Interictal Dysphoric Disorder Research Articles

Specific dysphoric disorders in epilepsy

To analyze affective-somatoform (dysphoric) disorders specific to epilepsy. Dysphoric disorders can be divided into 3 groups: “periictal” disorders, interictal dysphoric disorder and alternative affective-somatoform syndromes. There are 3 groups of risk factors for affective disorders in epilepsy including depressive and dysphoric: those associated with the disease, those associated with the treatment and those associated with psychosocial aspects. Treatment for depression in epilepsy includes medication and psychotherapy. At the first stage of drug therapy, anticonvulsants are corrected, and at the second, an antidepressant is added. Cognitive behavioral therapy is the most effective method of psychotherapy. Dysphoric disorders in epilepsy are presented by a wide range of conditions, both paroxysmal and non-paroxysmal, and have their own classification and development factors, which must be taken into account when choosing adequate therapy.

Temporal lobe epilepsy and interictal dysphoric disorder: a case report and literature review

Temporal lobe epilepsy and interictal dysphoric disorder: a case report and literature review

Interictal Dysphoric Disorder in Epilepsy and Its Relationship with Specific Clinical and Demographic Variables.

Patients with epilepsy present a variety of psychiatric comorbidities, with mood disorders and anxiety disorders as well as interictal dysphoric disorder as the most frequent and often associated with comorbid mental conditions. Interictal dysphoric disorderand ictal and peri-ictal changes may contribute to overall clinical symptomatology in epilepsy, as well as subjective and objective adverse effects of anti-epileptic drugs. We performed a post-hoc analysis to verify the relation of interictal dysphoric disorder with specific clinical and demographic variables in people with epilepsy, including the correlation between interictal dysphoric disorder and anti-epileptic drugs. We found no correlation between the incidence of interictal dysphoric disorder and drug-resistant epilepsy, and no correlation between the incidence of interictal dysphoric disorder and sex was observed. The results of our analysis indicate that patients with interictal dysphoric disorder, compared with those with no interictal dysphoric disorder, had epilepsy onset at a later age, had had a history of psychiatric treatment and had distinctly lower, but not statistically significant, percentage of active employment status. Another finding was the frequent suicide attempts in people with epilepsy (11.5%). However, there was no relationship with interictal dysphoric disorder. We also did not find any evidence supporting the impact of epileptic medication on the incidence of interictal dysphoric disorder nor did the data contribute to support the evidence of interictal dysphoric disorder as a standing-alone phenomenon. An essential issue in epilepsy is awareness and understanding of interictal dysphoric disorder and concomitant mental health abnormalities as this is crucial for clinical practice and may significantly determine the progression and management of epilepsy if it remains ignored, and hence lead to a severe decline in life quality.

Clinical relevance of interictal dysphoric disorder and its impact on quality of life in drug-resistant epilepsy

ObjectiveThis study aims to assess the prevalence of Interictal Dysphoric Disorder (IDD) in drug-resistant epilepsy (DRE) and to describe its clinical and psychopathological profile, including personality, as well as its impact on quality of life (QOL). MethodA retrospective cross-sectional study from an Epilepsy Unit from January 2007 to December 2017. All patients were diagnosed with DRE. Patients underwent a battery of tests (HADS, SCL-90R, PDQ-4+, QOLIE-31) and a psychiatrist assessed the presence of Axis-I disorders and IDD. Statistical procedures were carried out using R-4.0.1 software. ResultsA total of 282 patients were included. A statistically significant association was found between IDD and mood and anxiety disorders (p < 0.001 and p < 0.05 respectively), and between IDD and higher scores in all HADS and SCL-90-R items compared to subjects without IDD (p < 0.001). A statistically significant association was also found between IDD and obsessive–compulsive, borderline and depressive personality disorder (p < 0.05). Scores in all QOLIE-31 items except for ‘medication effects’ were significantly lower in subjects with IDD compared with subjects without IDD (p < 0.001). ConclusionsIn DRE, IDD subjects show differences in the psychopathological profile and QOL scores compared to subjects without a diagnosis of IDD. An early diagnosis of IDD could facilitate prompt interventions which might positively impact QOL.

