Long-term outcome in children with temporal lobe seizures. I: Social outcome and childhood factors.

One-hundred children, diagnosed as having temporal lobe epilepsy and reported on in 1966, have been followed into adult life. In this 1977 survey they have been coded into four social outcome categories, A, B, C and D. A: 33 per cent are found to be seizure-free and independent; B: 21 per cent are socially and economically independent but are receiving anticonvulsant treatment and are not necessarily seizure-free; C: O9 per cent are dependent either on their parents or in institutions; D: 5 per cent died under the age of 15. Biological factors ascertained and coded in childhood are related to adult outcome. Eight adverse factors emerged: an IQ below 90, onset of seizures before 2 years 4 months, five or more grand mal attacks, temporal lobe seizure frequency of one per day or more, a left-sided focus, the hyperkinetic syndrome, catastrophic rage and special schooling. The presence of first-degree relatives with seizure disorders was a good prognostic sign. Disorderly homes in childhood did not significantly affect adult outcome. All but one of those achieving Group A status had received normal schooling. In general, the prognosis for children with limbic seizures is clear before the end of adolescence. A simple count of the number of childhood adverse factors predicts adult outcome at a high level of significance.     

Psychopathology and young people with Down's syndrome: childhood predictors and adult outcome of disorder

There is a scarcity of follow‐up studies into adult life of psychiatric disorder in young people with intellectual disability. The key aims of the present study were: (1) to determine the outcome of psychopathology present in childhood in individuals with Down's syndrome (DS); and (2) to look at childhood predictors of adult psychiatric disorder. Fifty‐two young people with DS were identified from a sample of 193 subjects examined in childhood and adolescence for psychiatric and behaviour disorder. These young adults were interviewed for the presence of psychiatric disorder. No significant relationship was found between childhood mental disorder and psychiatric disorder in adult life for those individuals with DS. Early childhood factors of psychiatric disorder, challenging behaviour and family environment, except social background, did not predict adult psychopathology in young people with DS. Childhood disorder in individuals with DS has a good early prognosis with little evidence of continuity of the disorder into adult life.     

Recent onset pseudoseizures--clues to aetiology.

PURPOSE: To examine associations of potentially aetiological significance for the development of pseudoseizures by comparing patients with recent onset pseudoseizures with patients with recent onset epilepsy. METHODS: A prospective study of consecutive patients with recent onset pseudoseizures and epilepsy presenting to two Swedish hospitals. Demographic characteristics, somatic symptoms, depression severity, personality disorder, potential childhood aetiological factors and recent life events were elicited from clinical data and a research interview, which included a structured clinical interview for DSM-IV, a measure of perceived parental care and a life events inventory. RESULTS: Twenty patients with pseudoseizures of duration less than 12 months (mean 5.4 months) were compared with 20 patients with recent onset epilepsy. There was no statistically significant difference in the rate of current psychiatric disorder. Patients with recent onset pseudoseizures were however more likely to have a borderline personality disorder (P<0.05), and to recollect less parental warmth and more paternal rejection (P=0.0001) in childhood. They had no more life events in the 3 months prior to onset but did report more when the whole year before onset was assessed (P<0.001). CONCLUSIONS: Perceived childhood neglect, borderline personality, and an excess of life events over the preceding year is associated with pseudoseizures of recent onset more than with epilepsy. The study was limited by the small sample size making type two errors likely. However, by selecting both cases and controls with recent onset symptoms, the potential bias of differing illness durations and complicating factors of chronicity that have affected previous studies was avoided.     

TEMPORAL LOBE EPILEPSY Social Conditions and Rehabilitation after Surgery

A social investigation was performed of 74 patients with temporal lobe epilepsy resistant to medication, who underwent unilateral temporal lobectomy 1960-1969. The patients were compared to their sibilings and to the general population in Denmark. Comparatively many patients were born out of wedlock. The level of schooling achieved was lower than expected, and this was most pronounced in patients with an early onset of epilepsy. The number of patients having received further education was also smaller than calculated. At the time of the operation all patients were socially incapacitated by their epilepsy; this was most pronounced in males, of whom 30 per cent were institutionalized and 32 per cent were receiving disablement pension; at follow-up the figures were 6 per cent and 52 per cent, respectively. Working capacity was markedly improved postoperatively, and at follow-up 39 per cent were in full-time employment. Relief from seizures (or almost complete relief), normal intelligence, normal psychiatric status, and operation before the age of 18 years were factors which favourably influenced the postoperative working capacity. The majority of the patients were unmarried or divorced, and few of the group had children. Their housing conditions were inferior to those of their siblings and of the general population. Parental social class distribution showed an excess in the highest and lowest social classes compared to the Danish population. The patients were subjected to downward social mobility, presumably caused by their illness, as their siblings displayed an upward mobility, which was most marked in the females.     

