Neuropsychiatric aspects of epilepsy

Epilepsy is one of the commonest neurological disorders, affecting approximately 50 million people worldwide, and it is now recognized as a disorder of the brain characterized not only by recurrent seizures, but also by its neurobiological, cognitive, psychological, and social consequences. In general, psychiatric disorders show a uniformly increased prevalence in epilepsy, as compared to the general population. This chapter focuses on major axis I disorders encountered in adults with epilepsy, namely mood and anxiety disorders and psychoses, with special emphasis on differential diagnosis and treatment. The contribution of epilepsy treatment, such as epilepsy surgery and antiepileptic drugs, is also discussed. Psychogenic non-epileptic seizures (PNES) resemble epileptic seizures, but they are not caused by ictal epileptiform activity. PNES represent another frequently encountered condition in neuropsychiatric clinics. Epidemiology, differential diagnosis and management of PNES are discussed.

Associations of psychosis-risk symptoms with quality of life and self-rated health in the Community

Background: Understanding factors related to poor quality of life (QoL) and self-rated health (SRH) in clinical high-risk (CHR) for psychosis is important for both research and clinical applications. We investigated the associations of both constructs with CHR symptoms, axis-I disorders, and sociodemographic variables in a community sample. Methods: In total, 2683 (baseline) and 829 (3-year follow-up) individuals of the Swiss Canton of Bern (age-at-baseline: 16–40 years) were interviewed by telephone regarding CHR symptoms, using the Schizophrenia Proneness Instrument for basic symptoms, the Structured Interview for Psychosis-Risk Syndromes for ultra-high risk (UHR) symptoms, the Mini-International Neuropsychiatric Interview for current axis-I disorders, the Brief Multidimensional Life Satisfaction Scale for QoL, and the 3-level EQ-5D for SRH. Results: In cross-sectional structural equation modelling, lower SRH was exclusively significantly associated with higher age, male gender, lower education, and somatoform disorders. Poor QoL was exclusively associated only with eating disorders. In addition, both strongly interrelated constructs were each associated with affective, and anxiety disorders, UHR and, more strongly, basic symptoms. Prospectively, lower SRH was predicted by lower education and anxiety disorders at baseline, while poorer QoL was predicted by affective disorders at baseline. Conclusions: When present, CHR, in particular basic symptoms are already distressful for individuals of the community and associated with poorer subjective QoL and health. Therefore, the symptoms are clinically relevant by themselves, even when criteria for a CHR state are not fulfilled. Yet, unlike affective and anxiety disorders, CHR symptoms seem to have no long-term influence on QoL and SRH.

A depressão nas mulheres de meia-idade: Estudo sobre as utentes dos cuidados de saúde primários

É estudada a prevalência de perturbações depressivas numa amostra de mulheres com idades compreendidas entre os 35 e os 65 anos, utentes dos cuidados de saúde primários. Todas as mulheres (n = 179) responderam à versão portuguesa da Center for Epidemiologic Studies Depression Scale (CES-D) e, as que aceitaram (n = 127), participaram numa entrevista clínica estruturada adaptada do módulo de avaliação das perturbações do humor da Structured Clinical Interwiew for DSM-IV Axis I Disorders (SCID-I), a fim de avaliar a presença de várias formas de depressão segundo os critérios do DSM-IV. Verificou-se que 13% destas mulheres satisfaziam os critérios para o diagnóstico de episódio depressivo major, 19% satisfaziam os critérios para perturbação distímica e 5,5% satisfaziam os critérios propostos para episódio depressivo minor. São analisadas as relações da idade, nível de instrução, estatuto conjugal, ter filhos, ter filhos em casa, ter filhos a cargo e outras variáveis sociodemográficas com a ocorrência de perturbações depressivas. DOI: http://dx.doi.org/10.17575/rpsicol.v19i1/2.397

Study of Life Stressors and Suicidal Intent of Suicidal Attempters with or Without Axis 1 Psychiatric Comorbidities: A Case Control Study

Background: Suicide attempts and Psychiatric illness are interrelated in a complex and bi directional way such that either of them leaves an impact on the other. People with Psychiatric morbidity are at high risk of attempting suicide. Even though extensive research works have been done in suicide, there is a paucity of studies focusing the mentally ill attempters, especially with reference to Intent and Lethality. Hence the present study designed to study the various parameters , contributing factors and Risk factors associated with suicide attempts of patient with Axis I disorders. Aim: 1.To assess the life stressors and suicidal intent in suicide attempters with Axis I psychiatric disorders. 2. To assess the life stressors and suicidal intent in suicide attempters without Axis I psychiatric disorders. 3. Compare the life stressors and suicidal intent in suicide attempters with and without axis I disorders. Material and Methods: The study subjects of this case control study were recruited from the patients referred to the department of Psychiatry from Medicine, Surgical and Intensive care wards for Psychiatric evaluation.30 patients of attempted suicide who had Axis I diagnosis as per the ICD – 10 criteria were taken as cases and 30 age and sex matched patients were taken as controls. Results: 1.The suicidal intent is high in Suicide attempters with Axis I Disorders. 2. The lethality is high in Suicidal attempters with Axis I Disorders. 3. Stress factors play a major role in Suicide attempters with Axis I disorders.