Interictal dysphoric disorder and psychopathology in drug-resistant epilepsy

Interictal dysphoric disorder and psychopathology in drug-resistant epilepsy

Dysphoria and Irritability-Diagnostic Pitfalls in the Assessment of Interictal Dysphoric Disorder in Epilepsy.

This article aims to review the concept of epilepsy-specific psychiatric disturbance, Interictal Dysphoric Disorder (IDD), focusing on issues related to its core symptoms and methodological pitfalls. In the psychiatric literature, an epilepsy-specific pleomorphic mood disorder has been long recognized and described as IDD, a condition characterized by eight symptoms, which are grouped into four labile depressive symptoms, two labile affective symptoms, and two specific symptoms. The existence of IDD is still a matter of debate because of several methodological issues. The main features of IDD, such as dysphoria and irritability, lack precise and clear definition. This review article explores the different definitions and approaches towards both terms described in the psychiatric literature and the rationale for modifying the diagnostic process of IDD.

Past Trauma Is Associated With a Higher Risk of Experiencing an Epileptic Seizure as Traumatic in Patients With Pharmacoresistant Focal Epilepsy.

Objective: The present study aimed to evaluate the prevalence of traumatic experienced seizures (TES) and of postepileptic seizure PTSD (PS-PTSD) in patients with pharmacoresistant focal epilepsy and to explore the determining factors of TES.Methods: We conducted an observational study enrolling 107 adult refractory epilepsy patients. We used the DSM-5 criteria of traumatic events and PTSD to define TES and PS-PTSD. We assessed all traumatic life events unrelated to epilepsy, general and specific psychiatric comorbidities, and quality of life.Results: Nearly half (n = 48) of the 107 participants reported at least one TES (44.85%). Among these, one-third (n = 16) developed PS-PTSD. The TES group was more likely to experience traumatic events unrelated to epilepsy (p < 0.001), to have generalized anxiety disorder (p = 0.019), and to have specific psychiatric comorbidities [e.g., interictal dysphoric disorder (p = 0.024) or anticipatory anxiety of seizures (p = 0.005)]. They reported a severe impact of epilepsy on their life (p = 0.01). The determining factors of TES according to the multifactorial model were the experience of trauma (p = 0.008), a history of at least one psychiatric disorder (p = 0.03), and a strong tendency toward dissociation (p = 0.03).Significance: Epileptic seizures may be a traumatic experience in some patients who suffer from pharmacoresistant epilepsy and may be the source of the development of PS-PTSD. Previous trauma unrelated to epilepsy and psychiatric history are determining factors of TES. These clinical entities should be explored systematically.

Interictal dysphoric disorder in people with and without epilepsy

Interictal dysphoric disorder (IDD) has been regarded as an affective disorder occurring only in people with epilepsy (PWE). Data showing similar characteristics and similar prevalence of IDD in patients with migraine and with psychogenic nonepileptic seizures question the epilepsy-specific nature of IDD. The aim of the study was to investigate the nature of IDD in people with prevalent epilepsy with mood disorders and people with mood disorders who are free of neurological disease. This is a case-control study, with 142 patients with a confirmed diagnosis of epilepsy and major depressive disorder (MDD; cases) and 222 patients with MDD only (controls). MDD diagnosis was confirmed by a structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (SCID-I-RV). We used the Beck Depression Inventory and the Beck Anxiety Inventory to estimate anxiety and depression levels and the Interictal Dysphoric Disorder Inventory (IDDI) to confirm the presence of IDD. Mann-Whitney U test, Pearson chi-squared, Spearman correlation, and logistic regression were used. No differences were found in the prevalence of IDD between PWE with MDD and people with MDD alone (88.73% vs. 85.13%, χ2=.96, p=.32). There were no differences between the groups overall or for any IDDI subscales (all p>.05). In both groups, IDD symptoms were grouped with the same incidence and had the same duration and periodicity. IDD was not associated with epilepsy (odds ratio = .84, 95% confidence interval = .40-1.98, p=.72). No significant correlation was found between epilepsy, demographic characteristics, and all IDDI subscales (all p>.05). Notably, patients with IDD suffered from affective disorders longer (6.68±6.82 years vs. 3.7±3.97 years, p=.001) and also received higher scores on all psychometric scales (all p<.05). This study does not confirm the specificity of IDD for epilepsy. The presence of IDD symptoms may be associated with a more severe course of MDD and significant anxiety distress.

