General Prevalence Of Psychiatric Disorders

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The lifetime prevalence of psychiatric disorders in the general population is high, ranging from 41% to 50% (Kessler et al., 1994; Offord et al., 1996 ; Bijl et al., 1998). On the other hand, the 1-year prevalence ranges between 18.6% and 30% (Kessler et al., 1994) Offord et al., 1996 ) Bijl et al., 1998).

Few population-based studies have evaluated the prevalence of psychiatric disorders in epilepsy, and different study methods produce variability in results. Table 1.1 shows the studies evaluating psychiatric comorbidity in non-selected populations with epilepsy (general population or practice-based). Three of these studies used structured interviews to obtain DSM-IV diagnoses and found similar prevalence rates of mental health conditions in people with epilepsy, that is, 37% (Davis et al., 2003), 29% (Pond and Bidwell, 1960) and 23.5% (Tellez-Zenteno et al., 2005). These prevalence rates are all higher than in the general population. On the other hand, studies that did not use standardized interviews, such as those by Gudmundsson (1966) and Pond and Bidwell (1960), found even higher prevalence rates of psychiatric diagnoses in people with epilepsy (54%). Prevalence rates in studies using ICD codes from administrative data Jalava and Sillanpaa, 1996) Bredkjaer et al., 1998) Hackett et al.) 1998) Stefansson et al., 1998) Gaitatzis et al., 2004b) are highly variable, reflecting the issues in accuracy described above. For example, Stefansson reported a prevalence of 35.3%, Hackett 23.1%, Gaitatzis 41%, Bredkjaer 16.8% and Jalava 24%. Interestingly

TABLE 1.1 Non-selected populations

Author N Ascertainment Type of Use of controls method of population psychiatric conditions

Pond and

245 PE

Psychiatric

Open

Only explored

Bid we11 (1960),

interview

population

psychiatric

UK

not based on

(health survey)

comorbidity in

DSM-IV

Children

patients with epilepsy

Gudmundsson

654 PE

Interview with

Open

Only explored

(1966), Iceland

physician (no

population

psychiatric

standardized

(health survey)

comorbidity

interview)

Children and adults

in patients with epilepsy

Graham and

63 PE

Psychiatric

Open

Controlled

Rutter (1970),

144 PWE

interview (non-

population

(healthy

Isle of Wight

standardized interview)

(PBS) Children

children)

Edeh and

88 PE

CIS

Adults with

NCOE

Toone (1987),

epilepsy from

London

GP practice

Havlova (1990),

225 PE

Chart review

Cohort of

NCOE

Prague

children from a hospital with a neurology program in Prague

Forsgren

713 PE

Chart review

Open

NCOE

(1992),

population

Sweden

(health survey) Adults

Prevalence Prevalence Prevalence Prevalence Prevalence Prevalence Prevalence of of of of of of of psychiatric depression anxiety schizophrenia psychosis personality alcohol conditions (%) disorder (%) (%) disorders dependence w_w_w_(%)

48" 22" 15" 1" 3.4" 2.2" NS

Jalava and

94 PE

Chart review

Adults with

Controlled

Sillanpaa (1996),

199 PWE

and I CD-9

epilepsy from

(random healthy

Finland

different sources

residents of

Finland and

employee

controls of a

printing house)

Bredkjaer et al.

67,116

ICD-8

National

NCOE

(1998),

PWE

patient register

Denmark

Stefansson et al.

241 PE

ICD-9

Adult patients

Controlled

(1998)

482 PWE

receiving

(same list as

disability

PWE)

benefits

Hackett et al.

26 PE

ICD-10

Open

Controlled

(1998), India

1377

population

(healthy adults)

PWE

(health survey)

Adults

Davies et al.,

67 PE

Psychiatric

Open

Controlled

2003), UK

10249

interview based

population

(non-epileptic

PWE

on DSM-IV

(health survey)

patients)

criteria

Children

Ettinger et al.

775 PE

CES-D

Open

All had

(2004), USA

population

epilepsy

(health survey)

Adults

Gaitatzis et al.

5834 PE

ICD-9

Patients from

Controlled

(2004a,b),UK

a database

(patients without

generated from

epilepsy)

GP All age

groups

Strine et al.