Fourteen-year follow-up of speech/language-impaired and control children: psychiatric outcome

OBJECTIVE: To examine the association between early childhood speech and language disorders and young adult psychiatric disorders. METHOD: In a longitudinal community study conducted in the Ottawa-Carleton region of Ontario, Canada, interviewers administered structured psychiatric interviews to age 19 participants who were originally identified as speech-impaired only, language-impaired, or nonimpaired at age 5. The first stage of the study took place in 1982 when participants were 5 years old, and the latest stage of the study took place between 1995 and 1997 when participants had a mean age of 19 years. This report examines the association between early childhood speech/language status and young adult psychiatric outcome. RESULTS: Children with early language impairment had significantly higher rates of anxiety disorder in young adulthood compared with nonimpaired children. The majority of participants with anxiety disorders had a diagnosis of social phobia. Trends were found toward associations between language impairment and overall and antisocial personality disorder rates. Males from the language-impaired group had significantly higher rates of antisocial personality disorder compared with males from the control group. Age of onset and comorbidity did not differ by speech/language status. The majority of participants with a disorder had more than one. CONCLUSIONS: Results support the association between early childhood speech and language functioning and young adult psychiatric disorder over a 14-year period. This association underscores the importance of effective and early interventions.     

Interictal dysphoric disorder in patients with localization-related epilepsy: Diagnostic relationships with DSM-IV psychiatric disorders and the impact of psychosocial burden

BackgroundSome patients with epilepsy develop intermittent and pleomorphic affective–somatoform symptoms, termed interictal dysphoric disorder (IDD). Other psychiatric disorders have been extensively investigated in patients with epilepsy, but there are few clinical studies investigating the comorbidity patterns of IDD and common psychiatric disorders (PDs). In particular, the impact of IDD on the psychosocial burden of patients remains unclear.MethodsThe participants were 128 adult Japanese outpatients with localization-related epilepsy (LRE). In order to determine the comorbidity patterns for IDD and PDs, we conducted a comprehensive diagnostic investigation for IDD and DSM-IV psychiatric disorders. Based on these analyses, participants were divided into groups according to the comorbidity patterns for IDD and PDs in order to compare both suicide risk and quality of life (QOL).ResultsThe findings indicated that 19.5% of participants had IDD, and 55.5% had PDs. Younger age at epilepsy onset and refractory complex partial seizures were associated with IDD, but the duration and type of epilepsy were not. Patients with IDD were more likely to have comorbid PDs as follows: mood disorders (odds ratio, OR: 8.30; 95% confidence interval, CI: 3.15–21.83), anxiety disorders (OR: 8.81; 95% CI: 3.30–23.49), and psychotic disorders (OR: 7.72; 95% CI: 2.83–21.06). Group comparisons demonstrated that there were no patients with IDD but without PD. Furthermore, patients with IDD and with PDs had a significantly higher suicide risk and lower QOL compared to the other groups, even after adjusting for the influences of confounding factors.ConclusionInterictal dysphoric disorder adds extreme psychosocial burden and is associated with multiple PDs in patients with LRE. The present study suggests that IDD has a specific prognostic significance. However, whether IDD is nosologically independent from conditions diagnosed using standardized psychiatric diagnostic systems such as DSM-IV must be further assessed by future research.     

GENETIC FACTORS IN TEMPORAL LOBE EPILEPSY

Genetic investigation of 74 patients with temporal lobe epilepsy, resistant to medication, who underwent unilateral temporal lobectomy 1960-1969. Thirty per cent had a positive family history of epilepsy; 49 per cent of other neurological diseases; and 46 per cent of major psychiatric disorders. Neither of the genetic factors per se influenced the therapeutic result or the psychiatric status at follow-up. A multiple epileptic or neurological predisposition affecting first degree relatives unfavourably influenced the prognosis regarding relief from seizures. A multiple psychiatric predisposition in parents and/or siblings unfavourably influenced the psychiatric status.     