Psychiatric disorders in patients with resistant temporal lobe epilepsy two years after undergoing elective surgery. A longitudinal study

PurposePsychiatric morbidity in temporal lobe epilepsy (TLE) is frequent and negatively affects patients’ life quality. Surgery is the procedure of choice when treating seizures, although the effects on psychiatric disorders remain unclear. We evaluate the effect of surgery on psychiatric disorders in patients with TLE two years after the intervention, to then shed light on how these are related to anxiety and depression symptoms, and Interictal Dysphoric Disorder (IDD). MethodsWe included data from 65 patients with TLE whose psychiatric evaluations were performed according to DSM-IV criteria. Anxiety and depression symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS) test. ResultsAt 2-year follow-up, anxiety and depressive disorders decreased, and psychotic disorders augmented without statistical significance. Baseline psychiatric disorders predisposed to psychiatric pathology at 2-year follow-up and did not correlate with epilepsy outcome after surgery. Postoperative psychiatric disorders correlated with the seizure incidence two years after the intervention, suggesting that epilepsy and psychiatric disorders were associated in processes such as surgery. De novo psychiatric disorders represented 52% of postoperative psychiatric pathology, 62% being psychotic disorders. De novo psychiatric disorders became more frequent from the first year of surgery, occurring mainly in patients free of seizures. The HADS test scores and IDD correlated with psychiatric disorders at 2-year follow-up. ConclusionsBaseline psychiatric disorders did not influence surgery outcome, but correlated with psychiatric disorders’ prevalence two years after surgery. Despite not finding statistical significance, surgery reduced the prevalence of psychiatric disorders, and de novo psychiatric disorders were associated with an improvement in the epilepsy course at 2-year follow-up.

Ictal fear is associated with anxiety symptoms and interictal dysphoric disorder in drug-resistant mesial temporal lobe epilepsy

Interictal dysphoric disorder (IDD) is a poorly understood psychiatric disorder of epilepsy patients. Interictal dysphoric disorder is characterized by depressive, somatoform, and affective symptoms observed in up to 5.9% of drug-resistant mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). This study aimed to evaluate the association between ictal fear (IF) and the psychiatric symptoms and diagnosis in MTLE-HS patients. We included 116 (54.3% male) consecutive adult patients (36 ± 11 years) with MTLE-HS. Anxiety and depression symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS) and the psychiatric diagnosis were according to Fourth Edition of the Diagnosis and Statistical Manual of Mental Disorders (DSM-IV). The independent association between the occurrence of IF aura and the psychiatric diagnosis was determined by binary regression. When compared to those with other auras or without aura, patients reporting IF have higher HADS anxiety, but not HADS depression, scores. Ictal fear was independently associated with the diagnosis of interictal dysphoric disorder (OR, IC 95% = 7.6, 1.3–43.2, p = 0.02), but not with the diagnosis of anxiety (OR, CI 95% = 0.72, 0.08–6.0, p = 0.73), depression (OR, CI 95% = 0.94, 0.19–4.8, p = 0.94) or psychotic disorders (p = 0.99). Only patients with drug-resistant MTLE-HS were included and the small number of cases with DD diagnosis in the sample. In MTLE-HS patients, the occurrence of IF is associated with higher levels of anxiety symptoms and IDD. The results provide insights about fear-related neural network connections with anxiety symptoms and the IDD in MTLE-HS.

