Cognitive function,depression, anxiety and quality of life in Chinese patients with untreated unruptured intracranial aneurysms

Detected unruptured intracranial aneurysms (UIA) are becoming more common with the increased utilization of CT angiography, MR angiography and digital subtraction angiography. A proportion of patients with UIA remain untreated. We investigated to assess cognitive function, depression, anxiety and quality of life (QoL) in Chinese patients with untreated UIA. Thirty one Chinese patients with untreated UIA and 25 healthy controls were identified and matched for variables including age, sex, and living area. Cognitive function was evaluated with the Montreal Cognitive Assessment (MoCA). Depression, anxiety and QoL were screened with the Self-Rating Depression Scale, Self-Rating Anxiety Scale, and Short Form-36, respectively. Non-parametric tests were used for comparisons between groups. No patient had cognitive dysfunction at 1 month or 1 year after detection of UIA. However, a significant decrease of overall MoCA subscores was found in 30 (97%) of 31 patients 5 years after UIA discovery, suggestive of mild cognitive impairment. A significant decrease in depression and anxiety was found in patients over time. QoL in patients was reduced most prominently in psychosocial function and social activities 1 year after detection of UIA, but these improved to within normal limits at the end of the follow-up period. For Chinese patients with untreated UIA, depression, anxiety and reduced QoL may be short-term complications. Mild cognitive impairment may be a long-term complication.     

Headache induced by the use of combined oral contraceptives

The aim of this study was to assess the impact of psychological features in the choice of coping strategies in multiple sclerosis (MS) patients, and their influence on quality of life (QoL). One hundred four patients (72 women, age 45.3 ± 10.9 years, disease duration 17.9 ± 13.2 years, Expanded Disability Status Scale 2.8 ± 2.0) were assessed through the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Eysenck Personality Questionnaire, the Coping Orientation for Problem Experiences-New Italian version and the MSQoL-54. MS patients were less likely to use problem-focused strategies, whereas avoiding strategies were adopted more frequently. The use of positive strategies positively influenced both mental and overall QoL. Depression had a negative impact on all QoL domains and anxiety on mental domains. These data point out the importance of a comprehensive assessment of MS patients. Orienting therapeutic interventions, to oppose depression and anxiety and to favour more appropriate coping strategies can improve the patients’ QoL.     

Characteristics associated with anxiety,depressive symptoms,and quality-of-life in a large cohort of implantable cardioverter defibrillator recipients

Objective

Although most patients with implantable cardioverter defibrillators (ICDs) adjust well, some have considerable psychological distress. Factors associated with psychological adjustment in ICD-recipients are still not well understood. Our purpose was to describe quality-of-life (QoL) and prevalence of self-reported symptoms of anxiety and depression in a large national cohort of ICD-recipients, and to determine socio-demographic, clinical, and ICD-related factors associated with these variables.

Methods

A cross-sectional, correlational design was used. All eligible adult ICD-recipients in the Swedish ICD- and Pacemaker Registry were invited to participate. Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS), and QoL with the EuroQol-5D.

Results

A total of 3067 ICD-recipients (66 ± 11 years, 80% male) were included. The mean HADS score was 3.84 ± 3.70 for anxiety symptoms and 2.99 ± 3.01 for symptoms of depression. The mean EQ-5D index score was 0.82 ± 0.21. The probability of symptoms of anxiety and depression was associated with younger age, living alone, and a previous history of myocardial infarction or heart failure. Additionally, female ICD-recipients had a higher probability of symptoms of anxiety. A higher level of ICD-related concerns was most prominently related to symptoms of anxiety, depressive symptoms and poorer QoL, while number of shocks, ICD-indication and time since implantation were not independently related.

Conclusions

In this large cohort of ICD-recipients, the association of ICD-related concerns with symptoms of anxiety, depressive symptoms, and poor QoL suggests that ICD specific factors should be addressed in order to improve outcomes.     