Suicide attempts in adult patients with idiopathic generalized epilepsy

Aims:  To study clinical features of adult patients with idiopathic generalized epilepsy with special attention to suicidal behavior.
Methods:  We reviewed the medical records of 145 consecutive adult patients with electro-clinically confirmed idiopathic generalized epilepsy and identified those with a history of at least one attempted suicide. Clinical variables in relation to their epilepsy and psychiatric conditions were analyzed.
Results:  Seven patients (4.8%) had a history of suicide attempts with drug overdose, and one of these patients committed suicide after multiple attempts. All attempts were made interictally without direct relation to their epileptic seizures. All had at least one co-morbid mental disorder (two with dual diagnosis). Although their psychiatric diagnoses varied, they all appeared to have increased emotional instability and poor impulse control. Only one patient's attempt was directly associated with her co-morbid depression.
Conclusions:  Physicians managing people with epilepsies should be aware of psychiatric disturbances and suicidal behavior in idiopathic generalized epilepsy.     

Concurrent Illnesses in Adults with Childhood-Onset Epilepsy: A Population-Based 35-Year Follow-Up Study

Summary: Purpose: To ascertain the occurrence of concurrent illnesses in adults with epilepsy since childhood.
Method: After a mean follow-up of 35 years of a prospective, population-based long-term followed patient cohort with epilepsy since childhood, comorbidity was examined in 176 surviving (100 of them with epilepsy only) and 44 dead patients and in random and employee controls.
Results: Somatic comorbidity varied from 84 to 95% in patients and from 67 to 74% in controls. No significantly increased risk of somatic diseases could be shown. Psychosomatic disorders were associated in 46-74% of patients and in 42-75% of controls, and psychiatric disorders were associated in 11-23% of patients and in 7% of controls. As compared with random controls, patients with epilepsy had only a 4.0- to 4.2-fold risk of psychiatric disorders or of combinations of somatic, psychosomatic, and/or psychiatric disorders. Patients received psychotropic drugs 8.6 times more frequently than employee controls. The risk for psychiatric and psychsomatic disorders was higher than expected in patients with childhood-onset epilepsy, regardless of whether or not they were still receiving antiepileptic drugs (AEDs).
Conclusion: Epilepsy per se, but not AEDs, has an apparent association with the occurrence of psychiatric and psychosomatic disorders. Risk for somatic comorbidity is not increased.     

The psychiatric comorbidity of epilepsy

Several studies have assessed the prevalence of psychiatric disorders in epilepsy. They are characterized by considerable heterogeneity, because of differences in the population setting and type of study. A non-systematic review of the literature allows us to draw some useful, although not definite, conclusions. Six per cent of people with epilepsy in the general population appear to suffer from a psychiatric disorder, while this rises to 10-20% in populations with temporal lobe and/or refractory epilepsy. Mood disorders are the most common culprit (24-74%), particularly depression (30%), followed by anxiety disorders (10-25%), psychoses (2-7%) and personality disorders (1-2%). This comorbidity appears to be related to endogenous and exogenous (including iatrogenic) factors and to the severity and chronicity of epilepsy. Conditions such as schizophrenia-like psychosis of epilepsy and interictal dysphoric disorder are represented only in epilepsy. Adequate recognition and treatment of psychiatric conditions in epilepsy is essential for patient management because of their considerable burden in morbidity and quality of life.     

Psychiatric disorders at five years among children with birthweights less than 1000g: a regional perspective

The relationship between extremely low birthweight (ELBW) and psychiatric disorder was investigated in a cohort of children of 500 to 1000g birthweight, born between 1980 and 1982. At five years of age data were collected for 82 of 90 survivors on psychiatric symptoms, parent-reported developmental delay and various aspects of psychosocial disadvantage. Compared with controls, ELBW children did not come from more disadvantaged environments, but were much more likely to experience developmental delay and problems with motor co-ordination. 16 per cent had an attention deficit disorder with hyperactivity (ADDH), compared with 6.9 per cent of controls. Rates of conduct disorder and emotional disorder were not raised, indicating that ELBW is a specific risk factor for ADDH. Controlling for the effect of neurodevelopmental problems rendered the association between ELBW and ADDH non-significant.     

Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in adult psychiatry. A 20-year register study

Abstract

Nylander L, Holmqvist M, Gustafson L, Gillberg C. Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in adult psychiatry. A 20-year register study. Nord J Psychiatry 2012;Early Online:1–7 Objective: Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are increasingly recognized in adults. This study aimed to assess trends in diagnostic practice, diagnostic delay and comorbidity regarding ADHD and ASD in adult psychiatric patients. Methods: Individuals with diagnosed ADHD or ASD were identified in an adult psychiatry register comprising 56,462 patients. Results: ADHD was diagnosed in up to 2.7% and ASD in 1.3% of the patients. Most cases were diagnosed within 2 years of first contact with adult psychiatry, but some patients were treated for 10 years or more before being diagnosed with ADHD or ASD. Seventy per cent of ADHD and 56% of ASD patients were treated as outpatients only. Other psychiatric diagnoses were registered in about 60%. Affective disorders were common in patients with ADHD. Psychoses and intellectual disability were more common in ASD patients. Psychoactive substance use-related disorders were considerably more common in those with ADHD. Concomitant ADHD and ASD were seldom diagnosed in this clinical material. Conclusion: ADHD and ASD were probably much underdiagnosed in the studied group of psychiatric patients. Other psychiatric diagnoses were common, but not ADHD with concomitant ASD.     

Social factors and psychopathology in epilepsy

One hundred and six epilepsy patients were assessed over a period of 6 months for psychiatric morbidity, social support, stressful life events in previous year and disability. 45 patients (42.45%) had a psychiatric diagnosis. Organic depressive disorder headed the list (16.98%) followed by mild cognitive disorder (11.32%) and tobacco dependence (8.49%). There was no significant difference in the mean age, sex, mean education, age at onset of epilepsy, duration of epilepsy, psychiatric diagnosis, mean scores on social support scale, presumptive stressful life event scale and disability assessment schedule between different types of epilepsy. The difference in mean scores of presumptive stressful life events scale and disability assessment schedule between epileptics with and without psychiatric diagnosis was not statistically significant.     

Minimal brain dysfunction in childhood: outcome in late adolescence and early adult years.

Seventy-three patients, diagnosed in childhood as having minimal brain dysfunction syndrome and further classified as either developmental lag (38%) or organic brain syndrome (62%), were followed into late adolescence and early adult life. At follow-up 7% were free of psychiatric disorder, 80% had various types of personality disorder, and 14% were borderline psychotic. Global outcome was rated as satisfactory in 20%, unsatisfactory in 80%. Associated with an unsatisfactory outcome were these initial findings: low normal or borderline intelligence, multiplicity of behavioral and neuropsychological findings, learning disabilities, special class placement, and initial classification of organic brain syndrome. Initial differentiation between developmental lag and organic brain syndrome foreshadowed different psychopathological features having significant polarities and little overlap, as well as different global outcome.     

Current and lifetime incidence of psychiatric disorders among a group of extremity sarcoma survivors

Thirty-five survivors of extremity sarcomas being followed in a University-Hospital orthopedic clinic were evaluated for current and lifetime presence of psychiatric disorders. Patients were assessed for cognitive abilities using the Cognitive Capacity Screening Examination and for psychiatric disorders using a structured interview format, the Schedule for Affective Disorders and Schizophrenia-Lifetime version. The criteria for psychiatric disorders were the Research Diagnostic Criteria. Two patients were excluded because of cognitive deficiencies; thirty-three patients (mean age = 37.7 yr) were formally evaluated at a mean time of 2.6 yr following cancer diagnosis and surgery. Forty-five per cent of patients were given the diagnosis of at least one lifetime psychiatric disorder. Fifteen per cent of patients reported a current episode. Affective disorders and alcoholism were the most frequently reported disorders.     

Conversion disorders in childhood: a retrospective follow-up study of 84 inpatients

The medical histories of 84 children who had been diagnosed as having conversion disorder were reviewed in a follow-up study, and the validity of this diagnosis was examined. The female:male ratio was 2.1:1, although below the age of 10 the ratio was almost equal. The medical histories of 62 per cent of the patients showed an organic illness, and 51 per cent had various slight to moderate EEG disturbances. The validity of the diagnosis was very high: only five were found to have organic disease during the follow-up period. Children with symptoms of conversion disorder should receive appropriate medical investigations, but the authors question whether extensive investigations could not be replaced by screening tests, combined with early psychiatric intervention.     

