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Psychological Aspects of Epilepsy Psychological Aspects of Epilepsy
Kami Marchese, Psy.D.
True or False?
It is normal to feel depressed when you have epilepsy
True or False?
Suicide is a major cause of death in epilepsy.
True or False?
Depression can be caused by antiepileptic medication.
True or False?
Feelings of anxiety and/or depression can be the manifestation of a seizure.
Most Common Psychological Conditions In Epilepsy
*Depression Anxiety Mania Psychosis
Symptoms of Depression
Depressed mood most of the day Loss of interest in activities Feelings of worthlessness Decreased concentration, indecisiveness Increased irritability Recurrent thoughts of death Change in appetite, weight loss or gain Sleep disturbance Loss of energy Psychomotor agitation or retardation
Types of Depression
Major Depressive Disorder (MDD) Dysthymic Disorder
The difference between the two is
based on severity, persistence, and
chronicity.
Lifetime Prevalence of Depression in Adults
10-20% - controlled epilepsy 20-60% - recurrent seizures
5.8% - in general nonepileptic
population
Suicide
Suicide is 5-10 times higher in PWE than in the general population
It is up to 25 times higher in people with temporal lobe partial seizures vs general population
What is Unique About Epilepsy? Psychosocial
Reaction to illness itself Lack of acceptance Poor adjustment to the diagnosis
Individual’s adjustment Impact of epilepsy on the family
Stigma and discrimination Lack of control and fear caused by random
seizure occurrence
Stages of Adjustment Disbelief Shock Denial Fear Anger Depression Anxiety Guilt
Why In Epilepsy? Psychosocial
Lack of social support Need to make significant adjustments in
lifestyle Work limitations
Dangerous heights, operating machinery, changing or cutting back on hours
Giving up driving privileges Childbearing concerns
Why In Epilepsy?Physiological
(Directly Caused by Epilepsy)
Reaction to seizure medication Brain regions are the same Endocrine or metabolic effects
Antiepileptic Drugs (AED)that can cause depression
Phenobarbital Primidone (Mysoline) Tiagabine (Gabitril) Vigabatrin (Sabril) Felbamate (Felbatol) Topiramate (Topamax) *Carbamazepine (Tegretol) and
Valproic Acid (Depakote) *less frequent
Physiological Causes of Mood Disorders
Overlap in brain regions involved in epilepsy and depression PWE who had temporal lobe scarring had
higher depression scores than other patients
Depression is more frequent in PWE of temporal and frontal lobe origin
Comorbidity of epilepsy and migraine Strong association between migraine and
depression
Depression Specific to Epilepsy
Classified according to the temporal relation to seizure occurrence Pre-ictal: Prior to seizure onset
Ictal: During the seizure and the expression of seizure
Post-ictal: After seizure (includes up to 120 hours)
Inter-ictal: Unrelated to seizure occurrence
Inter-ictal Depression
Most common among PWE Commonly presents as
dysthymic disorder with waxing and waning course
Ictal Depression
Can be the clinical expression of a simple partial seizure where depression is the predominant or only feature
Depression and Quality of Life (QOL)
Studies have shown that depression is the strongest predictor of QOL
Even more than seizure frequency and severity
Cognitive Functioning
Diminished attention and concentration
Memory loss Reduced processing speed Difficulty making decisions
True or False?
It is normal to feel depressed when
you have epilepsy.
TRUE
True or False?
Suicide is a major cause of death in epilepsy.
TRUE
True or False?
Feelings of anxiety and/or depression can be the manifestation of a seizure.
TRUE
True or False?
Depression can be caused by antiepileptic medication.
TRUE
Next Steps
Seek treatment Anti-depressant
medication Individual or
group counseling