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.     

Self-reported seizure frequency and time to first event in the seizure monitoring unit

PURPOSE: To compare seizure frequency reported in the clinic with time to first diagnostic event during video-EEG monitoring. The effect of the artificial environment of the monitoring unit on self-reported seizure frequency was explored. METHODS: The 155 consecutive patients were seen in the Washington University Epilepsy Center and subsequently underwent video-EEG monitoring during 2001. Of these, 112 had a diagnostic event during monitoring; 31 left without having a definite event; and 12 could not provide an estimate of seizure frequency in the clinic. The time to first event was compared with self-reported seizure frequency. The patients were then divided into three equal groups (tertiles) based on mean seizure frequency, and time to first seizure was compared between groups. Then the numbers of patients staying >7 days without ever having an event were compared between the low and high seizure-frequency groups. Finally, Kaplan-Meier survival curves were calculated. RESULTS: No correlation was found between self-reported seizure rate and time to diagnostic event (r= 0.18; p = 0.06). Time to first event was 2.8 days in the low seizure-frequency group (mean, 2.2/month), 2.1 days in the medium (mean, 8.8/month), and 2.1 days in the high (mean, 24.1/month) groups, which were not significantly different (p = 0.19). Of patients in the low-frequency group, 79% had an event within 7 days. CONCLUSIONS: In the artificial environment of the monitoring unit, self-reported outpatient seizure frequency is not an accurate predictor of duration of video-EEG monitoring required to make a definitive classification of clinical events and should not contribute to the decision as to whether to refer a patient for monitoring.     

Lung function,asthma symptoms,and quality of life for children in public housing in Boston: a case-series analysis

Background  

Children in urban public housing are at high risk for asthma, given elevated environmental and social exposures and suboptimal medical care. For a multifactorial disease like asthma, design of intervention studies can be influenced by the relative prevalence of key risk factors. To better understand risk factors for asthma morbidity in the context of an environmental intervention study, we conducted a detailed baseline evaluation of 78 children (aged 4–17 years) from three public housing developments in Boston.     

Importance and knowledge of oral contraceptives in antepartum, low-income, African American adolescents

STUDY OBJECTIVE: To assess motivation, sense of self-efficacy and knowledge of oral contraceptives (OC) in antepartum, African-American Adolescents and young adults following OC counseling. METHODS: Gravid African-American females, less than 25 years of age, receiving prenatal care at the Prentice Ambulatory Clinic at Northwestern Memorial Hospital were eligible for this study. Participants were enrolled after 34 weeks gestation, received one session of standardized OC counseling and then completed a series of questions regarding importance, confidence and knowledge of OCs. RESULTS: Forty-three adolescents and young adults participated in this study. Almost all participants agreed that it was important to plan their next pregnancy and to avoid unplanned pregnancies. On average, participants were extremely confident they could take a pill each day. Yet, while most were confident that they knew what to do if they missed one pill, only 37% actually knew what to do if they missed one pill. CONCLUSION: Despite high motivation and confidence in their ability to take OCs following pregnancy, many in this cohort did not fully understand the counseling that they had received. It is important for clinicians to bear in mind that patients may express motivation and confidence about using OCs, but still lack knowledge of the more complex and critical aspects of OC use. Additional education and support are needed in high-risk populations to ensure effective contraceptive knowledge.     

Psychiatric comorbidity, health, and function in epilepsy

Epilepsy is a chronic condition that has complex effects on social, vocational, and psychological function. Several psychiatric disorders have been shown to have increased prevalence in persons with epilepsy compared to the general population. Depression appears to be the most common psychiatric comorbidity, but anxiety and other diagnoses have not been extensively investigated. Several studies have found that depression or psychological distress may be the strongest predictors of health-related quality of life, even including seizure frequency and severity, employment, or driving status. Despite the high prevalence and adverse effects of comorbid psychiatric disorders in epilepsy, very little is known about optimal treatment strategies, or even the efficacy of standard treatments. Further research is needed to increase understanding of the mechanisms of psychiatric illness in epilepsy, the effects of depression and anxiety on long-term clinical outcomes, and the most effective treatments.     

School and family participation in a longitudinal study of tobacco use: some methodological notes

School-based recruitment of youth for a research purpose is problematic, as one has to deal with multiple ethical and practical constraints. This study reports on predictors of schools' and families' participation in a longitudinal study of tobacco use among 11-year-old children. School size, but not tobacco policy, was linked to participation. High parental education and average social status in the residence area were associated with parental consent. Given the social background, prevalence of parental tobacco use was close to the expected. Compliance of responsible adults in youth research cannot be predicted on the basis of simple behavioural models.