KLIPPEL-TRENAUNAY AND STURGE-WEBER OVERLAPPING SYNDROME WITH CRANIOFACIAL IMPAIRMENT: A CASE REPORT

Klippel-Trenaunay syndrome (KTS) is characterized by a triad of port wine stains, venous malformations, and unilateral bone and/or tissue hypertrophy. Sturge-Weber syndrome (SWS) is a neurocutaneous syndrome of a classical triad of capillary malformations, ipsilateral leptomeningeal angiomatosis, and ocular involvement. The coexistence of KTS and SWS is rare, and only a few cases have been reported. Here, we describe a combination of KTS and SWS and report a case of a 27-year-old male patient, diagnosed with interictal dysphoric disorder, epilepsy, and mild intellectual disability. He presents with port wine stains involving the right side of his face and the right upper limb and skeletal hypertrophy. We also observed angiomatosis involving both lips on the right side causing macrocheilia, resulting in hypertrophy of buccal mucosa, malocclusion, and enlargement of the tongue. These characteristics add an extra challenge to the dental treatment and must be known by dental practitioners. Klippel-Trenaunay syndrome (KTS) is characterized by a triad of port wine stains, venous malformations, and unilateral bone and/or tissue hypertrophy. Sturge-Weber syndrome (SWS) is a neurocutaneous syndrome of a classical triad of capillary malformations, ipsilateral leptomeningeal angiomatosis, and ocular involvement. The coexistence of KTS and SWS is rare, and only a few cases have been reported. Here, we describe a combination of KTS and SWS and report a case of a 27-year-old male patient, diagnosed with interictal dysphoric disorder, epilepsy, and mild intellectual disability. He presents with port wine stains involving the right side of his face and the right upper limb and skeletal hypertrophy. We also observed angiomatosis involving both lips on the right side causing macrocheilia, resulting in hypertrophy of buccal mucosa, malocclusion, and enlargement of the tongue. These characteristics add an extra challenge to the dental treatment and must be known by dental practitioners.

P.271 Interictal dysphoric disorder and pharmacological treatment in a sample of patients with drug-resistant epilepsy in an epilepsy unit in Barcelona

P.271 Interictal dysphoric disorder and pharmacological treatment in a sample of patients with drug-resistant epilepsy in an epilepsy unit in Barcelona

Psychiatric comorbidity and temporal lobe epilepsy surgery outcome

Pharmacoresistance in PWE is frequently associated with psychiatric comorbidity. The effectiveness of epilepsy surgery is well established, established; however, the impact of surgery on depression and anxiety remains controversial. To study possible association between psychiatric comorbidity in patients with temporal lobe epilepsy (PTLE) and epilepsy surgery outcome. PTLE who underwent anterior temporal lobectomy with amygdalohippocampectomy were examinined before surgery and 6 months after. The diagnosis of psychiatric disorder was verified by a structured diagnostic interview for DSM-IV (SCID-I). Epilepsy-specific interictal dysphoric disorder (IDD) was also assessed. Seizure outcome was determined according to Engel’s classification. 18 PTLE aged 35 ± 9.16 years with the age of the onset of epilepsy 13.67 ± 10.75 years, duration 21.39 ± 12.24 years and frequency 11.72 ± 7.23 seizures per month were examined. 11 of them suffered from major depression, 6 had anxiety and 2 - obsessive-compulsive disorders. IDD was detected in 16 patients. 10 patients were treated with psychopharmacotherapy. 10 PTLE achieved Engel Class I with significant (P < 0.05) reduction of IDD in 7 of them. In 8 PTLE with Engel II and III outcomes no appreciable changes in IDD were observed. Only 4 from 18 PTLE with different surgery outcomes had no signs of any psychiatric disorder 6 months after. All of them were treated with psychopharmacotherapy before and after the surgery. In PTLE and comorbid psychiatric disorders who underwent anterior temporal lobectomy with amygdalohippocampectomy Engel Class I outcome was associated with the significant reduction of epilepsy-specific IDD.