Co-morbidity of personality disorder and clinical syndrome in high-risk incarcerated offenders

Purpose In light of the clinical importance of understanding co-morbidity within offender populations, the purpose of this paper is to examine the prevalence and comorbidities of clinical disorder (Axis I) and personality disorder (Axis II) within a sample of high risk, male offenders located in a high secure, prison-based personality disorder treatment service. Design/methodology/approach The study utilised clinical assessment data for both Axis I diagnoses (Structured Clinical Interview for DSM-IV) and Axis II diagnoses (International Personality Disorder Examination) of 115 personality disordered offenders who met the criteria for the treatment service between 2004 and 2015. Findings Co-morbidity between Axis I and Axis II diagnoses was high, with 81 per cent of the sample having co-morbid personality disorder and clinical disorder diagnosis. The most prevalent Axis I disorder was substance misuse, and Axis II was antisocial, borderline, and paranoid personality disorder. Following χ2 analysis, Cluster A personality disorder demonstrated co-morbidity with both mood disorder and schizophrenia/other psychotic disorder. Paranoid, schizoid, narcissistic, and avoidant personality disorder demonstrated a level of co-morbidity with Axis I disorders. There was no association found between the clinical disorders of substance use and anxiety with any personality disorder within this sample. Practical implications In part these results suggest that certain Axis II disorders may increase the risk of lifetime Axis I disorders. Originality/value The findings of no co-morbidity between the clinical disorders of substance use and anxiety with any personality disorder within sample are inconsistent to previous findings.

Gir pålitelige tegn gyldige diagnoser? Den psykiatriske revolusjonen og bruk av diagnoseverktøyet SCID på en massemorder

Både reformen av den amerikanske diagnosemanualen Diagnostic and Statistical Manual of Mental Disorders (DSM) i 1980 og utviklingen av diagnoseverktøy basert på denne reformen, som Structured Clinical Interview for DSM Axis I Disorders (SCID I), har blitt kalt en revolusjon innenfor psykiatrien. Det viktigste med denne revolusjonen var at den la til grunn observerbare tegn og symptomer for diagnostiseringen. Den skulle, som de viktigste pådriverne for endringen framhevet, ”focus on observable behavior only”, og ikke gjøre slik psykatrien hadde gjort tidligere, å fokusere på ”unconscious processes.” Med fokus på det observerbare skulle psykiatriens diagnoser og verktøy bli mer pålitelige. Revolusjonen var en epistemologisk transformasjon. Denne artikkelen viser at den også var en ontologisk transformasjon. Grunnlaget for å fokusere på ”observable behavior only” var en tillit til statistiske analyser og at sykdommen ville vise seg gjennom et bestemt antall forekomster av tegn og symptomer. Fra et statistisk grunnlag som i høyden kunne brukes til å si noe om sannsynlighet for en sykdom, ble bestemte fordelinger av tegn brukt som grunnlag for å konkludere om bestemte sykdommers 156 Tidsskrift for Forskning i Sygdom og Samfund, nr. 25, 157-171 eksistens. Gyldigheten til sykdommer ble basert på statistiske beregninger av forekomster av observerbare tegn. Artikkelen problematiserer både det epistemologiske og ontologiske grunnlaget for denne revolusjonen gjennom en studie av de vitenskapelige arbeider og begrunnelser som ledet fram til transformasjonen, samt ved studie av diagnoseverktøyet SCID i bruk. SCID blir studert gjennom bruken av verktøyet på massemorderen Anders Behring Breivik. Dette caset er et unikt materiale siden SCID ble brukt to ganger av to forskjellige team av psykiatere, og med diametralt forskjellig utfall. Caset brukes dermed til å tydeliggjøre svakhetene med grunnlagstenkningen. Do reliable signs give valid diagnoses? The psychiatric revolution and the use of its diagnostic instrument on a mass murdererThe reform of the American diagnostic manual for mental illnesses, Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980 and the development of psychometric instruments based on this reform, like the Structured Clinical Interview for DSM Axis I Disorders (SCID I), has been called a revolution in psychiatry. The most important element in this revolution was that the diagnostic criteria was based on a knowledge production that “focus on observable behavior only”, and not, as psychiatry had done earlier, with “reference to unconscious processes.” By focusing on the observable, the diagnostic criteria and instruments in psychiatry should become more reliable. The revolution represented an epistemological transformation. This article shows that it was also an ontological transformation. The grounding for focusing on “observable behavior only” was a trust in statistical analyses and a belief that a specific illness could be found from specific number of appearances of signs and symptoms. From a statistical grounding, which could be used for saying something about the probability of an illness, specific distributions of signs were used for claiming the existence of illness. The validity of illnesses was based on statistical distributions of observable signs. This article problematizes the epistemological and ontological grounding of this revolution through a study of the scientific publications leading to the revolution and also by studying the use of the diagnostic instrument SCID. The latter is studied through the case of the mass murderer Anders Behring Breivik. This case gives a unique material, as Breivik was tested twice by two different psychiatric expert teams, but with diametrically opposed outcomes. The case is used to make evident some of the inherent weaknesses of the grounding.