Depression and other psychological risks following myocardial infarction

BACKGROUND: There is consistent evidence that depression symptoms predict long-term mortality following a myocardial infarction, and recent results show a dose-related gradient. The importance of other psychological variables remains unclear. METHODS: This study examines the relative importance of depression, anxiety, anger, and social support in predicting 5-year cardiac-related mortality following a myocardial infarction and assesses the role of any common underlying dimensions. The design of this cohort analytic study involves self-reports (Beck Depression Inventory, state scale of the State-Trait Anxiety Inventory, 20-item version of the General Health Questionnaire, Modified Somatic Perception Questionnaire, Anger Expression Scale, Perceived Social Support Scale, number of close friends and relatives, and visual analog scales of anger and stress). The study was conducted in 10 Montreal-area hospitals. The patients included 896 persons who experienced a myocardial infarction, aged 24 to 88 years (232 were women), followed up for 5 years using Medicare records; baseline data were complete for 95.0% of the patients. The intervention was usual care, and the main outcome measure was 5-year cardiac-related mortality. RESULTS: The Beck Depression Inventory (P<.001), the State-Trait Anxiety Inventory (P =.04), and the 20-item version of the General Health Questionnaire (P =.048) were related to outcome), but only depression remained significant after adjustment for cardiac disease severity (hazards ratio per SD, 1.46; 95% confidence interval, 1.18-1.79) (P<.001). Exploratory factor analysis revealed 3 underlying factors: negative affectivity, overt anger, and social support. There was also a covariate-adjusted trend between negative affectivity scores and outcome (P =.08). Furthermore, residual depression scores (P =.001) and negative affectivity scores (P =.05) were linked to cardiac-related mortality after adjustment for each other and cardiac covariates. CONCLUSIONS: Negative affectivity and some unique aspect of depression predict long-term cardiac-related mortality following a myocardial infarction independently of each other and cardiac disease severity. Additional research is needed to characterize the mechanisms involved.     

Do pain,anxiety and depression influence quality of life for people with amyotrophic lateral sclerosis/motor neuron disease? A national study reconciling previous conflicting literature

Introduction

The importance of elucidating the relationships between pain, mood and quality of life (QoL) amongst people with amyotrophic lateral sclerosis/motor neuron disease is evident to clinicians, yet the literature is limited and inconsistent. We explored the relationships between pain, depression, anxiety and QoL to reconcile the previous contrasting findings and inform future research and clinical practice.

Methods

Patient-reported outcomes were obtained as part of the Trajectories of Outcomes in Neurological Conditions study. Mood and QoL scales underwent Rasch analysis. Correlation coefficients examined the strength of association between variables of interest. A bivariate regression model was developed to examine the effects of pain, depression and anxiety on joint psychological and physical QoL domains.

Results

Of 636 people with ALS, 69% reported pain, of these most had mild pain. Seven percent (7%) of participants exceeded published cutoffs for probable depression and 14% had probable anxiety. Pain, depression and anxiety all influence quality of life; depression has a significant effect on both physical and psychological domains of QoL, whereas pain affects physical QoL and anxiety psychological QoL.

Conclusions

These results show the importance of expressing quality of life in a conceptually appropriate way, as failing to take account of the multidimensional nature of QoL can result in important nuances being overlooked. Clinicians must be aware that pain, depression and anxiety all worsen QoL across their ranges, and not just when pain is severe or when anxiety or depression reach case level.

     

Impact of depression and disability on quality of life in Iranian patients with multiple sclerosis

Multiple sclerosis (MS) can influence all aspects of a patient's health. This study determines the main factors affecting quality of life (QoL) in Iranian MS patients. QoL (Multiple Sclerosis Impact Scale; MSIS-29), disability (Expanded Disability Status Scale; EDSS) and depression (Beck Depression Inventory; BDI) were assessed in 106 MS patients. EDSS, clinical course and MS duration significantly correlated with physical MSIS-29. Depression highly correlated with both physical and psychological MSIS-29. Regression analyses showed that depression and EDSS predicted physical health. Psychological health was predicted by depression. These findings highlight that depression and physical disability strongly influence QoL in Iranian MS patients.     

Improvement in depression associated with partial epilepsy in patients treated with lamotrigine

Interictal depression is common in patients with epilepsy and it significantly impacts quality of life. Previous studies indicate that lamotrigine may have antidepressant properties. Thirteen adults with uncontrolled partial seizures and concomitant depression were evaluated using measures of depression [Montgomery and Asberg Depression Rating Scale (MADRS) and the MMPI Depression Scale] and anxiety [Spielberger's State-Trait Anxiety Inventory (STAI)] to test the effects of lamotrigine on mood. Evaluations after 5 weeks and again after 3 months of lamotrigine treatment demonstrated significant improvement in depression and anxiety. Mean MADRS overall scores were significantly lower than pretreatment baseline at the 5-week and 3-month evaluations. The mean MMPI Depression score was significantly lower than baseline at the 3-month evaluation. State anxiety scores were significantly reduced from baseline after 5 weeks, but not at 3 months, whereas Trait anxiety scores were reduced from baseline at the 5-week and 3-month evaluations.     

