Preventing depression in adolescents with epilepsy

PURPOSE: The goal of the work described in this article was to test the possibility of preventing depression among adolescents with epilepsy. METHODS: Adolescents with newly diagnosed epilepsy (104 patients) were screened for depression. The risk for depression was increased in 30 (28.8%) patients (mean age 17.4, 60% females) who were randomized into two equal treatment groups: (1) cognitive-behavioral intervention (CBI) group and (2) treatment with counseling as usual (TAU) group. The Beck Depression Inventory (BDI), Center for Epidemiological Study on Depression (CES-D) scale, Hamilton Depression Scale (HAMD), and Quality of Life in Epilepsy Inventory (QOLIE-31) were administered at baseline and during the 9-month follow-up. RESULTS: Initial BDI and HAMD scores for the two groups were comparable. Depression was diagnosed during follow-up in three patients in the TAU group. Subthreshold depressive disorder significantly improved at follow-up in the BCI group compared with the TAU group (P<0.05). QOLIE-31 Total scores significantly correlated with both mood improvement and seizure-free state.     

A randomized controlled trial of a manual-based psychosocial group intervention for young people with epilepsy [PIE]

We conducted an exploratory RCT to examine feasibility and preliminary efficacy for a manual-based psychosocial group intervention aimed at improving epilepsy knowledge, self-management skills, and quality of life in young people with epilepsy.MethodEighty-three participants (33:50 m/f; age range 12–17 years) were randomized to either the treatment or control group in seven tertiary paediatric neuroscience centres in the UK, using a wait-list control design. Participants were excluded if they reported suicidal ideation and/or scored above the cut off on mental health screening measures, or if they had a learning disability or other neurological disorder. The intervention consisted of six weekly 2-hour sessions using guided discussion, group exercises and role-plays facilitated by an epilepsy nurse and a clinical psychologist.ResultsAt three month follow up the treatment group (n = 40) was compared with a wait-list control group (n = 43) on a range of standardized measures. There was a significant increase in epilepsy knowledge in the treatment group (p = 0.02). Participants receiving the intervention were also significantly more confident in speaking to others about their epilepsy (p = 0.04). Quality of life measures did not show significant change. Participants reported the greatest value of attending the group was: Learning about their epilepsy (46%); Learning to cope with difficult feelings (29%); and Meeting others with epilepsy (22%). Caregiver and facilitator feedback was positive, and 92% of participants would recommend the group to others.ConclusionThis brief psychosocial group intervention was effective in increasing participants' knowledge of epilepsy and improved confidence in discussing their epilepsy with others. We discuss the qualitative feedback, feasibility, strengths and limitations of the PIE trial.     

康复期抑郁症患者心理干预对照分析

目的 探索心理干预对康复期抑郁症患者的疗效。方法 以HAMD和NOSIE为量化指标，对32例患者进行心理干预研究，并以30例患者做对照。结果 经t检验，研究组与对照组相比较，HAMD、中的总分及6个因子减分值和NOSIE中的总估计分及6个因子减分值均有显著差异。结论 心理干预对康复期抑郁症患者有较好的疗效。     

Screening for major depression in epilepsy with common self-report depression inventories

PURPOSE: Major depression is a common psychiatric comorbidity in chronic epilepsy that is frequently unrecognized and untreated. A variety of self-report mood inventories are available, but their validity as well as ability to detect major depression in epilepsy remains uncertain. The purpose of this study was to determine the ability of two common depressive symptom inventories to identify major depression in people with epilepsy. METHODS: In total, 174 adult patients with epilepsy underwent standardized psychiatric interview techniques [Mini International Neuropsychiatric Interview (MINI) and Mood Disorders module of the Structured Clinical Interview for DSM-IV Axis I Disorders-Research Version (SCID-I)] to determine the presence of current major depression. Subjects completed two self-report depression inventories [Beck Depression Inventory-II (BDI-II), Center for Epidemiological Study of Depression (CES-D)]. The ability of these self-report measures to identify major depression as identified by the gold standard structured interviews was examined by using diagnostic efficiency statistics. RESULTS: Both the BDI-II and the CES-D exhibited significant ability to identify major depression in epilepsy. All ROC analyses were highly significant (mean area under the curve, 0.92). Mean sensitivity (0.93) and specificity (0.81) were strong, with excellent negative predictive value (0.98) but lower positive predictive value (0.47). CONCLUSIONS: Common self-report depression measures can be used to screen for major depression in clinical settings. Use of these measures will assist in the clinical identification of patients with major depression so that treatment can be initiated.     

