Spectrum of psychological disorders in patients with pharmacoresistant epilepsy under conditions of a neurosurgical hospital

The epilepsy is a common neuropsychiatric disease. The persisting social prejudices regarding diseases of the nervous system, especially epilepsy, and neglect of the pathopsychological side of the disease, significantly reduce the possibility for the full implementation of rehabilitation measures after surgical treatment. This article presents the results of a study evaluating psychopathological disorders and suicidal intent in patients with epilepsy at the stage of pre-surgical preparation.

OBJECTIVE: to assess the characteristics and severity of disorders of the psychopathological spectrum in patients with a pharmacoresistant form of epilepsy in a neurosurgical hospital.

MATERIALS AND METHODS. We examined 107 patients with an established diagnosis of epilepsy in the conditions of a neuropsychiatric and neurosurgical hospital. Depending on the profile, the beds are divided into 2 groups. A clinical and psychological examination was carried out with verification of the psychopathological state and a psychometric study.

RESULTS. Our study revealed that patients with a neurosurgical profile are characterized by a wider range of psychopathological disorders, and the severity of these conditions. The structure of mental disorders is dominated by psychotic spectrum disorders. The indicated psychopathological framework requires the removal of patients in need of neurosurgical treatment as a separate risk group for the formation of suicidal intentions, especially at the stage of social rehabilitation after surgery.

1. Moshe S, Perucca E, Ryvlin P, Tomson T, Epilepsy: new advances, Lancet, 2015;385:884–98, https://doi.org/10.1016/S0140–6736(14)60456–6

2. Spencer S, Huh L, Outcomes of epilepsy surgery in adults and children, Lancet Neurol, 2008;7:525–37, https://doi.org/10.1016/S1474–4422(08)70109–1

3. Macrodimitris S, Sherman E, Forde S, Tellez-Zenteno J, Metcalfe A, Hernandez-Ronquillo L, Wiebe S, Jette N, Psychiatric outcomes of epilepsy surgery: a systematic review, Epilepsia, 2011;52:880–90, https://doi.org/10.1111/j.1528–1167.2011.03014.x

4. Devinsky O, Barr W, Vickrey B, Berg A, Bazil C, Pacia S, Langfitt J, Walczak T, Sperling M, Shinnar S, Spencer S, Changes in depression and anxiety after resective surgery for epilepsy, Neurology, 2005;65:1744–9, https://doi.org/10.1212/01.wnl.0000187114.71524.c3

5. Reuber M, Andersen B, Elger C, Helmstaedter C, Depression and anxiety before and after temporal lobe epilepsy surgery, Seizure, 2004;13:129–35, https://doi.org/10.1016/S1059–1311(03)00073–6

6. Hermann B, Wyler A, Ackerman B, Rosenthal T, Short-term psychological outcome of anterior temporal lobectomy, J Neurosurg, 1989;71:327–34, https://doi.org/10.3171/jns.1989.71.3.0327

7. Hermann B, Wyler A, Somes G, Preoperative psychological adjustment and surgical outcome are determinants of psychosocial status after anterior temporal lobectomy, Journal Neurol Neurosurg Psychiatry, 1992;55(6):491–496, https://doi.org/10.1136/jnnp.55.6.491

8. Wheelock I, Peterson C, Buchtel H, Presurgery expectations, postsurgery satisfaction, and psychosocial adjustment after epilepsy surgery, Epilepsia, 1998;39(5):487–494, https://doi.org/10.1111/j.1528–1157.1998.tb01410.x

9. Pompili M, Girardi P, Tatarelli G, Angeletti G, Tatarelli R. Suicide after Surgical Treatment in Patients with Epilepsy: A Meta-Analytic Investigation, Psychol Rep, 2006;98(2):323–338, https://doi/org/10.2466/pr0.98.2.323–338

10. Hamid H, Devinsky O, Vickrey B, Berg A, Bazil C, Langfitt J, Walczak T, Sperling M, Shinnar S, Spencer S. Suicide outcomes after resective epilepsy surgery, Epilepsy & Behavior, 2011;20(3):462–464, https://doi.org/10.1016/j.yebeh.2010.12.031

11. Ivanova N.E., Kravtsova S.V., Ivanov A.Yu., i dr. Epidemiologicheskie aspekty epilepticheskogo statusa pri zhenskoi epilepsii // Sovremennye problemy nauki i obrazovaniya, 2018, V.4 (in Russ)

12. Shova N.I., Mihajlov V.A., Odincova G.V. i soavt. Sovremennyj vzglyad na problemu formirovaniya suicidal'nogo povedeniya u pacientov s farmakorezistentnoj formoj epilepsii v posleoperacionnom periode (literaturnyj obzor), Translyacionnaya medicina, 2019;6(2): 5–11, (in Russ)