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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?.

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Psychological Aspects of Epilepsy

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  1. Psychological Aspects of Epilepsy Kami Marchese, Psy.D.

  2. True or False? • It is normal to feel depressed when you have epilepsy

  3. True or False? • Suicide is a major cause of death in epilepsy.

  4. True or False? • Depression can be caused by antiepileptic medication.

  5. True or False? • Feelings of anxiety and/or depression can be the manifestation of a seizure.

  6. Most Common Psychological Conditions In Epilepsy • *Depression • Anxiety • Mania • Psychosis

  7. 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

  8. Types of Depression • Major Depressive Disorder (MDD) • Dysthymic Disorder The difference between the two is based on severity, persistence, and chronicity.

  9. Lifetime Prevalence of Depression in Adults • 10-20% - controlled epilepsy • 20-60% - recurrent seizures • 5.8% - in general nonepileptic population

  10. 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

  11. 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

  12. Stages of Adjustment • Disbelief • Shock • Denial • Fear • Anger • Depression • Anxiety • Guilt

  13. 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

  14. Why In Epilepsy?Physiological (Directly Caused by Epilepsy) • Reaction to seizure medication • Brain regions are the same • Endocrine or metabolic effects

  15. 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

  16. 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

  17. 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

  18. Inter-ictal Depression • Most common among PWE • Commonly presents as dysthymic disorder with waxing and waning course

  19. Ictal Depression • Can be the clinical expression of a simple partial seizure where depression is the predominant or only feature

  20. Depression and Quality of Life (QOL) • Studies have shown that depression is the strongest predictor of QOL • Even more than seizure frequency and severity

  21. Cognitive Functioning • Diminished attention and concentration • Memory loss • Reduced processing speed • Difficulty making decisions

  22. True or False? • It is normal to feel depressed when you have epilepsy. TRUE

  23. True or False? • Suicide is a major cause of death in epilepsy. TRUE

  24. True or False? • Feelings of anxiety and/or depression can be the manifestation of a seizure. TRUE

  25. True or False? • Depression can be caused by antiepileptic medication. TRUE

  26. Next Steps • Seek treatment • Anti-depressant medication • Individual or group counseling

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