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Medical science
Azizova Rano, Umirkulov Otabek, Tashkent Medical Academy E-mail: mbshakur@mail.ru
FEATURES OF CLINICAL COURSE OF EPILEPSY ASSOCIATED WITH ANXIETY AND DEPRESSIVE DISORDERS
Abstract: As a result of a study of 129 patients with epilepsy, a high frequency (73.6%) of associated psycho-pathological disorders of anxiety and depressive nature was detected, with their prevalence in women (66.1%). Distinctive clinical features of epilepsy associated with anxiety and depressive disorders are pharmacoresistance, the prevalence of simple partial ideatorial and emotional-affective seizures and the presence of affective disorders of the anxiety-depressive circle in history before the onset of the disease (79.8%).
Keywords: epilepsy, depression, anxiety disorders, diagnosis.
Epilepsy and various epileptic syndromes are among the most common diseases in the clinical practice of neurologists, psychiatrists and family doctors. The overall incidence of epilepsy in developed countries is about 50 per 100 thousand of population per year, the prevalence is 4-10 per thousand of population (0.5-1.0%). There is a high incidence of mental disorders associated with epilepsy (up to 66%) [2; 3], therefore the study of the clinical and etiopathogenetic features of these disorders is of considerable interest [4].
It is noted that among the mental disorders associated with epilepsy, depressive and anxiety disorders are most common, mostly at the non-psychotic level [1; 5], and among patients with temporal epilepsy they rank first among all mental disorders and are present in more than half of the cases [3; 4; 6].
Clinically, such disorders are a combination of polymorphic, atypical and mixed forms, which requires careful diagnosis and selection of combined psychopharmacotherapy. In some cases, affective disturbances of anxiety and depressive nature associated with epilepsy are leading in the clinical picture of epilepsy, masking it, which can lead to diagnostic errors [2; 6].
Objective: to assess the frequency of anxiety and depressive disorders in patients with epilepsy in accordance with the clinical characteristics of the disease.
Materials and research methods: in the period from 2016 to 2018, the TMA clinic received 129 patients with epilepsy, of whom 49(38%) were men and 80(62%) women. According to general demographic characteristics, the distribution was as follows: the average age of the subjects in the total sample was (30 ± 9.9) years, 25 people (19.4%) had secondary education, 55 people (42.6%) had specialized secondary education, 49 higher education people (38%), not working were 98 people (76%), workers - 31(24%). 51(39.5%) had a family, were officially or not officially married, 78(60.5%) had no families. 57(44.2%) people did not have a disability group, 38(29.5%) people had a disability group III, 34(26.4%) had a II group.
Psychometric scales were used to obj ectify the clinical assessment of the condition: a) Hamilton Anxiety Rating Scale, HAMA, 1960); b) The Montgomery-Asberg Depression Symptom Rating Scale, Montgomery-Asberg Depression Rating Scale, MADRS, 1979) self-inquiry scale Beck Depression Rating Scale (Beck Depression Inventory, BDI, 1961). Scales all patients filled in by listening to the instructions for filling.
All patients were examined according to approved diagnostic standards for epilepsy.
All patients received antiepileptic therapy at the time of the survey. 6 people (4.7%) received a combination of antiepi-leptic drugs with tranquilizers, 18(14%) - with neuroleptics, 16(12.4%) - with antidepressants. In terms of the duration of antiepileptic therapy, the overall distribution was as follows: 11 people (8.5%) took antiepileptic therapy for less than a year, 26(20.2%) - from 1 to 5 years, 19(14.7%) - from 5 to 10 years, 73(65.6%) - more than 10 years. 77 people (59.7%) had taken barbiturates in the past. Most of the surveyed received treatment with a combination of drugs from the group of carbamazepines and the group of valproates - 40(31%) people, 23(17.8%) - received carbamazepine monotherapy, 16 - (12.4%) received combined treatment with three drugs, which included carbamazepine, topiramate and valproate. 9 people (7.0%) were on monotherapy with valproate and the same received a combination of topiramate and carbamazepine. 1 person (0.8%) at the time of the survey took lamotrig-ine as monotherapy, 1(0.8%) - levetiracetam, 3(2.3%) - barbiturates were taken as monotherapy. All patients underwent additional neurometabolic therapy.
