Systematic Literature Review of Psychiatric Comorbidities in Adults with Epilepsy.
Systematic Literature Review of Psychiatric Comorbidities in Adults with Epilepsy.
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DOI：
10.3988/jcn.2021.17.2.176
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
Sajatovic M
中科院分区：
文献类型：
--
作者：
Lu E;Pyatka N;Burant CJ;Sajatovic M
精神疾病在癫痫(PWE)患者中尤为常见。这项系统的文献回顾确定了最初的研究文章，这些文章基于对PWE样本的临床评估报告了精神疾病的患病率，并评估了我们对精神健康共病的研究中发现的人群的临床特征。收录的文章是用英语写的，从2008年到2018年出版，重点是18岁的成年人，他们的精神诊断是通过临床评估确定的，例如在医疗记录、临床医生精神评估、结构化诊断访谈和精神疾病特定的精神健康筛查问卷中发现的那些。主要结果是精神合并症的患病率占PWE总样本的百分比。其他数据包括总体样本量、平均年龄、癫痫类型、研究设计和诊断方法。采用改良的渥太华纽卡斯尔量表对研究质量进行评估。所有23篇符合纳入标准的文章都与观察性研究有关。心境障碍和焦虑障碍是最常见的精神疾病共病，患病率分别为35.0%和25.6%。重度抑郁障碍是最常见的情绪障碍，患病率为24.2%。在焦虑症中，创伤后应激障碍(PTSD)的报告患病率最高，为14.2%，其次是一般焦虑症，为11.1%。其他合并症包括精神病(5.7%)、强迫症(3.8%)、精神分裂症(1.7%)、双相情感障碍(6.2%)和药物滥用(7.9%)。根据两项研究的报告，自杀的共同流行率为9.3%。颞叶癫痫(TLE)与较高的精神共病水平相关。在23项研究中，两项(8.7%)比较了TLE和颞叶外叶癫痫(ETLE)的精神并发症，其中一项研究发现TLE(53.8%)比ETLE(25%)更常见抑郁。在癫痫发作类型方面，部分癫痫发作与抑郁症的患病率高于全身性癫痫发作。这项对最近原始研究的系统文献回顾发现，PWE患者中精神健康并存的患病率相对较高。情绪障碍和焦虑症是最常见的共病，而精神分裂症和双相情感障碍等精神病谱系疾病要罕见得多。共病的患病率可能因癫痫类型和治疗反应而异。这些发现表明，抑郁症和焦虑症的筛查工具应该作为癫痫护理培训的一部分，而治疗PWE的神经学专家应该随时可以获得其他相对常见疾病的资源，如创伤后应激障碍和药物滥用障碍。
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. 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. 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. 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.
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