Depression and quality of life in multiple sclerosis

OBJECTIVES: Health related quality of life (QoL) has gained increasing influence as a relevant evaluation criterion in multiple sclerosis. The high prevalence of psychiatric comorbidity in MS is, however, hardly ever considered in studies concerning QoL. MATERIALS AND METHODS: In 60 patients of a MS outpatient clinic, symptoms of anxiety (Zung Anxiety Scale) and depression (Zung Depression Scale), as well as the health-related quality of life were rated and set into relation to the EDSS and to the duration of illness, respectively. RESULTS: There was a highly significant correlation between depression as well as anxiety and the self-assessed quality of life. Depression was the by far strongest predictor for reduced QoL. CONCLUSION: Clinical studies, which seek to register the increasingly important evaluation criterion of health-related quality of life in MS, should consider the prevalence of depressive disorders and the decisive effect of depression on the self-assessed quality of life of affected patients.     

Comorbid attention-deficit/hyperactivity disorder in adult psychiatric outpatients with depressive or anxiety disorders

Background. There are very few studies reporting on the prevalence and the contribution of not previously diagnosed ADHD in the clinical picture of other psychiatric disorders. The aim of our study is to determine the prevalence and clinical correlates of comorbid attention deficit/hyperactivity disorder (ADHD) in adult psychiatric outpatients with depressive or anxiety disorders. Methods. During a 6-month period, 114 outpatients with depressive or anxiety disorders were evaluated for ADHD diagnosis. Assessment included interviews with both patient and relatives/friends and the use of a daily diary. Moreover, the patients completed the self-report scales Beck Depression Inventory (BDI), Spielberger's Anxiety Inventory (STAI), and the Symptom Checklist-90-R Rating Scale (SCL-90-R). Results. A total of 22 out of 114 patients (19.3%) received an ADHD diagnosis for the first time in their life. Comorbid ADHD compared to non ADHD patients scored significantly higher (p < 0.05) for depression (BDI), state and trait anxiety (STAI) and in the following SCL-90-R factors: Positive Symptoms Distressing Index, Positive Symptoms Index, Somatization, Obsessive Compulsive, Depression, Anxiety, and Hostility. Conclusions. ADHD might go unrecognized among psychiatric outpatients. Patients with depressive or anxiety disorder reporting more severe symptomatology should be carefully screened for possible comorbid adult ADHD.     

Depression and quality of life in monogenic compared to idiopathic,early‐onset Parkinson's disease

Quality of life (QoL) is decreased in PD and is linked with depression and anxiety. However, little is known about QoL in monogenic PD. Subjects with mutations in PD genes were recruited from ongoing family and genetic studies (manifesting carriers, n = 23; nonmanifesting carriers, n = 19). For comparison purposes, we included patients with idiopathic PD (IPD; n = 128; early onset, n = 38; late onset, n = 90), healthy controls (n = 127), and data on depressive symptoms of 144 patients with major depression (treated controls). Depression affected 31% of early‐onset PD cases, 21% of late‐onset cases, and 44% of manifesting carriers of mutations in PD genes, but was rare in the nonmanifesting carriers (7%) and healthy controls (5%). Subjects with Parkinson‐associated depression reported fewer feelings of guilt or self‐doubt than treated controls, but the occurrence of suicidal ideation was associated with severity of depression only. Social phobia (P = 0.018) and agoraphobia (P = 0.059) were more common in manifesting carriers than in any other group. QoL was decreased in the Parkinson groups, particularly in the early‐onset cases (P < 0.001), and QoL correlated with depression in all analyses. In our study, monogenic and IPD cases were comparable in QoL and depression characteristics. The QoL and, possibly, overall prognosis of all PD patients can be improved by appropriate attention and treatment for depression, sleep impairments, and anxiety, even if the treatment of the motor problems cannot be further optimized. © 2012 Movement Disorder Society     