Results of the study: among all the examined patients, the symptoms of anxiety disorder were identified in 95 people (73.6%), among whom 19 people (14.7%) had mild anxiety disorders, 49(38%) had moderate severity, in 27(20.9%) - heavy.
Among the patients of this group of men there were 39(41.1%), women - (58.9%). The average age of patients in
FEATURES OF CLINICAL COURSE OF EPILEPSY ASSOCIATED WITH ANXIETY AND DEPRESSIVE DISORDERS
this group was (31.0 ± 11.2) years, the average duration of the disease was (15.8 ± 12.9) years.
When analyzing the clinical picture of patients with a predominance of associated anxiety disorders, three subgroups were identified: with predominantly anxiety-phobic symptoms, generalized anxiety symptoms, and anxiety symptoms against the background of cerebroscence.
In the first subgroup there were 34 (37.8%) people, in the second - 26 (27.3%), in the third - 35 (36.8%).
Among patients with a predominance of anxiety-phobic symptoms in the clinical picture (34 patients, 37.8%), the majority were women.
In most patients, the disease duration was up to 10 years (27 people, 79.4%). Mild and moderate anxiety disorders associated with psycho-traumatic events were noted in 27 of them (79.4%) in the history before the onset of epilepsy. They did not have a connection between the course of epilepsy, the frequency of seizures and their nature and intensity of anxiety-phobic disorders.
Among patients with a predominance of symptoms of generalized anxiety disorder in the clinical picture - 26 (27.3%) were mostly male patients (19 people, 73%). In most patients, the disease duration was more than 10 years (21 people, 80.7%). In the clinical picture of such patients, in addition to epileptic seizures, there were signs of generalized anxiety disorder.
Symptoms of depression of varying severity occurred in more than half of all patients examined - 75 (58.1%) people. It was also noted that self-assessment of the symptoms of de-
pression by patients was slightly lower than the clinical physician's assessment of the presence of symptoms of depression.
When analyzing the clinical picture of depressive disorders, it was found that among patients of this group, 21(28%) people had a predominance of depressive-hypochondriac symptom complex, 43(57.4%) - astheno-depressive, in 11(14.6%) - in the structure of depression was noted the predominance of dysphoric affect.
In cases where depressive-hypochondrial symptoms in the interictal period prevailed in the clinical picture, a combination of hypothymic affect with hypochondriacal complaints, expressions of concern for their health, with pronounced signs of anxious alertness for any changes in well-being was noted. Patients had various phobias, such as the fear of a seizure in a public place, as well as various kinds of phobias that are not directly related to seizures, such as an obsessive fear of death, the fear of making the wrong decision, etc.
Findings:
1. The study revealed a high frequency (73.6%) of associated psychopathological disturbances of anxiety and depressive nature in patients with epilepsy with their prevalence in women (66.1%, p 0.05).
2. Distinctive clinical features of epilepsy associated with anxiety and depressive disorders are pharmacoresistance, the prevalence of simple partial ideatorial and emotional-affective seizures and the presence of affective disorders of the anxiety-depressive circle in history before the onset of the disease (79.8%).
References
1. Barragan E. Epilepsy and related psychiatric conditions. In: J. M. Rey (Ed.) IACAPAP e-textbook of child and adolescent mental health // Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions.2012.- 13 p.
2. Grabowska-Grzyb A., Jedrzejczak J., Naganska E., Fiszer U. Risk factors for depression in patients with epilepsy. Epilepsy Behav., 2006.- 8(2).- P. 411-417.
3. Kalinin V. V., Zheleznova E. V., Sokolova L. V., Zemlyanaya A. A., Subbotin K. Y. Focus laterality and interface between depression and anxiety in patients with temporal lobe epilepsy. Epileptology. The modern state of science. 2016. -P. 145-155.
4. Kowski A. B., Weissinger F., Gaus V., Fidzinski P., Losch F., Holtkamp M. Specific adverse efcts of antiepileptic drugs - A true-to-life monotherapy study // Epilepsy & Behavior. 2016; 54: 150-157.
5. Shmeleva L. M. The use of voxel morphometry for diagnosing lesions of the limbic structures in temporal epilepsy with affective disorders. Review of Psychiatry and Medical Psychology.2013.- No. 2.- P. 23-31.
6. Wieshmann U. C., Baker G. Efficacy and tolerability of anti-epileptic drugs- an internet study // Acta Neurol Scand. 2017; 135: 533-539.
