Clinical and psychosocial factors associated with fatigue in patients with Parkinson's disease

Fatigue is an important contributor to poor quality of life. The aim of our research was to identify factors associated with fatigue among patients with Parkinson's disease (PD). The sample consisted of 150 patients. The Multidimensional Fatigue Inventory (MFI), Unified Parkinson's Disease Rating Scale (UPDRS), Hospital Anxiety and Depression Scale (HADS) and Charlson co-morbidity index were used for analysis. Demographic data were obtained in a structured interview. T-test, χ²-test and general linear regression were used. Fatigue was reported in 81% of the patients, with the worst scores in physical fatigue. Mood disorders and worse UPDRS scores were associated with fatigue.     

癫痫患儿的焦虑情绪及影响因素分析

目的 观察癫痫患儿的焦虑状态,并探讨患儿的性别、抑郁、个性情况以及监护人的焦虑、抑郁和个性等对患儿焦虑状态的影响.方法 采用儿童社交焦虑量表(SASC)、儿童抑郁自评量表(DSRS)、焦虑自评量表(SAS)、Beck抑郁自评问卷(BDI)以及儿童和成人艾森克个性问卷(EPQ)对95例癫痫患儿及其监护人的焦虑、抑郁、个性的3个维度进行评分,同时与对照组118例儿童的焦虑状态进行比较.结果 癫痫患儿SASC得分较对照组儿童高,癫痫组女童较男童得分高,患儿各年龄段的焦虑水平随年龄增长而增高,13～15岁癫痫组儿童得分较同年龄段对照组高,差异均有统计学意义(P＜0.05).癫痫组SASC得分与DSRS、儿童EPQN、P量表得分呈正相关,与E量表得分呈负相关;与监护人SAS得分呈正相关,与监护人EPQ E量表得分呈负相关;而与监护人BDI以及EPQP、N量表得分之间无相关关系.监护人文化程度相同时,癫痫组和对照组SASC得分差异无统计学意义(P＞0.05);监护人文化程度不同时,癫痫组SASC得分差异无统计学意义(P＞0.05).监护人职业相同时,癫痫组和对照组SASC得分差异无统计学意义(P＞0.05);监护人职业不同时,癫痫组SASC得分差异无统计学意义(P＞0.05).患儿发作形式、影像学表现及病程不同时,患儿SASC得分差异无统计学意义(P＞0.05).结论 癫痫患儿的焦虑水平较正常儿童升高,且与患儿的性别、年龄、患儿和监护人的焦虑或抑郁水平及某些个性特征相关,而与患儿的发作形式、影像学表现、病程长短、监护人的职业和文化程度无关.     

Association of subjective anxiety, depression, and sleep disturbance with quality-of-life ratings in adults with epilepsy

Purpose :  To determine the relative contributions of subjective anxiety, depression, sleep disturbance, and seizure-related variables to quality-of-life scores in adults with epilepsy, and the interrelationships among these factors.
Methods :  Consecutive adult patients with epilepsy attending neurology outpatient clinics were recruited. Patients completed the following scales: Hospital Anxiety and Depression Scale (HADS), Hamilton Anxiety Rating Scale, Medical Outcomes Study (MOS) Sleep Scale, Epworth Sleepiness Scale, and Quality of Life in Epilepsy Inventory-31 (QOLIE-31). Univariate and multivariate linear regression models were used to identify variables associated with QOLIE-31 overall score. Path analysis model was constructed to test for interrelations between the variables.
Results :  Two hundred forty-seven patients completed the questionnaires. By multivariate analysis, in order of degree of contribution, HADS anxiety subscale score, MOS Sleep Scale Sleep Problems Index score, HADS depression subscale score, number of current antiepileptic drugs used, and seizure freedom in the past 4 weeks, significantly correlated with QOLIE-31 overall score, accounting for 65.2% of the variance. Complex interrelationships were present between these factors. A general linear model to predict QOLIE-31 overall score in the presence of these factors was constructed.
Conclusion :  Subjective anxiety, depression, and sleep disturbance exerted greater effect than short-term seizure control on quality of life scores of patients with epilepsy. These factors should be considered simultaneously when evaluating effects of treatment on quality of life.     

