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Title: Two distinct symptom-based phenotypes of depression in epilepsy yield specific clinical and etiological insights
Austin Authors: Rayner, Genevieve ;Jackson, Graeme D ;Wilson, Sarah J
Affiliation: Austin Health, Heidelberg, Victoria, Australia
Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria
The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne Brain Centre, Heidelberg, Victoria, Australia
Comprehensive Epilepsy Programme, Melbourne Brain Centre, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 27-Jul-2016 2016-07-27
Publication information: Epilepsy & Behavior 2016; online first: 27 July
Abstract: Depression is common but underdiagnosed in epilepsy. A quarter of patients meet criteria for a depressive disorder, yet few receive active treatment. We hypothesize that the presentation of depression is less recognizable in epilepsy because the symptoms are heterogeneous and often incorrectly attributed to the secondary effects of seizures or medication. Extending the ILAE's new phenomenological approach to classification of the epilepsies to include psychiatric comorbidity, we use data-driven profiling of the symptoms of depression to perform a preliminary investigation of whether there is a distinctive symptom-based phenotype of depression in epilepsy that could facilitate its recognition in the neurology clinic. The psychiatric and neuropsychological functioning of 91 patients with focal epilepsy was compared with that of 77 healthy controls (N=168). Cluster analysis of current depressive symptoms identified three clusters: one comprising nondepressed patients and two symptom-based phenotypes of depression. The 'Cognitive' phenotype (base rate=17%) was characterized by symptoms taking the form of self-critical cognitions and dysphoria and was accompanied by pervasive memory deficits. The 'Somatic' phenotype (7%) was characterized by vegetative depressive symptoms and anhedonia and was accompanied by greater anxiety. It is hoped that identification of the features of these two phenotypes will ultimately facilitate improved detection and diagnosis of depression in patients with epilepsy and thereby lead to appropriate and timely treatment, to the benefit of patient wellbeing and the potential efficacy of treatment of the seizure disorder. This article is part of a Special Issue entitled "The new approach to classification: Rethinking cognition and behavior in epilepsy".
DOI: 10.1016/j.yebeh.2016.06.007
PubMed URL:
Type: Journal Article
Subjects: Brain networks
Focal epilepsy
Appears in Collections:Journal articles

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