Predictors of clinically significant anhedonia in refractory epilepsy.

BACKGROUND: Anhedonia, the inability to feel pleasure or motivation for reward, is a core feature of depression in epilepsy, but can occur independent from depression. It is reported in over a third of people with epilepsy and has a significant impact on quality of life. OBJECTIVES: This study determined whether specific features of medication refractory epilepsy are predictive of anhedonia. DESIGN: We assessed 267 patients with medication refractory epilepsy for anhedonia, primarily using the clinically validated Snaith-Hamilton Pleasure Scale (SHAPS) scale. METHODS: Patients with clinically significant anhedonia were compared with those without for key demographics, epilepsy characteristics and medication using a logistic regression analysis. RESULTS: We found that seizure frequency (p < 0.01) but not duration of epilepsy was significantly associated with anhedonia. We also found that benzodiazepine use was significantly associated (p = 0.01) with anhedonia, and levetiracetam/brivaracetam and sodium valproate were significantly negatively associated with anhedonia (0.01 and 0.03 respectively). CONCLUSION: High seizure burden in medication refractory epilepsy is significantly associated with anhedonia. Specific antiseizure medications are also associated with the development of anhedonia, but it is unclear whether their use is causative or influenced by the presence of anhedonia.

The impact of recreational cannabis use on neuropsychological function in epilepsy.

Cannabis use is associated with neuropsychological impairments in the general population, but little is known about the impact on cognitive function in people with epilepsy who are already at increased risk of difficulties due to the essential comorbidities of the disease. We compared the performance of 42 people with epilepsy (PWE) who reported regular cannabis use with 254 age matched, non-cannabis-using PWE. Patients completed tests of intellectual reserve, memory, language and processing speed. Approximately one in 17 patients (5.9 %) reported current cannabis use. Cannabis use was not associated with epilepsy type. Males were 1.8 times more likely to report cannabis use compared to females. Cannabis use was associated with lower intellectual reserve (Reading IQ: t = 2.8, p < 0.01, Cohen's d = 0.49), reduced encoding of new information (List Learning: t = 3.3, p < 0.001, Cohen's d = 0.56) and enhanced susceptibility to distraction on a subsequent recall task (t = 3.07, p < 0.01, Cohen's d = 0.51. In regression models cannabis use was significantly associated with impairments in learning and recall after controlling for elevated levels of anxiety and depression. Our data indicates that recreational cannabis use in people with epilepsy amplifies deficits in new learning and enhances susceptibility to distraction in the retention of newly learnt material. Recreational cannabis use should be considered when interpreting the significance of these cognitive impairments when they are recorded in a clinical assessment.

A Comparison of Social Exclusion Towards People with Depression or Chronic Back Pain.

Objectives: Research comparing mental and physical health stigma is scarce. The aim of this study was to compare social exclusion towards hypothetical males and females with depression or chronic back pain. Furthermore, the study investigated whether social exclusion is associated with participant's empathy and personality traits, while controlling for their sex, age and personal exposure to mental/physical chronic health conditions. Design: This study employed a cross-sectional questionnaire design. Methods: Participants (N = 253) completed an online vignette-based questionnaire and were randomly allocated to either a depression or chronic back pain study condition. Measures of social exclusion through respondents' willingness to interact with hypothetical individuals, empathy and the Big Five personality traits were completed. Results: Willingness to interact scores did not significantly differ depending on the diagnosis or sex of the hypothetical person in the vignette. For depression, higher levels of conscientiousness significantly predicted less willingness to interact. Whilst being a female participant and having higher empathy significantly predicted greater willingness to interact. For chronic back pain, higher empathy significantly predicted greater willingness to interact, with no significant predictors found from the Big Five personality traits. Conclusion: Findings indicate that females and males with depression or chronic back pain face similar levels of social exclusion, with empathy being a core variable driving social exclusion behaviours. These findings enhance our understanding of potential variables driving social exclusion, in-turn informing campaign development to reduce public stigma towards depression and chronic back pain.

Anhedonia in epilepsy.

BACKGROUND: Anhedonia, the impaired ability to experience pleasure, is a core feature of major depressive disorder, one of the most common comorbidities in epilepsy. It is also reported as a clinical feature independent of depression in a number of other neurological conditions. This study aimed to establish the prevalence of anhedonia in a sample of people with epilepsy, with and without a diagnosis of depression, and to examine the clinical and demographic characteristics of those who present with this symptom. METHODS: A consecutive sample of 211 people (118 female, 93 male, mean age 38.09 years) completed the Snaith-Hamilton Pleasure Scale (SHAPS) to determine the presence of anhedonia and the Hospital Anxiety and Depression Scale to determine levels of anxiety and depression. The majority of patients had focal epilepsy (n = 165), and the remaining patients had generalized epilepsy (n = 22), or unclassified epilepsy (n = 24). Sixteen percent of the sample had a clinical diagnosis of depression at the time of the study. RESULTS: Over one in three of the sample (35%) reported significant anhedonia on the SHAPS. While these patients were more likely to have a diagnosis of depression (p < 0.01), 30% of people without a diagnosis of depression also reported significant anhedonia. Difficulties gaining pleasure on 12 of the 14 items on the SHAPS were associated with cognitive difficulties, with those reporting an inability to feel pleasure on the item scoring significantly lower on tests of cognitive function than those who were able to gain pleasure. Of the three cognitive domains examined (overall intellectual ability, verbal memory, and processing speed), a poor memory had the strongest relationship; with lower memory function associated with an impaired ability to experience pleasure on 9 of the 14 items. CONCLUSION: While anhedonia is well recognized as a feature of depression, our data suggests that it can be present in up to a third of people with epilepsy who do not have a diagnosis of depression. Cognitive difficulties, particularly impaired memory function may mediate some features of anhedonia. The implications of these findings for the clinical management of anhedonia in people with epilepsy are discussed.