癫癎患者生活质量的研究

目的探讨成年癫癎患者生活质量状况及其影响因素.方法实验组86例癫癎患者,对照组59名健康自愿受试者.用世界卫生组织生存质量量表中文版简表(Q0 L-BREF)、癫癎患者生活质量量表(QOLIE-31)评定生活质量;用症状自评量表评价心境健康;分析各种影响因素的作用.结果实验组生活质量在心理领域得分比对照组低(P＜0.05);除精力/疲乏领域外的各领域均有50%以上实验组QOLIE-31得分低于平均水平;实验组的抑郁、焦虑分均比对照组明显增高(P＜0.0001);影响QOLIE总分的三个因素按作用大小依次是抑郁、焦虑和用药种数.结论癫癎患者生活质量下降,心境健康恶化;对总体QOLIE影响最大的因素是抑郁、焦虑和用药种数.     

Anxiety and depression in children with epilepsy and their mothers

OBJECTIVE: Children with epilepsy have high rates of depression and anxiety. The majority of studies concentrate on the children with epilepsy, but the emotional impact of epilepsy on family members is of clinical concern. In this cross-sectional study we aimed to examine the association between epilepsy in childhood and adolescence, and anxiety and depression in these patients and their mothers. METHODS: We studied 35 children and adolescents with seizures (age range, 7-19 years), 35 gender-matched healthy controls (age range, 8-17) who did not have any chronic medical illness, and mothers of these individuals (n=70) in a cross-sectional analysis. We administered the Kovac Child Depression Inventory (CDI) and State-Trait Anxiety Inventory for Children (STAIc) to the children. We administered the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) to the mothers of these children. Pearson correlations were used to analyze dependence between variables, and Student's t test was used to compare mean values between test scores. RESULTS: Patients with epilepsy had higher CDI scores (mean+/-SD, 12.48+/-6.35) than controls (9.31+/-5.11) (P<0.05), whereas the STAIc scores did not differ between cases (34.03+/-8.29) and controls (35.20+/-6.23) (P<0.05). Mothers of children with epilepsy did not have more depression or anxiety symptoms than mothers of children without epilepsy as measured by BDI and STAI scores (P>0.05). There was no correlation between mothers' scores and patients' or controls' scores. CONCLUSIONS: These results support findings from previous studies that children and adolescents with epilepsy have a higher frequency of depressive but not anxiety symptoms than the general population of healthy children and that this is independent of their mothers' symptoms.     

Differentiating anxiety and depression symptoms in patients with partial epilepsy

Anxiety and depression are separate psychiatric conditions that are often interrelated. This study examines whether they exist independently in this population of patients with partial epilepsy and if they affect all quality-of-life domains. Adult epilepsy patients taking two or more antiepileptic drugs completed a health status survey including demographic items, the Hospital Anxiety and Depression Scale, and the Quality of Life in Epilepsy-10 (QOLIE-10). The questionnaire was completed by 201 epilepsy patients. Symptom prevalences of anxiety (52% none, 25% mild, 16% moderate, 7% severe) and depression (62% none, 20% mild, 14% moderate, 4% severe) were high. All health-related quality-of-life (HRQOL) domains worsened significantly with increasing levels of anxiety and depression: Total QOLIE-10 scores decreased from 72+/-18 in patients with no anxiety to 54+/-13 in those with mild, 48+/-18 in those with moderate, and 40+/-23 in those with severe anxiety (P<0.0001). Total QOLIE-10 scores decreased from 70+/-16 in patients with no depression to 50+/-16 in those with mild, 45+/-16 in those with moderate, and 24+/-21 in those with severe depression (P<0.0001). No significant difference in anxiety scores was observed controlling for seizure frequency or epilepsy duration. Regression analyses showed that anxiety and depression account for different proportions of variance as predictors of HRQOL (R2=0.337 (anxiety) and 0.511 (depression)). The data suggest that patients may benefit from increased attention to the role of anxiety separately from depression.     

