Maladaptive personality traits in patients with epilepsy and psychogenic non-epileptic seizures.

OBJECTIVE: We aimed to evaluate the sociodemographic, clinical, and psychological characteristics associated with psychogenic non-epileptic seizures (PNES) in patients with epilepsy, with particular emphasis on the personality profile assessed from a dimensional perspective. METHODS: The cohort study included 77 consecutive inpatients with active epilepsy aged 36-55 years; 52 (67.5%) were female. The presence of PNES was confirmed by video-EEG monitoring. All patients underwent the Mini-International Neuropsychiatric Interview to diagnose psychiatric disorders. All participants completed the Neurological Disorders Depression Inventory in Epilepsy, the Epilepsy Anxiety Survey Instrument - brief version, and the Personality Inventory for DSM-5 and ICD-11 Brief Form Plus Modified. Chi-square and Fisher's exact tests were used to compare categorical variables, and the Brunner-Munzel test was used for quantitative variables. RESULTS: Twenty-four patients (31.2%) had both epilepsy and PNES. There were no significant differences in social, demographic or clinical characteristics, psychiatric diagnoses or depression severity. Compared to patients with epilepsy alone, patients with epilepsy and PNES had higher anxiety scores and more pronounced maladaptive personality traits such as disinhibition and psychoticism. SIGNIFICANCE: The main novelty of our study is that using the recently proposed dimensional approach to personality disorders and an appropriate instrument we assessed all personality domains listed in two of the most widely used classifications of mental disorders (DSM-5 and ICD-11) in PWE with and without PNES. To our knowledge, this is the first study to demonstrate the association of the maladaptive traits of psychoticism and disinhibition with the development of PNES in PWE.

[Psychogenic non-epileptic seizures in autistic spectrum disorder]. / Psikhogennye neepilepticheskie pristupy pri rasstroistve autisticheskogo spektra.

Psychogenic non-epileptic seizures (PNES) are paroxysmal conditions that resemble epileptic seizures, but are not accompanied by epileptiform activity on the electroencephalogram and are not associated with other neurological or somatic disorders. Unrecognized PNES places a heavy burden on the patient and family, and on the health care system. Among many possible combinations of PNES with psychiatric disorders, autistic spectrum disorders are the least studied. This article presents a case of a 19-year-old female patient with autistic spectrum disorder and paroxysmal events and the presence of potentially epileptogenic changes in the brain. A multidisciplinary approach made it possible to diagnose PNEP in the patient.

[Comorbidity of psychogenic non-epileptic seizures with mental disorders]. / Komorbidnost' psikhogennykh neepilepticheskikh pristupov s psikhicheskimi rasstroistvami.

The present review discusses the comorbidity of psychogenic non-epileptic seizures (PNES) with other mental disorders. Data on the prevalence of mood, anxiety, psychotic and personality disorders are presented. The role of traumatic experience in the development of PNES is described. Special attention is given to PNES as an independent nosological entity and its place in the modern classifications of mental disorders.

[Psychometric properties of the Russian version of the brief «Reasons for Living Inventory¼]. / Psikhometricheskie svoistva russkoyazychnoi versii «Kratkogo oprosnika prichin dlya zhizni¼.

OBJECTIVE: To investigate psychometric properties of the Russian version of the brief Reasons for Living Inventory (bRFL) in patients with non-psychotic mental disorders (NPMD) and to define its association with current suicide ideation. MATERIAL AND METHODS: Six hundred and 15 consecutive patients with NPMD were included. The median age was 27 (19) years; 403 (65.5%) were female. Cronbach's alpha, Cronbach's alpha coefficient if an item is deleted and corrected item-total correlation were used for the internal consistency evaluation. The internal structure assessment was based on the exploratory and confirmatory factor analysis. To identify an association of bRFL with current suicidal ideation, MANCOVA was used. RESULTS: An internal consistency of bRFL was good (Cronbach's Alpha-0.856). The exploratory factor analysis revealed a 6-factor model, explaining 80.22% of variance. These factors were: «survival and coping beliefs¼, «responsibility to family¼, «child related concerns¼, «fear of suicide¼, «fear of social disapproval¼ and «moral objections¼. The confirmatory factor analysis indicated a good agreement of the 6-factor model with an empirical data (CMIN/DF - 2.98, CFI - 0.956, SRMR - 0.05, RMSEA - 0.057, PNFI - 0.497). Regardless of gender and age, the total scores of bRFL and its subscales were significantly lower in patients with suicide ideation (p<0.01). CONCLUSION: The Russian version of bRFL is a reliable and valid tool for the assessment of the adaptive beliefs and expectations that form an anti-suicidal barrier.