Effects of a brief psychotherapeutic intervention on resilience and behavior in patients with drug-resistant mesial temporal lobe epilepsy and late seizure recurrence after surgery

Seizure recurrence (SR) after epilepsy surgery in patients with medically resistant temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS) can compromise medical treatment and quality of life (QOL). However, there is a scarcity of interventions specifically addressing this issue in the literature. We aimed to evaluate the impact of a four-week psychotherapeutic intervention on the levels of resilience, behavioral symptoms, and QOL of patients with drug-resistant TLE-MTS who underwent corticoamygdalohippocampectomy (CAH) and who presented with late SR. Fifty patients who had been diagnosed with TLE-TMS, undergone CAH, and presented with late SR were included. The study instruments included a clinical and sociodemographic questionnaire and the Brazilian versions of the Connor–Davidson Resilience Scale (CD-RISC-10), the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), the Interictal Dysphoric Disorder Inventory (IDDI), and the Quality of Life in Epilepsy Inventory (QOLIE-31). Significant reductions in the IDDI (p < 0.001) and NDDI-E (p < 0.001) scores, improvements in the CD-RISC-10 (p < 0.001) and QOLIE-31 (p < 0.001) scores, and positive correlations between resilience levels and QOL (p < 0.01), as well as a negative correlation between depressive symptoms and resilience (p < 0.01) and QOL (p < 0.01), were observed after the psychotherapeutic intervention. Improvements in the resilience levels and QOL, with concomitant reductions in depressive symptoms, were observed in patients with TLE-MTS and late SR after a brief psychotherapeutic intervention. Since there is a lack of studies that measured the impact of interventions in this patient subpopulation, these results may support the development of treatment strategies for this specific group.

Interictal dysphoric disorder of epilepsy: A continuing diagnostic challenge

ObjectiveThe interictal dysphoric disorder (IDD) is a proposed epilepsy-specific mood disorder characterized by a cluster of symptoms such as depressed mood, irritability, euphoria, and anxiety. Since its introduction, the concept of IDD has been a matter of debate. This study aimed to evaluate the frequency of the IDD and the association between psychiatric disorders and IDD. We also analyzed potential associations between IDD symptoms and epilepsy-related variables. MethodsA consecutive group of 118 outpatients with epilepsy were screened. Ninety-six patients met inclusion criteria and examined by a trained psychiatrist using Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders fourth edition Text Revision (DSM-IV-TR) (SCID-I). In order to diagnose IDD, all participants completed the self-rating questionnaire consisting of a set of questions aimed to assess the eight key symptoms of IDD. On completion of the questionnaire, the psychiatrist reviewed all the data for completeness and accuracy with the patient. ResultsIn our group with epilepsy, we observed IDD in 49.0% (47 of 96) of people with epilepsy (PWE) with substantial overlap (85%) of IDD with depressive and anxiety disorders. The frequency of depressive mood, anergia, and irritability was significantly higher in patients with IDD diagnosis. Older age at epilepsy onset was associated with IDD. Study limitationsThe cross-sectional study design, a consecutive sample of patients presenting to a tertiary referral center, a small sample size of the population, and applied methodology could have affected the results. ConclusionsThe present study indicates that IDD occurs in high frequency in PWE with a substantial overlap of IDD with depressive and anxiety disorders. The study highlights the importance of the observer-based systematic approach for diagnosing IDD and the usage of operationalized diagnostic criteria for psychiatric comorbidities in PWE. Future research should be directed at validating whether IDD is nosologically independent of other psychiatric conditions.

Comprehensive analysis of presurgical factors predicting psychiatric disorders in patients with refractory temporal lobe epilepsy and mesial temporal sclerosis underwent cortico-amygdalohippocampectomy.

