未被识别。在中低收入国家（LMICs），这些疾病的诊断和治疗具有挑战性。
本横断面研究纳入了在印度西北部卢迪亚纳贫困社区进行的社区癫痫筛查项目中招募的参与者。使用神经障碍抑郁量表癫痫版（NDDI-E）和广泛性焦虑障碍 7 项（GAD-7）在两年的随访中对正在服用抗癫痫药物的确诊癫痫成人（年龄≥18 岁）进行两次抑郁和焦虑筛查。随后使用Brief Psychiatric Rating Scale 对他们进行症状访谈，然后由经验丰富的精神科医生进行评估以确认诊断。
在 240 名确诊癫痫患者中，有 167 名（70%）为成年人，其中 116 名（70%）最终参与了研究。在一年的随访后，NDDI-E 的截断值为 15，发现 14 名（12%）患者患有抑郁症，两年后为 17 名（15%）。GAD-7 的截断值为 6，一年时有 22 名（19%），两年时有 32 名（28%）患有焦虑症。NDDI-E 的曲线下面积估计为 0.62（95%置信区间，0.51-0.73；SE：0.06；p=0.04），GAD-7 为 0.62（95%置信区间，0.46-0.78；SE：0.08；p=0.12）。Brief Psychiatric Rating Scale 发现 63 名（54%）有精神症状的患者，其中 60 名（52%）被确诊为精神疾病。精神疾病诊断与高中以下教育相关（优势比[OR]：2.59，95%置信区间，1.12-5.1；p=0.03），癫痫发作年龄较晚（OR，1.05，95%置信区间：1.0-1.10；p=0.04），入组时至少每年发作一次（OR，2.36，95%置信区间：1.0-5.58；p=0.05）和使用氯巴占（OR，5.09，95%置信区间，1.40-18.42；p=0.01）。
癫痫患者中常见抑郁和焦虑。我们的研究结果强调了在资源有限的中低收入国家（LMICs）中，筛查工具、NDDI-E 和 GAD-7 的低检出率，以及专业人员管理的诊断评估相对更好。此外，先前确定的截断值不适用于本研究的社区。