Effects of intensive neuropsychological rehabilitation for acquired brain injury

The objective of the study was to examine the effects of a comprehensive neuropsychological rehabilitation programme (Intensive NeuroRehabilitation, INR) on the emotional and behavioural consequences of acquired brain injury (ABI). The participants were 75 adult patients suffering from ABI (33 traumatic brain injury, 14 stroke, 10 tumour, 6 hypoxia, 12 other), all of whom were admitted to the INR treatment programme. The main outcome measures were: general psychological well-being (Symptom-Checklist-90), depression and anxiety (Beck Depression Inventory-II, Hospital Anxiety and Depression Scale, State Trait Anxiety Inventory), and quality of life (Quality of Life in Brain Injury). The study was a non-blinded, waiting-list controlled trial. During the waiting-list period no or minimal care was provided. Multivariate analysis of the main outcome measures showed large effect sizes for psychological well-being (partial η²?=?.191, p?η²?=?.168, p?η²?=?.182, p?η²?=?.130, p?=?.001). Changes on neuropsychological tests did not differ between the groups. It was concluded that the INR programme improved general psychological well-being, depressive symptoms, anxiety, and quality of life. The programme does not affect cognitive functioning.     

Prevalence,pattern and impact of depression on quality of life of stroke survivors

Abstract

Objective. This study documented the incidence, pattern and impact of depression on QoL of stroke-survivors within 6-month post-stroke. Methods. This study involved 65 stroke survivors consecutively recruited at ictus from a tertiary health institution in Nigeria. The National Institute of Health Stroke-Scale, Stroke-Specific Quality-of-Life (SSQOL), international classification of diseases (tenth edition) and Center for Epidemiological Scale-Depression (CES-D) were administered at ictus to assess stroke-severity, QoL and depression respectively. The SSQOL, ICD-10 and CES-D were subsequently administered every other week for 6 months. Data were treated using Spearman's correlation coefficient, Mann–Whitney U-test and multivariable stepwise linear regression analysis (P=0.05). Results. Participants were age 58.1±15.7 years; 38 and 27 hemorrhagic and ischaemic stroke respectively. Twenty-six (40%) and 60.0% had moderate and severe stroke, respectively. The QoL at post-stroke periods were significantly influenced (P<0.05) by depression, age, marital status, spouse supports, stroke-severity, and educational-attainment. Depression determined (P<0.05) poor QoL in stroke-survivors. Co-morbidity with stroke severity was a determinant (P<0.05) of poor QoL and death. The haemorrhagic stroke survivors had significantly higher (P<0.05) QoL at post-stroke periods. Conclusion. Depression is associated with stroke. It is common within the first 6 months post-stroke and has negative impact on quality of life of stroke-survivors.     

Health‐related quality of life in multiple system atrophy

Although multiple system atrophy (MSA) is a neurodegenerative disorder leading to progressive disability and decreased life expectancy, little is known about patients' own evaluation of their illness and factors associated with poor health‐related quality of life (Hr‐QoL). We, therefore, assessed Hr‐QoL and its determinants in MSA. The following scales were applied to 115 patients in the European MSA‐Study Group (EMSA‐SG) Natural History Study: Medical Outcome Study Short Form (SF‐36), EQ‐5D, Beck Depression Inventory (BDI), Mini‐Mental state examination (MMSE), Unified MSA Rating Scale (UMSARS), Hoehn & Yahr (H&Y) Parkinson's disease staging scale, Composite Autonomic Symptom Scale (COMPASS), and Parkinson's Disease Sleep Scale (PDSS). Forty‐six percent of patients had moderate to severe depression (BDI ≥ 17); Hr‐QoL scores on the SF‐36 and EQ‐5D were significantly impaired. Pain, the only domain with similar scores in MSA and published PD patients, was reported more frequently in patients with MSA‐P (predominantly parkinsonian motor subtype) than MSA‐C (predominantly cerebellar motor subtype; 76% vs. 50%; P = 0.005). Hr‐QoL scores correlated most strongly with UMSARS motor, COMPASS, and BDI scores but not with MMSE scores, age at onset, or disease duration. The COMPASS and UMSARS activities of daily living scores were moderate‐to‐strong predictors for the SF‐36 physical summary score and the BDI and UMSARS motor scores for the SF‐36 mental summary score. This report is the first study to show that Hr‐QoL is significantly impaired in MSA. Although not all possible factors related to impaired Hr‐QoL in MSA could be assessed, autonomic dysfunction, motor impairment, and depression were most closely associated with poor Hr‐QoL, and therapeutic management, therefore, should concentrate upon these aspects of the disease. © 2006 Movement Disorder Society     