帕罗西汀联合加味逍遥散治疗抑郁症的随机对照研究

目的观察帕罗西汀联合加味逍遥散治疗抑郁症的疗效和安全性。方法采用随机数字表法将60例符合《国际疾病分类(第10版)》(ICD-10)抑郁症诊断标准的患者分为实验组和对照组各30例,两组均给予帕罗西汀20 mg/d治疗,实验组在此基础上加用加味逍遥散,对照组加用安慰剂治疗,于治疗前及治疗半月、1月、2月后采用汉密尔顿抑郁量表(HAMD)评定疗效,并于治疗前及治疗后2月抽血检验血清脑源性神经营养因子(BDNF)浓度,采用副反应量表(TESS)监测药物副反应。结果治疗半月、1月、2月后,实验组HAMD评分均较治疗前低,差异有统计学意义(P0.05)。治疗1月、2月后,对照组HAMD评分均低于治疗前,差异有统计学意义(P0.05)。治疗半月、1月、2月后,两组HAMD评分比较差异有统计学意义(P0.05)。治疗2月后,两组有效率比较差异有统计学意义(P0.05)。治疗1月、2月后,两组血清BDNF浓度均较治疗前高,差异有统计学意义(P0.05)。治疗2月后,实验组血清BDNF浓度高于对照组,差异有统计学意义(P0.05)。实验组不良反应发生率低于对照组,差异有统计学意义(P0.05)。结论帕罗西汀联合加味逍遥散对抑郁症的疗效优于单独使用帕罗西汀,副作用更少。     

癫痫与抑郁关系的研究进展

抑郁是癫痫患者中常见的精神障碍,严重地影响了患者的生活质量。传统的观点认为癫痫患者因为存在着诸多社会学问题易出现抑郁倾向,癫痫和抑郁是单向的联系,但大量的研究已经证明癫痫和抑郁之间存在双向的联系,一种异常状态的存在可能易转化为另一种异常状态的发展。癫痫和抑郁存在着共同的发病机制。本文主要就癫痫和抑郁的双向联系以及抗抑郁药物在癫痫患者中的应用进行阐述。     

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%).     

西酞普兰治疗癫痫伴发抑郁的系统评价

目的评价西酞普兰治疗癫痫伴发抑郁障碍患者的疗效及安全性。方法采用Cochrane系统评价的方法,计算机检索Pubmed、Embase、Cochrane Library、中国生物医学期刊文献数据库、中国期刊全文数据库、中文科技期刊全文数据库,检索时间为每个数据库建库到2012年6月,检索语言限制为英文和中文。全面收集西酞普兰治疗癫痫患者伴发抑郁的临床随机对照试验,评价纳入研究质量,进行Meta分析。结果共纳入2个研究,94例患者,均为国内单中心实验,Meta分析结果显示,西酞普兰对抑郁情绪的改善有效率高于对照组,差异有统计学意义[OR=18．11,95％CI（5．76～56．88）,P〈0．00001]。2个研究报道的不良反应为头疼、头晕、恶心、呕吐、失眠、镇静等。无研究报道生存质量。结论现有证据提示,西酞普兰能有效改善癫痫伴发抑郁患者的抑郁症状。部分患者出现不良反应,一般都很轻微。受纳入研究质量限制,以上结论有待开展更多高质量、大样本的随机双盲对照试验予以验证。     

心理干预对癫痫患者生活质量影响的Meta分析

目的系统评价心理干预对我国癫痫患者生活质量的影响。方法计算机检索维普中文科技期刊数据库、中国期刊网全文数据库、万方数据库及中国生物医学文献数据库,查找有关心理干预对癫痫患者生活质量影响的临床对照试验,检索时限为从建库至2012-12,由2位评价人员按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.3软件进行Meta分析。结果最终纳入8个临床对照试验,包括598例患者。Meta分析结果显示:(1)心理干预显著增加癫痫患者QOL总分及多个分项得分(P0.05);(2)干预组与对照组咨询前后QOL总分及各分项得分的差数均数差异均有统计学意义(P0.05或0.01)。结论心理干预可能有效改善癫痫患者的生活质量,且长期的干预效果比较稳定。受限于纳入研究的质量和数量,上述结论尚有赖于进一步开展更多大样本、多中心、高质量的临床研究加以验证。     