BackgroundThis study aimed to evaluate the predictive value of presurgical factors for psychiatric disorders (PD) in refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE‐MTS) patients underwent cortico‐amygdalohippocampectomy (CAH).MethodsA total of 98 refractory TLE‐MTS patients underwent CAH were consecutively enrolled in this cohort study. Several presurgical factors were recorded, such as married status, employment status, highest education, disease duration, family history of epilepsy, and disorganized VEEG background activity.ResultsThere were 17 (17.3%) refractory TLE‐MTS patients occurring PD after CAH, including 8 (8.2%) mood disorders, 7 (7.1%) anxiety disorders, 8 (8.2%) psychoses, and 1 (1.0%) interictal dysphoric disorder. Employed status correlated with low PD occurrence, while disease duration and asymmetric VEEG background activity positively correlated with PD occurrence. Multivariate logistic analysis revealed employed status (P = 0.009) could independently predict lower PD occurrence, while highest education (P = 0.027), disease duration (P = 0.028), seizure frequencies (P = 0.015), and asymmetric VEEG background activity (P = 0.034) could independently predict higher PD occurrence. Receiver operating characteristic curve showed combination of these five factors (area under curve (AUC) = 0.871, 95%CI: 0.783‐0.960) disclosed a great predictive value of PD occurrence. The sensitivity and specificity were 70.6% and 92.6% at the best cutoff point. In addition, the percentage of PD was increased with higher Engel classification (P = 0.003).ConclusionEmployed status, highest education, disease duration, seizure frequencies, and asymmetric VEEG background activity correlate with PD occurrence independently in epileptic patients.

Psychiatric Symptoms in Refractory Epilepsy During the First Year After Surgery

Psychiatric morbidity in drug-resistant epilepsy is frequent. Surgery is the best therapeutic alternative for treating seizures, but the current evidence concerning the effects of surgery on psychiatric disorders (PDs) is inconclusive. We aim to clarify surgery's role in long-term PDs. Using a prospective controlled study, we analyzed the psychopathologic outcomes of patients with drug-resistant epilepsy, comparing those who underwent surgery to those who did not due to not being suitable. Surgical candidates were paired (n = 84) with the immediately following nonsurgical candidates (n = 68). Both groups continued their usual medical treatment. We studied psychiatric changes for each group and analyzed de novo and remission cases. The assessments were made during the presurgical evaluation, and at 6 months (6-M) and 12 months (12-M) after surgery. Finally, we determined associated factors for postsurgical PDs. At 12 months, using the Hospital Anxiety and Depression Scale (HADS), anxiety improved in both groups (p = 0.000), while depression improved only in the surgical group (p = 0.016). Moreover, all symptom dimensions on the Symptom Checklist-90-R (SCL-90), as well as severity, distress, and total symptoms, decreased only in the surgical group. These ameliorations reached not only statistical significance but also clinical significance for depression (HADS) (p = 0.014) and the interictal dysphoric disorder (p = 0.013). The main predictors for PDs after surgery were as follows: the presurgical and 6-month psychiatric symptoms, the absence of surgery, seizure outcomes, and some antiepileptic and psychiatric drugs. This study provides evidence that surgery for epilepsy could have a role in improving some symptoms of psychiatric disorders 12-M after the surgery.

Cognitive and clinical variables associated with interictal dysphoric disorder in patients with epilepsy

PurposeThe relationship between interictal dysphoric disorder (IDD) and cognitive impairment in adult patients with epilepsy (PWE) is poorly studied. MethodsThe Interictal Dysphoric Disorder Inventory (IDDI) with cognitive and clinical aspects was compared with Quality of Life in Epilepsy Inventory (QOLIE-31) and Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) scores of 117 PWE at significance level p<0.05. ResultsInterictal dysphoric disorder occurred in 25 (21.4%) PWE, and it was significantly associated with the presence of psychiatric disorders (PD) (α2; p=0.007), presence of major depressive episodes (p=0.03), lower educational level, older individuals, and those with a lower performance in the category fluency test (VF) (9.7±5.1 vs. 12.2±4.2; t-test; p=0.037). There was a negative correlation between QOLIE-31 and IDD. The predictive factors for the occurrence of IDD were the presence of PD (p=0.014) and lower performance in the VF (p=0.013). ConclusionThe occurrence of IDD was high. Interictal dysphoric disorder was found in different epileptic syndromes, and it was associated with the presence of PD, depressive episodes, lower performance in VF, and lower quality of life (QoL).