合并癫痫的幕上低级别胶质瘤病人癫痫预后的影响因素分析

目的探讨合并癫痫的幕上低级别胶质瘤病人癫痫预后的影响因素。方法回顾性分析2015年6月至2019年1月手术治疗的80例合并癫痫的幕上低级别胶质瘤的临床资料。术后1年,采用Engel分级评估癫痫预后,Ⅰ级为预后良好,Ⅱ~Ⅳ级为预后不良。用多因素logistic回归分析检验影响癫痫预后的影响因素;受试者工作特征(ROC)曲线分析术前癫痫发作频率预测癫痫预后的价值。结果80例中,术后癫痫预后良好59例,预后不良21例。多因素logistic回归分析结果显示,异柠檬酸脱氢酶(IDH)1突变和术前癫痫发作频率高是胶质瘤病人术后癫痫的独立危险因素(P<0.05),全切肿瘤和术后化疗是保护性因素(P<0.05)。术前癫痫发作频率预测癫痫预后的ROC曲线下面积为0.805(95%置信区间0.685~0.914;P<0.05);当术前癫痫发作频率≥2次/月时,预测术后癫痫预后不良的灵敏度和特异度分别为92.86%和46.85%。结论IDH1突变和术前癫痫发作频率高是合并癫痫的幕上低级别胶质瘤病人癫痫预后不良的危险因素,而肿瘤全切除和术后化疗明显改善癫痫预后。     

失眠患者心理痛苦感调查及其影响因素分析

目的调查失眠患者的心理痛苦水平及其影响因素。方法纳入睡眠门诊147例失眠患者,使用心理温度计(distress thermometer, DT)评估失眠患者的心理痛苦水平,采用一般资料问卷、失眠严重指数、贝克抑郁量表、贝克焦虑量表、简化版睡眠相关不良信念和态度量表、社会支持评定量表、简易应对方式问卷评估失眠患者临床特征,分析其心理痛苦影响因素。结果 147例失眠患者中存在显著心理痛苦者114例,非显著心理痛苦者33例。显著与非显著心理痛苦失眠患者在婚姻状况、家庭月收入、失眠病程、家属失眠情况以及失眠严重指数、失眠担忧、贝克抑郁、贝克焦虑、客观支持和支持利用度评分方面存在统计学差异(P<0.01)。多因素线性回归发现失眠严重指数高(β=0.279,P<0.001)、对失眠的担忧(β=-0.126,P=0.010)、家庭月收入水平高(β=0.908,P=0.004)、家属失眠(β=1.516,P<0.001)是影响失眠患者心理痛苦水平的主要危险因素。结论心理痛苦感在失眠患者中普遍存在,失眠严重、对失眠担忧、亲属失眠、家庭高收入与心理痛苦密切相关。     

Factors contributing to depression in patients with epilepsy

We investigated factors contributing to depression in patients with epilepsy. Data were collected from 150 adult patients. Beck Depression Inventory (BDI), Beck Anxiety Inventory, Daily Hassles Scale, Epilepsy Self‐Efficacy Scale, Social Support Scale, Stress Coping Style Checklist, and Quality of Life in Epilepsy Inventory 31 (QOLIE‐31) were used. The mean BDI score was 13.4 [standard deviation (SD) 9.0]. Abnormal BDI scores were recorded in 93 patients. Six significant predictors of BDI were identified in a stepwise linear regression analysis: level of stress (p < 0.001), social support (p = 0.037), anxiety (p = 0.001), self‐efficacy (p < 0.001), employment status (p = 0.021), and age (p = 0.042). Stress accounted for 38.8% of the variance in BDI score, social support accounted for 6.8%, anxiety accounted for 3.9%, and the remaining three variables accounted for an additional 5.2% of the variance (total explained variance = 54.7%).     