Adult outcomes of childhood and adolescent depression. I. Psychiatric status

The present study was based on the clinical data summaries ("item sheets") of children who attended the Maudsley Hospital, London, England, during the late 1960s and early 1970s. These summaries were used to identify a group of 80 child and adolescent psychiatric patients with an operationally defined depressive syndrome. The depressed children were individually matched with 80 nondepressed psychiatric controls on demographic variables and nondepressive childhood symptoms by a computer algorithm. At follow-up, on average 18 years after the initial contact, information was obtained on the adult psychiatric status of 82% of the total sample. Adult assessments were made "blind" to case/control status. The depressed group was at an increased risk for affective disorder in adult life and had elevated risks of psychiatric hospitalization and psychiatric treatment. They were no more likely than the control group to have nondepressive adult psychiatric disorders. These findings suggested that there is substantial specificity in the continuity of affective disturbances between childhood and adult life.     

GLUT1 deficiency syndrome into adulthood: a follow-up study

GLUT1 deficiency syndrome (GLUT1DS) is a treatable neurometabolic disorder in which glucose transport into the brain is disturbed. Besides the classic phenotype of intellectual disability, epilepsy, and movement disorders, other phenotypes are increasingly recognized. These include, for example, idiopathic generalized epilepsy and paroxysmal exercise-induced dyskinesia. Since the disorder has only been recognized for two decades and is mostly diagnosed in children, little is known about the disease course. Our purpose was to investigate the disease course of GLUT1DS patients with the classic, complex phenotype from infancy into adulthood. We performed a systematic literature review as well as a cohort study, including GLUT1DS patients aged 18 years and older. The literature search yielded a total of 91 adult GLUT1DS patients, of which 33 patients (one-third) had a complex phenotype. The cohort study included seven GLUT1DS patients with a complex phenotype who were prospectively followed up in our clinic from childhood into adulthood. Our results show that epilepsy is a prominent feature during childhood in classic GLUT1DS patients. During adolescence, however, epilepsy diminishes or even disappears, but new paroxysmal movement disorders, especially paroxysmal exercise-induced dyskinesia, either appear or worsen if already present in childhood. Intellectual disability was not systematically assessed, but cognitive functions appeared to be stabile throughout life. Like children, adolescents may benefit from a ketogenic diet or variants thereof.     

The prevalence of abuse in Swedish female psychiatric users, the perpetrators and places where abuse occurred

The aims of the study were to investigate self-reported physical, sexual, emotional and economical abuse in Swedish female users of psychiatric services, who the perpetrators were and in which places abuse occurred. An anonymous self-administrated questionnaire was answered in the waiting room of the services. The drop-out rate was 21% and n=1382 women completed the questionnaire. Fifty-three per cent of the women had been abused during childhood, 63% during adulthood and 31% during past year. Seventy-four per cent of those exposed during childhood were also exposed later in life. Women subjected to abuse reported longer contact with psychiatric care. Regardless of life period, the majority reported multiple and frequent abuse. Emotional abuse was most frequent reported in both childhood and adulthood followed by physical and sexual abuse. The reported perpetrators were mainly male persons to whom the woman had an intimate relationship. Mostly the abuse occurred in the women's own home. However, other women, strangers, acquaintances and relatives were also stated as perpetrator and abusive acts also took place in other homes, outdoors or down town. The high prevalence of abuse and its multiplicity point to the necessity for the care and support system to prioritize abuse against women with psychiatric illness.     

Psychiatric comorbidities in epilepsy: Should they be considered in the classification of epileptic disorders?

The prevalence of psychiatric comorbidities is relatively high in people with epilepsy (PWE), as one in three patients will have experienced a psychiatric disorder in the course of their life. The new definition of epilepsy recognizes these comorbidities as part of the seizure disorder, which need to be recognized and treated together with the actual epileptic seizures. Psychiatric comorbidities have a complex relation with epilepsy, being associated with a negative course of the seizure disorder, worse tolerance of pharmacotherapy with AEDs, development of iatrogenic psychiatric complications from pharmacologic and surgical treatments, and increased mortality risks. Given their negative impact at several levels of the lives of PWE, should psychiatric comorbidities be included in a classification of the epilepsies? This question is addressed in this article.This article is part of a Special Issue entitled “The new approach to classification: Rethinking cognition and behavior in epilepsy”.