[Psychogenic non-epileptic seizures]. / Psikhogennye neepilepticheskie pristupy.

The review provides epidemiological data and discuss the associated burden of non-epileptic seizures (PNES). Data on the prevalence, socio-demographic and clinical risk factors for the development of PNES are presented. The hypotheses of the PNES origin, including the contribution of psychological trauma, are considered. We also describe contemporary methods for differential diagnosis of epileptic seizures and PNES, including biomarkers and the use of diagnostic questionnaires. Special attention is given to the issues of the psychiatric comorbidity of PNES.

[Pain perception and nonsuicidal self-injurious behavior]. / Vospriyatie boli pri nesuitsidal'nom samopovrezhdayushchem povedenii.

This review focuses on studies of pain threshold and tolerance in individuals with nonsuicidal self-injurious (NSSI) behavior. The data on methods of pain sensitivity studies are presented, with issues in animal modeling of NSSI discussed separately. The results of neuroimaging studies on pain sensitivity in individuals with NSSI are described, along with contribution of genetic factors, psychological variables, and disturbances in opioid and hypothalamic-pituitary-adrenal systems. A critical methodological analysis of the studies on pain sensitivity in individuals with NSSI was performed.

[Prognosis for surgical treatment of pharmacoresistant epilepsy: the role of mental and cognitive disorders]. / Prognoz khirurgicheskogo lecheniia farmakorezistentnoi épilepsii: rol' psikhicheskikh i kognitivnykh rasstroistv.

This review focuses on the role of mental and cognitive disorders in the prognosis for surgical treatment of pharmacoresistant epilepsy. The authors analyze historical aspects of the surgical treatment of epilepsy and present current data on the prognosis of operative intervention with respect to seizure control, cognitive functioning, and psychiatric disorders. The psychiatrist's role in the structure of preoperative and postoperative management of patients is considered.

[Anxiety disorders in epilepsy]. / Trevozhnye rasstroistva pri épilepsii.

This review is devoted to the place of anxiety disorders in the spectrum of psychiatric comorbidity in patients with epilepsy. The authors present general characteristics of anxiety manifestations and current views on the classification and qualification of anxiety disorders in such patients. Recent data show the relationship of anxiety with different forms of epilepsy, demographic and gender characteristics, localization of epileptic focus. The problem of bidirectional relationship of anxiety and epilepsy as well as the temporal relationship between anxiety and epileptic states are considered.

[Suicidality in epilepsy: epidemiology and clinical risk factors]. / Suitsidal'nost' pri épilepsii: épidemiologicheskie aspekty i faktory riska.

The results of studies on the prevalence of suicidal behavior in patients with epilepsy are discussed in the article. The reasons for the high incidence of suicides among patients with epilepsy are given, with special attention paid to social, demographic, clinical and pathopsychological risk factors. Existing gaps in our knowledge about suicidal behavior in patients with epilepsy are analyzed.

[Interictal dysphoric disorder: a current state of the problem]. / Mezhpristupnoe disforicheskoe rasstroistvo: sovremennoe sostoianie problemy.

The authors present a clinical description of interictal dysphoric disorder in patients with epilepsy compared to other similar disorders. The comorbidities of epilepsy and affective disorders, including atypical forms, are reviewed. Clinical aspects of affective somatoform syndrome are discussed.

[Subcortical laminar heterotopia 'double cortex syndrome']. / Podkorkovaia laminarnaia geterotopiia (sindrom 'dvoinoi kory').

This article presents a clinical case of a 29-year-old patient with 'Double cortex syndrome' with epilepsy, intellectual and mental disorders. Subcortical band heterotopia is a rare disorder of neuronal migration. Such patients typically present with epilepsy and variable degrees of mental retardation and behavioral and intellectual disturbances. The main diagnostic method is magnetic resonance imaging (MRI).

[Depression and epilepsy: comorbidities, pathogenesis, principles of therapy]. / Depressiya i epilepsiya: komorbidnost', patogeneticheskoe skhodstvo, printsipy terapii.

Numerous trials of last years confirm the bilateral link between depression and epilepsy with mutual complication of both diseases. Depression increases the risk of the first unprovoked paroxysm, worsens the compliance of epileptic patients, leads to decrease of the response both to therapeutic and surgical treatment and to increase of side effects of antiepileptic drugs. Depression is associated with high risk of suicidal behavior and reduces the quality of life level. Depression in epileptic patients is characterized by atypical clinical course in most cases what makes its diagnostics difficult and becomes the reason of the absence of the necessary pharmacologic and psychotherapeutic treatment. All of the above creates significant economical burden for the community because the epileptic patient with comorbid depression visits the physicians 2-4 times more often.