Self-reported memory problems in everyday activities in patients with epilepsy treated with antiepileptic drugs

ObjectiveThe goal of this study was to assess everyday memory complaints in a large cohort of patients with epilepsy treated with antiepileptic drugs and to determine demographic, clinical, and emotional state factors associated with patients’ self-perception of memory disturbances.MethodsThis cross-sectional epidemiological study was carried out in routine clinical practice using the Questionnaire of Memory Efficiency (QME) and the Hospital Anxiety and Depression Scale (HADS).ResultsSix hundred sixty-one patients were recruited. The time since epilepsy diagnosis was 17.3 years (SD = 12.5); the number of seizures in the past year 13.8 (SD = 4.8); the proportion of patients free of seizures in the last year 42.5%; the proportion of patients with partial seizures 73.2%; and the proportion of patients on monotherapy 56.3%. Total QME score was 110.0 (SD = 18.6). Depression and anxiety scores and polytherapy explained 38.7% of the QME variance.ConclusionsSubjective memory functioning in this cohort of patients with epilepsy was relatively good. Complaints expressed by these patients are explained mainly by the presence of depressive and anxiety symptoms.     

Sleep disturbances in relation to fatigue in major depression

Objective

This study aimed to investigate the independent correlations of subjective sleep disturbances (insomnia and daytime sleepiness) with the severity of fatigue in patients with major depression.

Methods

Eighty-one currently depressed patients (70 females and 11 males), aged between 23 and 65 years, with a DSM-IV diagnosis of major depressive disorder were studied. Patients with physical diseases or other conditions associated with prominent fatigue were excluded. The 17-item Hamilton Depression Rating Scale (HDRS), the Athens Insomnia Scale (AIS), and the Epworth Sleepiness Scale (ESS) were used for the cross-sectional assessment of the severity of depression, insomnia, and sleepiness, respectively. Severity of fatigue was measured with the Fatigue Severity Scale (FSS). Pearson's and Spearman's coefficients were used in bivariate correlations between FSS score and the independent variables (age, gender, inpatient/outpatient status, HDRS score, AIS total score, AIS individual item scores, and ESS score). A stepwise multiple regression analysis was then performed, with FSS score as the dependent variable.

Results

The severity of fatigue was significantly correlated with female sex, HDRS score, AIS total score, awakenings during the night (AIS item 2), compromised sleep quality (AIS item 5), and ESS score. Sleep quality (AIS item 5) and daytime sleepiness (ESS) were the only significant predictors of the severity of fatigue in the multiple regression analysis.

Conclusions

Both sleep quality and daytime sleepiness correlate independently with fatigue severity, as measured with the FSS, in patients with major depression. The FSS does not appear to be a ‘pure’ measure of fatigue in depressed patients, a finding with potential implications for the choice of appropriate fatigue measures in this population.     

Anxiety in children with epilepsy

Although the prevalence is unknown, affective disorders are more common in children with epilepsy than in healthy controls. The purpose of the present study was to examine the occurrence of anxiety in children and adolescents with epilepsy and to determine factors associated with elevation of these symptoms. Children and adolescents (n=101) between the ages of 6 and 16 years were given the Revised Children's Manifest Anxiety Scale (RCMAS). Mild to moderate symptoms of anxiety were reported by 23% of the patients. Based on regression analysis, factors significantly associated with increased anxiety included the presence of comorbid learning or behavioral difficulties, ethnicity, and polytherapy. Results suggest the need to monitor children and adolescents with epilepsy for affective symptoms in order to provide appropriate interventions.     

Utilization of care among drug resistant epilepsy patients with symptoms of anxiety and depression