The quality of life of people with dementia and their family carers

Background: We aimed to identify factors associated with the quality of life (QoL) of 'persons with dementia' (PWDs) and their family carers. Method: Two-hundred and thirty dyads of PWDs and their family carers were included. The PWDs were assessed with the Neuropsychiatric Inventory (NPI-Q), two Activities of Daily Living (ADL) scales, the Cornell Scale and the QoL-Alzheimer's Disease scale (QoL-AD; self- and proxy-reported scores). The carers were assessed with the QoL-AD and the Geriatric Depression Scale. Results: Factors associated with self-reported QoL were depression (β = -0.26, p < 0.001) and impaired ADL (β = -0.26, p < 0.001) and with proxy-rated QoL were NPI (β = -0.18, p = 0.02), depression (β = -0.32, p < 0.001) and impaired ADL (β = -0.43, p < 0.001). Factors associated with QoL in carers living together with the PWDs were depression (β = -0.56, p < 0.001) and having a hobby (β = 0.19, p = 0.01), whereas depression was associated with QoL in those who lived separately from the PWD (β = -0.60, p < 0.001). Conclusion: Depression and impaired ADL were associated with the self- and proxy-rated QoL of the PWDs, whereas depression in the carers negatively affected their QoL.     

成年癫痫患者抑郁、焦虑状况及生活质量调查

目的调查成年癫痫患者抑郁、焦虑的患病率及可能的危险因素;评价抑郁及焦虑对癫痫患者生活质量的影响。方法采用Beck抑郁问卷(BDI)、贝克焦虑量表(BAI)及癫痫患者生活质量量表-31(QO-LIE-31中文版),对200例成年癫痫患者的抑郁、焦虑情况及生活质量进行评估。结果在200例癫痫患者中43.5%伴发抑郁,28.5%伴发焦虑,23%伴发抑郁及焦虑。发作频繁、无有薪职业是癫痫患者伴发抑郁的重要危险因素,无有薪职业是癫痫患者伴发焦虑的危险因素。抑郁组及抑郁伴焦虑组的QOLIE-31总分及各项评分均低于非抑郁非焦虑组(P=0.000);焦虑组的QOLIE-31总分(P=0.004)及发作的担忧(P=0.019)、认知功能(P=0.009)方面的得分均低于非抑郁非焦虑组。结论抑郁和焦虑是癫痫患者常见的精神共病,严重影响了癫痫患者的生活质量。积极控制发作、为癫痫患者提供更多的就业机会是改善癫痫患者生活质量的重要因素。     

Quality of life in patients with orthostatic tremor

We assessed health-related quality of life (QoL) and depression, using the SF-36 and the Beck Depression Inventory (BDI), in 20 orthostatic tremor (OT) patients. All dimensions of the SF-36 were markedly reduced in OT and depression was found in 11 patients. The BDI score correlated significantly with several SF-36 subscores. We conclude that OT strongly impacts on QoL. The results highlight the importance of recognizing and treating depression in patients with OT.     

The effects of forest therapy on depression and anxiety in patients with chronic stroke

Objective: To assess whether forest therapy is effective for treating depression and anxiety in patients with chronic stroke by using several psychological tests. We measured reactive oxygen metabolite (d-ROM) levels and biological antioxidant potentials (BAPs) associated with psychological stress. Methods: Fifty-nine patients with chronic stroke were randomly assigned to either a forest group (staying at a recreational forest site) or to an urban group (staying in an urban hotel); the duration and activities performed by both groups were the same. Scores on the Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HAM-D17), Spielberger State-Trait Anxiety Inventory (STAI), d-ROMs and BAPs were evaluated both before and after the treatment programs. Results: In the forest group, BDI, HAM-D17 and STAI scores were significantly lower following treatment, and BAPs were significantly higher than baseline. In the urban group, STAI scores were significantly higher following treatment. Moreover, BDI, HAM-D17 and STAI scores of the forest group were significantly lower, and BAPs were significantly higher following treatment (ANCOVA, p <0.05). Conclusion: Forest therapy is beneficial for treating depression and anxiety symptoms in patients with chronic stroke, and may be particularly useful in patients who cannot be treated with standard pharmacological or electroconvulsive therapies.     

Quality of Life in relation to neuropsychiatric symptoms in Alzheimer's disease: 5‐year prospective ALSOVA cohort study

Objective

To examine the association between neuropsychiatric symptoms (NPS) with self‐ and caregiver‐rated Quality of Life (QoL) for patients with Alzheimer's disease (AD) during a 5‐year follow‐up.

