Abstracts

In patients with epilepsy (PWE) up to 50% of depressive episodes are atypical as they fail to meet any of the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Their semiology tends to be similar to dysthymic disorders and can therefore be referred as Dysthymic-like Disorders of Epilepsy (DLDE). The purpose of this study was to identify the most frequent symptoms of DLDE that could be used in the development of a screening diagnostic instrument. Sample A: 205 consecutive PWE from five outpatient epilepsy clinics underwent structured psychiatric interviews with two validated instruments used to identify Axis I diagnoses, according to the DSM-IV criteria (the Structured Clinical Interview for Axis I DSM-IV Disorders [SCID] and the Minin International Neuropsychiatric Inventory) and completed a 46 item instrument, the Mood and Anxiety Symptoms in Epilepsy (MASE), integrated by symptoms of depression (n = 16), anxiety (n = 11), irritability (n = 9), socialization difficulties (n = 5), increased energy (n = 3) and physical symptoms (n = 2). Each item inquires on the presence of a symptom for the last two weeks and is rated on a 4 Lickert Scale (1 [not at all] to 4 [all the time]) and was completed twice, two weeks apart. The MASE has a high internal consistency with a Chronbach alpha of 0.96. Among the 205 patients, 52 failed to meet any diagnostic criteria on the SCID and MINI but had a mean of 17.7[plusmn]7 positive symptoms (rated as 3 [some of the time] or 4 [all of the time]) on the MASE. Thirteen symptoms were identified by more than 50% of these patients.
: The presence of these 13 symptoms was investigated in a second sample, of 159 PWE and a DLDE (Sample B) who underwent an evaluation with the same psychiatric instruments. Among the 13 symptoms identified in [gt] 50% of sample A patients (see below), 11 were identified in [gt] 50% of sample B patients. These included: feel like crying (52%), disappointed (70%), moody (75%), worried (69%), tense (68%), get impatient easily (72%), agitated (55%), frustrated (65%), irritable and cranky (65%), prefer to be alone (62%), and tired (74%). Two symptoms identified in more than 50% in sample A but not in sample B included: angry and racing thoughts. DLDE is a pleomorphic mood disorder with symptoms of depression, anxiety and irritability. These 11 items are being evaluated for the development of a screening diagnostic instrument. (Supported by Glaxo-Smith-Kline.)