PurposeEpilepsy patients have a significantly higher rate of anxiety and depression than the general population, and psychiatric disease is particularly prevalent among drug resistant epilepsy patients. Symptoms of anxiety and depression might serve as a barrier to appropriate epilepsy care.The aim of this study was to determine if drug resistant epilepsy patients with symptoms of anxiety and/or depression receive different epilepsy management than controls.MethodWe identified 83 patients with drug resistant focal epilepsy seen at the Penn Epilepsy Center. Upon enrollment, all patients completed 3 self-report scales and a neuropsychiatric inventory and were grouped into those with symptoms of anxiety and/or depression and controls. Each patient's medical records were retrospectively reviewed for 1–2 years, and objective measures of outpatient and inpatient epilepsy management were assessed.ResultsAt baseline, 53% (n = 43) of patients screened positive for symptoms of anxiety and/or depression. The remaining 47% (n = 38) served as controls. Patients with anxiety and/or depression symptoms had more missed outpatient visits per year compared to controls (median 0.84 vs. 0.48, p = 0.02). Patients with symptoms of both anxiety and depression were more likely to undergo an inpatient admission or procedure (56% vs. 24%, p = 0.02).ConclusionFor most measures of epilepsy management, symptoms of anxiety and/or depression do not alter epilepsy care; however, drug resistant epilepsy patients with anxiety and/or depression symptoms may be more likely to miss outpatient appointments, and those with the highest burden of psychiatric symptoms may be admitted more frequently for inpatient services compared to controls.     

癫痫患者认知功能与睡眠质量的关系

目的 探讨癫痫患者认知功能与睡眠质量的关系.方法 对50例癫痫患者(试验组)及40例正常人(对照组)行蒙特利尔认知评估量表(MoCA)、Epworth嗜睡量表(ESS)和匹兹堡睡眠质量指数问卷(PSQI)评定,分析认知功能与睡眠质量的关系.结果 试验组与对照组认知功能障碍、嗜睡和睡眠紊乱检出例数分别为:42/50(84.00%):3/40(7.50%)(P＜0.05)、26/50(52.00%):9/40(22.50%)(P＜0.05)和13/50(26.00%):5/40(12.50%)(P＜0.05).两组患者的MoCA总分、MoCA 7个子项目、ESS总分、PSQI总分、PSQI子项目睡眠效率和睡眠障碍计分比较,差异有统计学意义(P＜0.05).相关分析显示MoCA总分与身高和文化程度呈正相关(r分别为0.361和0.321,P＜0.05),与年龄和发作频率呈负相关(r分别为-0.273和-0.271,P＜0.05).MoCA子项目记忆力和抽象能力分别与PSQI子项目催眠药物和日间功能障碍呈负相关(r分别为-0.262和-0.270,P＜0.05).结论 癫痫患者存在认知功能障碍和睡眠紊乱,癫痫患者认知功能影响因素有身高、文化程度、年龄和发作频率,记忆力和抽象能力分别与催眠药物及日间功能障碍相关.     

Risk factors for developing epilepsy after craniotomy in children

Introduction We performed a retrospective analysis of children undergoing supratentorial craniotomy, attempting to identify possible risk factors for postoperative epilepsy and the need for prophylactic anticonvulsant therapy.Materials and methods We analysed 107 consecutive patients (55% males) who had supratentorial craniotomy for a variety of diagnoses (tumours, trauma, infection, vascular malformations and others) during 1995–1999. Mean age at operation was 89 months (range: 1–180 months). Patients who presented with epilepsy were excluded. Postoperative epilepsy was considered present if patients required systematic pharmacological treatment, at a minimum follow-up of 6 months. Linear regression was used to analyse the effect of sex, anticonvulsant prophylaxis, duration of operation, closure of dura, postoperative infection, the diagnosis, anatomical region of brain affected, operation type (craniotomy/craniectomy) and the need for brain resection.Results Prophylactic anticonvulsants were given to 52% of the patients; 97% had craniotomy; in five patients, the dura was left open; in 33%, some kind of brain tissue resection had been performed; two patients (1.8%) developed postoperative infection; one patient died. Only 13 patients (12%) developed postoperative epilepsy. The only two factors with statistical significance were female sex (p=0.045) and the absence of dural closure (p=0.001). All other factors were not significant (p>0.258).Conclusions Postoperative epilepsy after supratentorial craniotomy is uncommon in children, incidence being 12%. The administration of prophylactic anticonvulsants does not appear to influence the risk of epilepsy. Surprisingly, females have statistically higher risk. Lack of dural closure has higher risk of epilepsy, but this may reflect the type of pathology.The material of this paper was presented at the 18th Biannual Congress of the European Society for Pediatric Neurosurgery, Kiruna, 15 June 2002.     

