ABSTRACT
Pathological gambling symptoms (PGS), that is, the subjective urge to gamble and the actual gambling behaviors, are currently acknowledged as relatively common symptoms among Western countries, with an estimated point prevalence of 0.6-1.1% in the general population. Converging evidence suggests that PGS are overrepresented in patients with neurological conditions affecting dopaminergic reward pathways, and can be expressed in both impulse control disorders and obsessive-compulsive spectrum disorders. This study explored the clinical correlates of PGS in patients with epilepsy. Eighty-eight consecutive adult outpatients recruited at three epilepsy clinics in northern Italy were assessed using the Gambling-Symptom Assessment Scale (G-SAS), along with a battery of psychometric instruments to index depression (Beck Depression Inventory [BDI]), anxiety (Spielberger State-Trait Anxiety Inventory [STAI]), and obsessionality (Yale-Brown Obsessive Compulsive Scale [YBOCS]) symptoms. On the G-SAS, patients with a diagnosis of temporal lobe epilepsy (TLE) reported a mean [sd] G-SAS score of 2.0 [5.7], significantly higher than patients with frontal lobe epilepsy (FLE) (0.6 [1.7]) and idiopathic generalized epilepsy (IGE) (0.4 [1.4]). Moreover, multiple regression analysis showed that G-SAS scores were selectively predicted by YBOCS scores, thus suggesting an association between the expression of obsessional spectrum symptoms and PGS in patients with TLE. Alterations in the mesolimbic reward system could represent the putative neuropathological substrate for this multifaceted clinical picture.
Subject(s)
Disruptive, Impulse Control, and Conduct Disorders/epidemiology , Disruptive, Impulse Control, and Conduct Disorders/psychology , Epilepsy, Temporal Lobe/epidemiology , Gambling/psychology , Obsessive-Compulsive Disorder/epidemiology , Adult , Anticonvulsants/therapeutic use , Cross-Sectional Studies , Diagnostic and Statistical Manual of Mental Disorders , Electroencephalography , Epilepsy, Temporal Lobe/diagnosis , Epilepsy, Temporal Lobe/drug therapy , Female , Humans , Magnetic Resonance Imaging , Male , Obsessive-Compulsive Disorder/diagnosis , Obsessive-Compulsive Disorder/psychology , Psychometrics , Surveys and QuestionnairesABSTRACT
PURPOSE: Different authors suggested the occurrence of a pleomorphic affective syndrome in patients with epilepsy named interictal dysphoric disorder (IDD). We sought to investigate whether IDD occurs only in patients with epilepsy and to validate IDD features against DSM-IV criteria. METHODS: Consecutive patients with a diagnosis of epilepsy (E) or migraine (M) have been assessed using the BDI, MDQ, and the Interictal Dysphoric Disorder Inventory (IDDI), a questionnaire specifically created to evaluate IDD symptoms. Diagnosis of current and lifetime DSM-IV Axis I disorders was established using the MINI Plus version 5.0.0. RESULTS: A total of 229 patients (E = 117; M = 112) were evaluated. Females were significantly more represented in the migraine group (E = 46.5% vs. M = 73.3% p = 0.009), but there was no difference in age, duration of the disease, or education level. Patients with epilepsy were more likely to screen positively at MDQ (E = 17% vs. M = 5.3% p = 0.006) and to have a diagnosis of bipolar disorder (E = 14.5% vs. M = 4.5% p = 0.013) as compared to migraine patients. There was no between-groups difference in IDD prevalence (E = 17%; M = 18.7%) and IDDI total scores (E = 4.1 +/- 2.0 vs. M = 3.8 +/- 2.0). Validation of IDD against DSM-IV categories showed current major depression being the foremost diagnostic category correlated with IDD in both epilepsy (OR = 0.32-0.12-0.88, p = 0.028) and migraine (OR = 0.10, 95% CI = 0.02-0.49, p = 0.004) samples. Current anxiety disorder correlated with IDD only in migraine patients (OR = 0.19, 95% CI = 0.05-0.77, p = 0.02). CONCLUSION: IDD represents a homogenous construct that can be diagnosed in a relevant proportion of patients but it is not typical only of epilepsy, occurring in other central nervous system disorders such as migraine.
Subject(s)
Depressive Disorder/diagnosis , Epilepsy/diagnosis , Migraine Disorders/diagnosis , Adult , Age of Onset , Anxiety Disorders/diagnosis , Anxiety Disorders/epidemiology , Anxiety Disorders/psychology , Bipolar Disorder/diagnosis , Bipolar Disorder/epidemiology , Bipolar Disorder/psychology , Cross-Sectional Studies , Depressive Disorder/epidemiology , Depressive Disorder/psychology , Diagnostic and Statistical Manual of Mental Disorders , Epilepsy/epidemiology , Epilepsy/psychology , Female , Humans , Male , Migraine Disorders/epidemiology , Migraine Disorders/psychology , Personality Inventory , Prevalence , Psychiatric Status Rating Scales/statistics & numerical data , Surveys and Questionnaires , Syndrome , Terminology as TopicABSTRACT
Clinical correlates of schizotypy were evaluated in 89 adult consecutive outpatients with epilepsy, using the Beck Depression Inventory, the State and Trait Anxiety Inventory, and the Schizotypal Personality Questionnaire (SPQ). Age at onset of the epilepsy significantly correlated with the constricted affect subscale of the SPQ, while a diagnosis of temporal lobe epilepsy correlated with the total SPQ score, the cognitive-perceptual factor of the SPQ, and the suspiciousness subscale of the SPQ. Schizotypal symptoms correlated with early onset of the seizures and a diagnosis of temporal lobe epilepsy, further confirming an association between psychoses and epilepsy.