427 PE

Kessler 6 scale

Open

Controlled

(2005), USA

30018

(depression

population

(non-epileptic

PWE

and anxiety

(Health

patients)

symptoms)

survey) Adults

35.3/29.7» NE NE 1.2/0.4» 6.2/2.3» 18.3/21» 5/2.3*

41 in PE» 18.2/9.2» 11.1/5.6» 0.7/0.1a 9/2» NE 2.4/0.4»

(Continued)

TABLE 1.1 (Continued)

Author

N

Ascertainment method of psychiatric conditions

Type of population

Use of controls

Prevalence of psychiatric conditions w

Prevalence of depression (%)

Prevalence of anxiety disorder (%)

Prevalence of schizophrenia (%)

Prevalence of psychosis (%)

Prevalence of personality disorders (%)

Prevalence of alcohol dependence (%)

Kobau et al.

4154

PWE

Self reported prevalence

Open population (Health survey) Children and adults

Controlled

(non-epileptic patients)

NE

39/15"

39/15"

NE

NE

NE

(2006), UK

499 PE

HADS

Adults with epilepsy from GP practice

NCOE

NS

11.2"

NS

NS

NS

NS

NS

36,984

PWE

CIDI

Open population (health survey) Adults

Controlled

(non-epileptic patients)

23.5/10.9d

17.4/10.8d

12.8/4.7d

NE

NE

NE

NE

PE, patients with epilepsy; PWE, patients without epilepsy; GP, general practitioners; PBS, population-based study; NCOE, non-controlled, only patients with epilepsy; NS, not stated; NE, not examined. aPoint prevalence; bPrevalence during a follow-up of 35 years; cLifetime prevalence; d12-month prevalence; eCombined anxiety and depression symptoms.

the study of Havlova (1990), where a review of charts was done (similar principle to ICD), the prevalence of psychiatric disorders was lower than studies using ICD codes. Studies using general practitioners ' registries such as those by Edeh and Toone (1987) and Gaitatzis et al. (2004b) report higher prevalence rates of psychiatric conditions (see Table 1.1) . The same effect is observed in the study by Stefansson et al. (1998), based on a list of patients with disability. The prevalence of psychiatric conditions in these types of studies could be higher compared with other methodologies because they are biased toward individuals seeking medical attention, for example, sicker populations. A study of 88 adult patients with epilepsy from general practices in the South of London reported a prevalence of psychosis of 4%. The ascertainment method in this study was performed using the clinical interview schedule (Edeh and Toone, 1987).

Studies of selected populations report considerably higher prevalence rates. Perini et al. (1996) performed a controlled study including patients with epilepsy, juvenile myoclonic epilepsy and diabetes; the corresponding rates of psychiatric disorders were 80%, 22% and 10%, respectively. Using standardized instruments, Silberman et al. (1994) evaluated 21 patients at an epilepsy center in the United States, and found a prevalence of psychiatric disorders of 71%. In candidates for epilepsy surgery, and using DSM-III criteria to identify psychiatric diagnoses, Manchanda et al. (1996) found psychiatric disorders in 47.3% of patients. In a study of patients with temporal lobe epilepsy and generalized epilepsy, Shukla et al. (1979) reported a prevalence of psychiatric disorders of 79% and 47%, respectively. Glosser et al. (2000) explored psychiatric disorders in patients with temporal lobe epilepsy who had epilepsy surgery; the prevalence was 65% before and after the resection. Blumer et al. (1998) explored psychiatric comorbidity before and after temporal resections and the prevalence was 57% and 39%, respectively. Finally, Wrench et al. (2004) evaluated the prevalence of psychiatric disorders before and after the surgery in 43 temporal and 17 extratemporal cases; the corresponding prevalences were 54% and 65% before the surgery and 54% and 33% after the surgery.

In summary, psychiatric comorbidity in epilepsy is very high regardless of the method of assessment. The prevalence of psychiatric conditions in people with epilepsy is at least double in studies of selected epilepsy populations as compared with those in non-selected and in the general population. Important variations among studies probably explain most of this variation, in particular the method of ascertainment and the study population.

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