抑郁、癫痫与癫痫并发抑郁症患者血清中细胞因子水平比较

目的通过检测抑郁、癫痫与癫痫并发抑郁症患者血清中细胞因子的水平,探讨细胞因子与抑郁、癫痫及癫痫并发抑郁症之间的关系。方法收集2004年9月~2009年4月期间在我院住院的首发抑郁症患者73例、原发性癫痫患者82例,采用Hamilton抑郁量表（HAMD）测试,将原发性癫痫患者分为癫痫组及癫痫合并抑郁组,选择35例心身健康的个体作为对照组。采用酶联免疫吸附法检测各组血清中,白介素IL-2、白介素IL-6和肿瘤坏死因子TNF-α水平,最后对测得的所有数据进行统计学检验分析。结果患病组与健康对照组年龄、文化程度及性别构成比之间无统计学差异。比较所有数据,结果显示抑郁、癫痫及癫痫并发抑郁症组血清IL-2、IL-6和TNF-α浓度均高于对照组,且差异有统计学意义（P＜0.05或0.01）。癫痫并发抑郁症组血清IL-2、IL-6和TNF-α浓度均略高于抑郁症患者,显著高于单纯癫痫患者,且差异有统计学意义（P＜0.05）。结论抑郁、癫痫及癫痫并发抑郁症患者存在细胞因子浓度改变,抑郁、癫痫及癫痫并发抑郁与细胞因子之间有重要关系。     

帕罗西汀对癫(癎)伴发抑郁患者的疗效分析

目的 探讨帕罗西汀对癫(癎)伴发抑郁患者临床治疗的有效性及安全性.方法 21例门诊与住院的癫(癎)伴发抑郁患者,入组前汉密顿抑郁量表(HAMD)24项评分≥18分,持续予帕罗西汀10～20mg·d-1晨服,治疗观察期均为8周,于入组后第4、8周分别用HAMD及Zung抑郁自评量表(SDS)评分,AEDs用药保持不变.结果 帕罗西汀治疗第8周后,HAMD量表评分由治疗前(25.33±4.89)降至(12.10± 6.12),SDS量表评分由治疗前(45.90±6.82)降至(28.95±6.98),差异均有统计学意义.不良事件发生率也基本上很轻微、短暂.治疗过程中,癫(癎)每月发作次数由治疗前的(1.43±0.92)到治疗后第8周的(1.57±0.98)(P＞0.05),差异无统计学意义.没有新发全身强直-阵挛发作的患者.结论 帕罗西汀对癫(癎)伴抑郁患者的治疗有效、安全.     

Prevalence of self-reported epilepsy or seizure disorder and its associations with self-reported depression and anxiety: results from the 2004 HealthStyles Survey

PURPOSE: To examine the prevalence of self-reported epilepsy or seizure disorder and its association with self-reported recent depression and anxiety in a large sample of the U.S. adult population. METHODS: We analyzed data from adults aged 18 years or older (n = 4,345) who participated in the 2004 HealthStyles Survey, a large mail panel survey designed to be representative of the U.S. population. RESULTS: Among U.S. adults aged 18 years or older, we estimated that 2.9% have been told by a doctor that they had epilepsy or seizure disorder, and an estimated 1.6% and 0.9% had active and inactive epilepsy, respectively. After controlling for demographic characteristics, we estimated that adults with self-reported epilepsy were twice as likely to self-report depression or anxiety in the previous year as were adults without epilepsy, and adults with active epilepsy were 3 times as likely to self-report depression and twice as likely to have anxiety in the previous year as were adults without epilepsy. CONCLUSIONS: Our findings highlight the burden of self-reported depression and anxiety among adults with self-reported epilepsy or seizure disorder, and suggest that healthcare providers should attempt to determine whether adult patients with epilepsy have any psychiatric comorbidity potentially to improve health outcomes. Questions about epilepsy and related factors should be routinely included on population-based surveys so that we can better understand the epilepsy distribution in the U.S. population and identify the unmet health and psychosocial needs of people with epilepsy.