Interictal dysphoric disorder: Further doubts about its epilepsy-specificity and its independency from common psychiatric disorders

PurposeThe interictal dysphoric disorder (IDD) is a proposed epilepsy-specific psychiatric condition characterized by a conglomerate of symptoms such as depression, irritability, euphoria, and anxiety. However, there are doubts about IDD as an independent entity and about its presumed epilepsy-specific nature. MethodsHere, we investigated the association between psychiatric disorders and IDD in 120 patients with epilepsy, also analyzing potential associations between IDD symptoms and epilepsy-related variables. To test the epilepsy-specificity of IDD, we also studied IDD rates in 28 patients with pure psychogenic non-epileptic seizures.For the assessment of psychopathology, we used a structured clinical interview to determine the presence and nature of Axis I disorders and clinical questionnaires to assess psychopathological symptoms (anxiety, depression and severity of global distress). In accordance with most previous studies, we used the Interictal Dysphoric Disorder Inventory to assess IDD symptoms. ResultsIn our epilepsy group, we observed an IDD in 33% (42 of 120) of the patients. We diagnosed IDD in 39% (11 of 28) of the patients with psychogenic non-epileptic seizures without epilepsy. The majority of the patients with epilepsy with IDD have or had a psychiatric disorder (33 with a current, 6 with a past Axis I diagnosis). Patients with epilepsy with IDD had higher scores on all psychopathology questionnaires compared to the epilepsy patients without IDD. ConclusionOur findings suggest that IDD is not epilepsy-specific in nature, but occurs with the same frequency and the same pattern of symptoms in a purely psychiatric sample. We found a large overlap of IDD and common psychiatric comorbidities, mainly depression and anxiety disorders. This result calls the presumed nosological independency of IDD into question.

The unnoticed interictal disphoric disorder

IntroductionPsychiatric morbidity in refractory epilepsy is frequent and has a negative influence on quality of life. Treatment-refractory epileptic patients are at higher risk of developing psychiatric disturbances. The interictal dysphoric disorder (IDD) has been described as a pleomorphic pattern of symptoms claimed to be typical of patients with epilepsy. It is characterized by 3/8 symptoms: depressive mood, anergia, pain, insomnia, fear, anxiety, irritability, and euphoric mood.ObjectivesTo provide evidence that psychiatric morbidity is high in refractory epilepsy and to describe associations to IDD.AimsThe present study aims to show that there are typical psychiatric conditions in epilepsy that can be unnoticed.MethodsWe cross-sectional analyzed the psychopathologic outcomes of patients with refractory epilepsy. The assessments methods included SCID for DSM-IV and clinical interview for epileptic specific psychiatric conditions.ResultsThe sample consists of 153 patients, with a mean age of 37. A total of 42.5% were males. One or more Axis I diagnoses was seen in 38% of the patients. The most common condition was IDD (27.1%), followed by affective and anxiety disorders (22 and 15.3% respectively). Considering patients with IDD, we found differences in locus (P = 0.001) (present in 34.3% of non-stablished locus, 8.6% of extra-temporal locus and 57.1% of temporal locus) but not with hemisphere, sex, type of crises, treatment. We neither found correlation with age, number of crisis or number of treatments.ConclusionsPsychiatric comorbidities as IDD do not appear in the DSM-IV but are prevalent and could be related with temporal locus.Disclosure of interestThe authors have not supplied their declaration of competing interest.