Altered upright face recognition and presence of face inversion effect in temporal lobe epilepsy: An event-related potential study.

AIM: Facial recognition can be assessed by examining an event-related potential component, namely the N170. The amplitude of the N170 is larger in response to inverted faces than to upright faces. To examine facial processing in patients with temporal lobe epilepsy (TLE), we investigated the amplitude of the N170, the face inversion effect, and the association between social functioning and face-specific configuration processing. METHODS: Sixteen patients with TLE and 17 normal controls (NC) participated in this study. Event-related potentials in response to upright or inverted neutral faces and bicycles were recorded. Social functioning was assessed by the socioeconomic status of the participants using the 5-point Hollingshead-Redlich Scale. RESULTS: Compared with NC, patients with TLE had decreased N170 amplitudes. The inversion effect was observed for face stimuli in both groups; however, no inversion effect was observed for bicycle stimuli. Additionally, in TLE patients, but not in NC, socioeconomic status was significantly correlated with the N170 amplitudes in response to upright faces. CONCLUSION: In a social context, upright faces are processed as a whole. This process is impaired in TLE. Conversely, inverted faces are processed analytically. This function is normal in TLE. Abnormal face-specific configuration processing may contribute to lower social functioning in TLE.

Clinical characteristics of patients with diagnostic uncertainty of major depressive disorder.

BACKGROUND: Physicians do not always confidently diagnose psychiatric disorders. The present study was conducted to identify the clinical characteristics of patients in whom a definitive diagnosis of major depressive disorder (MDD) could not be established. METHODS: The participants were 199 consecutive outpatients with MDD, who were comprehensively diagnosed using the Mini International Neuropsychiatric Interview (MINI). The physician in charge of each patient quantified his/her sense of self-confidence in diagnosing the patient with MDD using the self-rating questionnaire in which the score ranged from 1 (not at all confident) to 5 (definitely MDD). Using multiple logistic regression, the demographic and clinical factors of the patients in the low diagnostic confidence group (score less than or equal to 3, n=79) were compared with those in the high diagnostic confidence group (more than 3, n=120). RESULTS: Comorbidity of anxiety disorders (odds ratio (OR), 4.7), absence of remission (OR, 3.6), and non-melancholic features (OR, 3.5) were identified as the most discriminative variables associated with the low diagnostic confidence of MDD. CONCLUSION: The results show that physicians were unable to confidently diagnose MDD in 40% of the cases, and that comorbidity of anxiety disorders, absence of remission, and non-melancholic features independently predicted the diagnostic uncertainty of MDD.

Unraveling complex relationships among dysphoric disorder, localization-related epilepsy, and mood disorders.

BACKGROUND: Dysphoric disorder (DD), characterized by intermittent pleomorphic symptoms, has been believed to be specific to epilepsy. However, our previous study revealed that DD in patients with localization-related epilepsy was associated with a lifetime diagnosis of mood disorders. The present study was conducted to estimate the prevalence of DD in patients with mood disorders, but not epilepsy, and to identify the clinical similarities and differences of DD in patients with either epilepsy or mood disorders. METHODS: Subjects consisted of 104 patients with localization-related epilepsy (group E) and 101 patients with DSM-IV mood disorders, but not with epilepsy (group M). After a diagnostic investigation for DD and the euthymic state, defined as the absence of any mood episodes during the last 12months, we compared the clinical characteristics of DD in patients from groups E and M. RESULTS: Dysphoric disorder was apparently more common in group M (56.4%) than in group E (21.2%). However, 86.0% of patients in group M showed a temporal overlap between DD and the noneuthymic state, while 68.2% of patients in group E did not show this overlap. Moreover, the noneuthymic state was significantly associated with symptoms of DD, indicating that the diagnosis of DD was more likely to be overestimated when the subjects were in a noneuthymic state. The prevalence of DD, temporally independent of the noneuthymic state (pure DD), was estimated at 13.4% and 7.0% in groups E and M, respectively, and pure DD was 1.91 times more common in patients with epilepsy than in those with mood disorders. Diagnosis of pure DD was significantly associated with increased suicidality in group E, but not group M. CONCLUSION: The present results suggest that DD is more familiar to epilepsy than mood disorders, although DD is not specific to epilepsy. Moreover, suicidality is specifically associated with DD in patients with epilepsy.

The multiple diagnoses of comorbid anxiety disorders and higher interpersonal sensitivity predict treatment-resistant depression.

BACKGROUND: The present study was conducted to examine the hypothesis based on our previous studies, that the multiple diagnoses of comorbid anxiety disorders (ADs) and higher interpersonal sensitivity predict treatment-resistant depression (TRD). METHODS: The participants were 199 consecutive outpatients with major depressive disorder (MDD), who were comprehensively diagnosed using the Mini International Neuropsychiatric Interview (MINI). TRD was defined as the failure to achieve remission with two or more adequate antidepressant trials. Using multiple logistic regression, the clinical features including the number of comorbid ADs and the Interpersonal Sensitivity Measure (IPSM) score of the TRD group (N=31) were compared with those of the remission group (N=123). RESULTS: Comorbid ADs (odds ratio (OR), 4.5), higher IPSM score (OR, 4.1), suicidal risk (OR, 3.9), and non-melancholic features (OR, 3.3) were identified as the most discriminative variables associated with TRD. All the participants with two or more comorbid ADs (N=12) belonged to the TRD group. CONCLUSION: The results showed that the multiple diagnoses of comorbid ADs and higher interpersonal sensitivity were associated with TRD, suggesting that considering the concept of MDD with "anxious distress," which appears in DSM-5, may be useful for managing TRD.

Interictal dysphoric disorder in patients with localization-related epilepsy: Diagnostic relationships with DSM-IV psychiatric disorders and the impact of psychosocial burden.

BACKGROUND: Some patients with epilepsy develop intermittent and pleomorphic affective-somatoform symptoms, termed interictal dysphoric disorder (IDD). Other psychiatric disorders have been extensively investigated in patients with epilepsy, but there are few clinical studies investigating the comorbidity patterns of IDD and common psychiatric disorders (PDs). In particular, the impact of IDD on the psychosocial burden of patients remains unclear. METHODS: The participants were 128 adult Japanese outpatients with localization-related epilepsy (LRE). In order to determine the comorbidity patterns for IDD and PDs, we conducted a comprehensive diagnostic investigation for IDD and DSM-IV psychiatric disorders. Based on these analyses, participants were divided into groups according to the comorbidity patterns for IDD and PDs in order to compare both suicide risk and quality of life (QOL). RESULTS: The findings indicated that 19.5% of participants had IDD, and 55.5% had PDs. Younger age at epilepsy onset and refractory complex partial seizures were associated with IDD, but the duration and type of epilepsy were not. Patients with IDD were more likely to have comorbid PDs as follows: mood disorders (odds ratio, OR: 8.30; 95% confidence interval, CI: 3.15-21.83), anxiety disorders (OR: 8.81; 95% CI: 3.30-23.49), and psychotic disorders (OR: 7.72; 95% CI: 2.83-21.06). Group comparisons demonstrated that there were no patients with IDD but without PD. Furthermore, patients with IDD and with PDs had a significantly higher suicide risk and lower QOL compared to the other groups, even after adjusting for the influences of confounding factors. CONCLUSION: Interictal dysphoric disorder adds extreme psychosocial burden and is associated with multiple PDs in patients with LRE. The present study suggests that IDD has a specific prognostic significance. However, whether IDD is nosologically independent from conditions diagnosed using standardized psychiatric diagnostic systems such as DSM-IV must be further assessed by future research.