Methods

The ALSOVA 5‐year follow‐up study included, at baseline, 236 patients with either very mild (Clinical Dementia Rating Scale (CDR) 0.5), or mild (CDR 1) AD, together with their caregivers from three Finnish hospital districts. QoL was evaluated using patient self‐reported, and caregiver‐rated, QoL in AD (QoL‐AD) scores. NPS were assessed using the Neuropsychiatric Inventory (NPI), and AD severity was evaluated using the CDR, with cognition tested by the mini‐mental state examination. The performance of daily activities was assessed using the Alzheimer's Disease Cooperative Study–Activities of Daily Living Inventory.

Results

Over the 5‐year follow‐up period, patient self‐reported QoL‐AD scores did not change significantly (p = 0.245), despite increases in their NPS. However, caregiver‐rated patient QoL‐AD scores declined significantly (p ≤ 0.001), as total NPI scores increased during follow‐up. No NPS at baseline, and only apathy at follow‐up, correlated significantly (p = 0.007) with patient self‐rated QoL‐AD scores. Caregiver‐rated patient QoL‐AD scores correlated significantly with most NPS, especially (p ≤ 0.001) apathy, agitation, anxiety, irritability, depression, and delusions at baseline, and delusions, hallucinations, apathy, appetite disturbances, and anxiety during follow‐up.

Conclusions

Patient rated QoL‐AD scores are an unreliable tool with which to evaluate the success of therapy for NPS. Instead, caregiver‐rated scores for patients correlated well with NPI scores, and health care professionals in the clinic should preferentially use these. Copyright © 2017 John Wiley & Sons, Ltd.     

Functional,cognitive and emotional long–term outcome of patients with ischemic stroke requiring mechanical ventilation

Prognosis of patients with ischemic stroke requiring mechanical ventilation (MV) has been reported to be poor. However, longterm survival and functional outcome have scarcely been studied and nothing is known about the prevalence of cognitive impairment or depression in survivors and their quality of life (QoL).We identified all patients treated for acute ischemic stroke on a Neurological Intensive Care Unit during 3.5 years who required MV for more than 24 hours. Early mortality rate at 2 months and survival rates at 1 and 2 years were determined. Survivors were examined for functional outcome (modified Rankin Scale (mRS), Barthel Index), cognitive impairment (Mini Mental State Examination (MMSE)), depression (Beck Depression Inventory, BDI) and QoL (Short Form–36). Clinical characteristics on admission were analyzed for prognostic significance. Of 101 consecutive patients, 44% died within 60 days. Survival rates at 1 and 2 years were 40% and 33%, respectively.Age > 60 years (p = 0.002) and Glasgow Coma Scale score < 10 on admission (p = 0.002) were independent predictors of early and late mortality. History of myocardial infarction (p = 0.007) independently predicted late mortality at 2 years. Of 33 surviving patients, nine (27%) had a good functional outcome (mRS 0–2). Of 27 survivors who could be interviewed, 17 (63%) had no cognitive impairment (MMSE > 24) and 20 (74%) did not suffer from relevant depression (BDI < 19).In conclusion, longer–term survival of patients with ischemic stroke requiring MV was 33% and every fourth survivor resumed an independent life without dementia or depression. Older patients comatose on admission and with concomitant cardiovascular disease had the lowest probability of a favorable outcome.Drs. Schielke and Busch contributed equally to the study.     

Long-term outcome of vagus nerve stimulation for refractory partial epilepsy

We assessed 1- and 2-year outcomes of specific seizure types, quality of life, depression, and anxiety among patients treated with vagus nerve stimulation (VNS) for refractory partial epilepsy. Patients completed a seizure questionnaire, the Quality of Life in Epilepsy-89 (QOLIE-89) questionnaire, the Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI) at baseline and 1 year, and 2 years after activation of VNS. VNS was associated with >or=50% reduction in total seizure frequency in 54% of patients at 1 year and 61% of patients 2 years post-VNS activation compared with baseline. No statistically significant changes from baseline to 12 or 24 months were found in mean quality of life, depression, or anxiety measures in the overall study population. Patients with at least 50% reduction in seizures had significant improvement in anxiety at 12 and 24 months compared with patients who did not have the same degree of seizure reduction.