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Systematic Literature Review of Psychiatric Comorbidities in Adults with Epilepsy
BACKGROUND AND PURPOSE: Mental illness is disproportionately common in people with epilepsy (PWE). This systematic literature review identified original research articles that reported the prevalence of psychiatric comorbidities based upon clinical assessments in a sample of PWE and assessed the cli...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Korean Neurological Association
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053555/ https://www.ncbi.nlm.nih.gov/pubmed/33835737 http://dx.doi.org/10.3988/jcn.2021.17.2.176 |
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author | Lu, Elaine Pyatka, Nataliya Burant, Christopher J Sajatovic, Martha |
author_facet | Lu, Elaine Pyatka, Nataliya Burant, Christopher J Sajatovic, Martha |
author_sort | Lu, Elaine |
collection | PubMed |
description | BACKGROUND AND PURPOSE: Mental illness is disproportionately common in people with epilepsy (PWE). This systematic literature review identified original research articles that reported the prevalence of psychiatric comorbidities based upon clinical assessments in a sample of PWE and assessed the clinical features of the populations found in studies included in our review of mental health comorbidity. METHODS: The included articles were written in English and published from 2008 to 2018, and focused on adults aged ≥18 years who had psychiatric diagnoses determined in clinical assessments, such as those found in medical records, clinician psychiatric evaluations, structured diagnostic interviews, and mental health screening questionnaires specific for a psychiatric disorder. The primary outcome was the prevalence of psychiatric comorbidities as a percentage of the total sample of PWE. Additional data included the overall sample size, mean age, epilepsy type, study design, and method of diagnosis. A modified Newcastle Ottawa Scale was used to assess the quality of the studies. All 23 articles that were consistent with the inclusion criteria were related to observational studies. RESULTS: Mood disorders and anxiety disorders were the most common psychiatric comorbidities, with prevalence rates of 35.0% and 25.6%, respectively. Major depressive disorder was the most common mood disorder, with a prevalence of 24.2%. Post-traumatic stress disorder (PTSD) had the highest reported prevalence among anxiety disorders, at 14.2%, followed by general anxiety disorder at 11.1%. Other comorbidities included psychosis (5.7%), obsessivecompulsive disorder (3.8%), schizophrenia (1.7%), bipolar disorder (6.2%), and substance abuse (7.9%). The pooled prevalence of suicidality, as reported for two studies, was 9.3%. Temporal lobe epilepsy (TLE) was associated with higher levels of psychiatric comorbidity. Two (8.7%) of the 23 studies compared psychiatric comorbidities in TLE with that of extratemporal lobe epilepsy (ETLE), and one of these two studies found that depression was more common in TLE (53.8%) than in ETLE (25%). Regarding seizure types, partial seizures were associated with a higher prevalence of depression vs generalized seizures. CONCLUSIONS: This systematic literature review of recent original research found a relatively high prevalence of mental health comorbidities in PWE. Mood and anxiety disorders are the most common comorbidities, while psychotic spectrum conditions such as schizophrenia and bipolar disorder are much rarer. The prevalence of comorbidity may vary with the epilepsy type and treatment responsiveness. These findings suggest that screening tools for depression and anxiety should be included as part of the training for epilepsy care, while resources for other relatively common conditions such as PTSD and substance abuse disorders should be readily available to neurology specialists who treat PWE. |
format | Online Article Text |
id | pubmed-8053555 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Korean Neurological Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-80535552021-04-29 Systematic Literature Review of Psychiatric Comorbidities in Adults with Epilepsy Lu, Elaine Pyatka, Nataliya Burant, Christopher J Sajatovic, Martha J Clin Neurol Review BACKGROUND AND PURPOSE: Mental illness is disproportionately common in people with epilepsy (PWE). This systematic literature review identified original research articles that reported the prevalence of psychiatric comorbidities based upon clinical assessments in a sample of PWE and assessed the clinical features of the populations found in studies included in our review of mental health comorbidity. METHODS: The included articles were written in English and published from 2008 to 2018, and focused on adults aged ≥18 years who had psychiatric diagnoses determined in clinical assessments, such as those found in medical records, clinician psychiatric evaluations, structured diagnostic interviews, and mental health screening questionnaires specific for a psychiatric disorder. The primary outcome was the prevalence of psychiatric comorbidities as a percentage of the total sample of PWE. Additional data included the overall sample size, mean age, epilepsy type, study design, and method of diagnosis. A modified Newcastle Ottawa Scale was used to assess the quality of the studies. All 23 articles that were consistent with the inclusion criteria were related to observational studies. RESULTS: Mood disorders and anxiety disorders were the most common psychiatric comorbidities, with prevalence rates of 35.0% and 25.6%, respectively. Major depressive disorder was the most common mood disorder, with a prevalence of 24.2%. Post-traumatic stress disorder (PTSD) had the highest reported prevalence among anxiety disorders, at 14.2%, followed by general anxiety disorder at 11.1%. Other comorbidities included psychosis (5.7%), obsessivecompulsive disorder (3.8%), schizophrenia (1.7%), bipolar disorder (6.2%), and substance abuse (7.9%). The pooled prevalence of suicidality, as reported for two studies, was 9.3%. Temporal lobe epilepsy (TLE) was associated with higher levels of psychiatric comorbidity. Two (8.7%) of the 23 studies compared psychiatric comorbidities in TLE with that of extratemporal lobe epilepsy (ETLE), and one of these two studies found that depression was more common in TLE (53.8%) than in ETLE (25%). Regarding seizure types, partial seizures were associated with a higher prevalence of depression vs generalized seizures. CONCLUSIONS: This systematic literature review of recent original research found a relatively high prevalence of mental health comorbidities in PWE. Mood and anxiety disorders are the most common comorbidities, while psychotic spectrum conditions such as schizophrenia and bipolar disorder are much rarer. The prevalence of comorbidity may vary with the epilepsy type and treatment responsiveness. These findings suggest that screening tools for depression and anxiety should be included as part of the training for epilepsy care, while resources for other relatively common conditions such as PTSD and substance abuse disorders should be readily available to neurology specialists who treat PWE. Korean Neurological Association 2021-04 2021-03-18 /pmc/articles/PMC8053555/ /pubmed/33835737 http://dx.doi.org/10.3988/jcn.2021.17.2.176 Text en Copyright © 2021 Korean Neurological Association https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Review Lu, Elaine Pyatka, Nataliya Burant, Christopher J Sajatovic, Martha Systematic Literature Review of Psychiatric Comorbidities in Adults with Epilepsy |
title | Systematic Literature Review of Psychiatric Comorbidities in Adults with Epilepsy |
title_full | Systematic Literature Review of Psychiatric Comorbidities in Adults with Epilepsy |
title_fullStr | Systematic Literature Review of Psychiatric Comorbidities in Adults with Epilepsy |
title_full_unstemmed | Systematic Literature Review of Psychiatric Comorbidities in Adults with Epilepsy |
title_short | Systematic Literature Review of Psychiatric Comorbidities in Adults with Epilepsy |
title_sort | systematic literature review of psychiatric comorbidities in adults with epilepsy |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053555/ https://www.ncbi.nlm.nih.gov/pubmed/33835737 http://dx.doi.org/10.3988/jcn.2021.17.2.176 |
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