Abstracts

RATIONALE: Interictal psychiatric co-morbidity is a recognized complication of chronic epilepsy. Interest in the use of formal standardized psychiatric interview techniques to characterize lifetime-to-date and current psychiatric status is increasing; however, these procedures can be quite time consuming and are not designed for the typical clinical setting. Attempts have been made to develop brief and more efficient standardized clinical interview procedures and the Mini International Neuropsychiatric Interview (v 5.0), or MINI, was developed to be utilized in medical settings. The purpose of this multicenter investigation is to examine the utility of the MINI in characterizing psychiatric co-morbidity in epilepsy, compare the validity of MINI diagnoses of current major depressive episodes to the current gold standard (Structured Clinical Interview for DSM-IV Disorders [SCID]), and develop an efficient and valid self-report screening instrument to detect depressive symptoms in patients with epilepsy.
METHODS: Patients with chronic epilepsy underwent standardized clinical interview with the MINI as well as the Mood Disorders module of the SCID before completing several self-report mood questionnaires. Rates of DSM-IV mood disorders were identified with the MINI and SCID and the validity of the MINI determined. Selection criteria were: [gt]17 years of age, on stable AED treatment for the past 30 days, intact reading ability, and no prior epilepsy surgery or current vagal nerve stimulator.
RESULTS: The majority of the inital 26 patients enrolled were women (61.5%) on monotherapy (61.5%) with complex partial seizures (70%). The mean age of the sample was 37.4 years with a mean onset age of 18 years. MINI revealed that current Axis 1 disorders were common with Anxiety (50%) and Mood (40%) disorders the most frequent. Among current Mood disorders, most common were suicidality (23.1%), major depressive episodes (19.2%), and dysthymia (3.8%). Among the Anxiety disorders, most common were agoraphobia (30.8%), generalized anxiety disorder (19.2%), PTSD (11.5%), panic disorder (11.5%), and social phobia (11.5%). Using the SCID Mood module, current and lifetime-to-date disorders were common, including current (23.1%) and past (42.3%) major depressive episodes, current (3.8%) and past (3.8%) minor depression, current dysthymia (3.8%), mood disorder secondary to a medical condition (3.8%), and past hypomania (7.7%). Correlation between the MINI and SCID for current major depressive episodes was 0.89.
CONCLUSIONS: These preliminary results using the MINI indicate the following: 1) Axis I disorders are common among patients with chronic epilepsy, 2) anxiety and mood disorders are among the most frequent disorders, and 3) psychiatric co-morbidity can be efficiently screened with concise standardized psychiatric interview procedures that appear to have acceptable validity compared with the gold standard (SCID). This project will continue to accrue up to 200 patients leading to better estimates of the frequency and distribution of Axis 1 disorders in chronic epilepsy, the validity of the MINI, and the reliability and validity of a new self-report inventory to detect depressive symptoms in epilepsy.
[Supported by: Grant from GlaxoSmithKline.]; (Disclosure: Grant - Unrestricted Educational Grant from GlaxoSmithKline)