The role of hippocampal sclerosis in topiramate-related depression and cognitive deficits in people with epilepsy

PURPOSE: To clarify the role of hippocampal sclerosis (HS) in developing psychiatric and cognitive adverse events during therapy with topiramate (TPM) in patients with temporal lobe epilepsy (TLE). METHODS: We analyzed the data of 70 patients with TLE and HS and 128 patients with cryptogenic TLE matched for age, sex, starting dose, and titration schedule of TPM. They were selected from the first consecutive 431 patients started on TPM between 1995 and 1999. RESULTS: Patients with HS were more likely to develop cognitive adverse events (CAEs; p = 0.002) and depression (p = 0.018) and to be receiving a polytherapy regimen (p = 0.007). However, regression analysis demonstrated that only HS was a predictive factor for the occurrence of CAEs (OR = 2.4; p < 0.001) and depression (OR = 2.3; p = 0.02). CONCLUSIONS: Patients with TLE and HS were more prone to develop CAEs and depression than were patients with cryptogenic TLE, during TPM therapy, despite the same titration schedule. The presence of HS and not duration of epilepsy or polytherapy regimen represented the main risk factor.     

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。     

Randomized controlled trial of a cannabis-focused intervention for young people with first-episode psychosis

OBJECTIVE: To evaluate a cannabis-focused intervention (cannabis and psychosis therapy: CAP) for patients continuing to use cannabis following initial treatment for first-episode psychosis (FEP). METHOD: Consecutive admissions to an early psychosis program were screened and consenting individuals using cannabis in the 4 weeks prior to assessment participated. A single-blind randomized controlled trial compared CAP (n = 23) with a clinical control condition (psychoeducation, PE; n = 24). There were no significant differences between the CAP and PE groups on cannabis use at end of treatment and 6 months post-intervention. RESULTS: There were no significant group differences on psychopathology and functional ratings at follow-up. A significant reduction in cannabis use was observed for both groups over time. CONCLUSION: PE and specific cannabis-focused intervention are associated with similar reductions in cannabis use in an FEP cohort. Simple interventions may therefore be worth considering prior to intensive psychotherapeutic efforts with this population.     

心理干预对癫患者焦虑抑郁情绪的影响

目的:探讨心理干预对癫患者焦虑抑郁情绪的影响。方法:对163例成人癫患者在抗癫治疗的同时实施为期3个月的心理干预;采用中文版Zung焦虑自评量表(SAS)及抑郁自评量表(SDS)分别于干预前、干预后1个月和3个月进行评定。结果:163例癫患者实施心理干预后焦虑和抑郁情绪改善显著,并随干预时间延长而显著下降。与干预前比较,干预1周,SAS及SDS评分与干预前差异无统计学意义(P=0.469、0.272);干预1个月和3个月,SAS及SDS评分与干预前比较差异有显著统计学意义(F=15.196、16.207,P均<0.001)。结论:癫患者焦虑抑郁情绪明显;心理干预能够显著改善患者焦虑抑郁情绪;干预时间越长,效果越好。     

A randomized controlled trial of routines-based early intervention for children with or at risk for developmental delay

Routines-based early intervention (RBEI) for children with or at risk for developmental delay encourages collaboration between professionals and families to enhance children's participation in family routines with family-selected goals. We conducted the first single-blinded randomized control trial to examine the effectiveness of a 6-month RBEI vs. traditional home visiting (THV), which uses a curriculum focused on children's developmental domains. Thirty-one families with children aged 5–30 months (mean age 17.4 months) with or at risk for developmental delay were randomly assigned to an RBEI group (n = 15) or a THV group (n = 16). The enrolled children were evaluated using the Chinese version of Pediatric Evaluation of Disability Inventory (PEDI-C) and the Comprehensive Development Inventory for Infants and Toddlers (CDIIT) at 5 time points. Two-way mixed analysis of variance (ANOVA) was used to examine the group by stage interactions. Goal Attainment Scaling (GAS) and the Canadian Occupational Performance Measure (COPM) were applied to explore between-group differences on individualized goal achievement. PEDI-C showed that the RBEI group had a faster progress rate in self-care functions and independence in social functions in the first 3 months of intervention and at the 6-month follow-up. The RBEI group also scored higher on the GAS in the first 3 months of intervention. However, between-group differences in changes in the developmental domains on the CDIIT were not significant. Thus, RBEI was more effective than THV in promoting functional outcomes and reaching family-selected goals, while both interventions allowed equal improvement in developmental domains.