Monitoring and Managing Depressive Symptoms in Adolescents with Epilepsy

Depressive disorders are the most frequent psychiatric disturbances associated with epilepsy in adolescents and include a broad and heterogeneous spectrum of conditions that share hallmark features and symptoms such as sadness, irritability, decreased motivation or interests, fatigue, withdrawal, hopelessness, anhedonia, changes in appetite and weight, and sleep disturbances that are persistent and pervasive most days for at least 2 weeks. Using generic self-report depression surveys and current diagnostic codes, clinical and surveillance studies have revealed prevalence rates of 20–25% for depression in youth with epilepsy, with adolescents showing particular vulnerability. Furthermore, 20% of youth with epilepsy endorse suicidal ideation, and youth endorsing suicidal ideation do not necessarily have clinical symptoms of depression. Considering that depression in youth with epilepsy is a common comorbidity, characterized by poorer psychosocial and healthy-related outcomes and increased risk of suicide, a brief, free measure of specific depressive symptoms in youth with epilepsy would be beneficial. Recently, the NDDI-E-.Y inventory has been developed from the adult NDDI-E, and validated in many countries. NDDI-E-Y showed reliable and construct validity, being a brief screening tool (12 items) that can be easily included in routine epilepsy care.For the management of depressive symptoms in adolescents, interventions can be distinguished in non-pharmacological and pharmacological. The first includes psychoeducation which should clarify to adolescents and parents the main features of epileptic disorder, side effects of antiepileptic drugs, treatment modalities, how to cope with learning and social difficulties, in order to improve quality of life. Concurrently, a cognitive-behavioral therapy (CBT) including individual therapy, supportive and family therapy and school services, should be carried on. Psychopharmacology for depressive symptoms should be deserved to moderate to severe depressive symptomatology, only after deep assessment of prior and current antiepileptic and/or psychopharmacologic treatment. SSRIs including fluoxetin, sertraline, fluvoxamine and escitalopram should be first considered. Data coming from experimental studies in animals and humans seem to confirm no decrease of seizure threshold by SSRI adjunctive therapy

Parental Stress in New-Onset Epilepsy and After Therapy Withdrawal

Objective: To assess maternal and paternal stress inparents of children with epilepsy, at the time of diagnosis, after one year of follow-up and after therapy withdrawal.Methods: We investigated parental stress in a sample of 85 children aged 2-14 years, divided into two groups based on the diagnosis: Group 1 (50 patients) with Childhood Absence Epilepsy or Idiopathic Focal Epilepsy with Rolandic discharges; Group 2 (35 patients) with different forms of drug-resistant Epilepsy. Every parent completed the Parental Stress Index-Short Form at Time 0, when they received the diagnosis and patients started therapy, at Time 1, after 1 year of follow-up. Only parents of Group 1 completed the same questionnaire after 2 years therapy withdrawal.Results: We found high levels of stress in both mothers and fathers at Time 0, without statistically significant differences between the two groups.At Time 1, stress values were unchanged in Group 1 mothers; conversely, the levels of stress in Group 1 fathers were reduced, with average values that fell within the “normal range”. In group 2, stress levels were reduced both in mothers and fathers at Time 1, compared to Time 0, but equally fell into the "clinical range", for both parents.In Group1, even one and two years after therapy withdrawal, parental stress did not normalizeand all scores persisted in the “clinical range” in both mothers and fathers.Conclusions: Our study revealed that, the diagnosis of epilepsy itself tended to increase parental stress, apparently regardless of the severity of the disorder; even after a period of follow-up, when epilepsy was better controlled, overall parental stress remained high. Parental stresslevels remained higher than expected, even 2 years after the suspension of therapy and the absence of seizures. This was probably due to concerns with the reappearance of new seizures or a more severe type of epilepsy with the suspension of drug(s), and feelings of inadequacy with their parental role(s).</p

Neuropsychological Profile, Emotional/Behavioral Problems, and Parental Stress in Children with Neurodevelopmental Disorders

Background: The aim of our study was to trace a specific neuropsychological profile, to investigate emotional-behavioral problems and parental stress in children with Autism Spectrum Disorder Level 1/High functioning (ASD-HF), Specific Learning Disorders (SLD) and Attention Deficit/Hyperactivity Disorder (ADHD) disorders and to highlight similarities and differences among the three groups. Methods: We retrospectively collected the data from a total of 62 subjects with ASD-HF (n = 19) ADHD (n = 21), SLD (n = 22) and 20 typical development. All the participants underwent neuropsychological standardized test for the evaluation of cognitive profile (Wechsler Intelligence Scale for Children Fourth Edition—WISC-IV), behavioral and emotional problems (Child Behavior CheckList CBCL), and parental stress (Parental Stress Index Short Form—PSI-SF). The scores of the ASD-HF, ADHD, and SLD groups were compared using non-parametric statistic methods (Kruskall–Wallis H test and U Mann–Whitney for post-hoc analysis). Results: The ASD-HF group were significantly higher in all areas of the WISC-IV than the other two clinical groups. The SLD group performed significantly lower than ASD-HF in Working Memory Index. The SLD group showed lower scores on the somatic problems subscale than the other two groups. In the Difficult Child subscale of the PSI-SF, parents of ADHD children scored lower than the mothers of SLD subjects and higher than the fathers of SLD subjects. In all three groups there are specific deficiencies compared to the control group in the cognitive profile, behavioral and emotional problems, and parental stress. Conclusions: Our comparative analysis highlighted similarities and differences in three groups of children with different neurodevelopmental disorders, helping to better define cognitive, behavioral, and emotional characteristics of these children and parental stress of their parents

Social Media Use and Mood, Suicidal Ideation and Self-Harm in Adolescents

Objective: The aim of our observational study was to evaluate depressive symptoms in adolescent population, focusing on suicidal ideation and intentionality, and to establish the relationship between depressive symptoms/self-harm and the average time spent in social media. Methods: Our study was an observational cross-sectional study that involved three Middle Schools and three High Schools in the Campania region of Italy. One thousand three hundred sixty-five students 11-19 years of age were recruited (mean age=15 years; female=51%, male=49%). Percentage of adhesion was 95%. All the subjects were administered three self-report questionnaires, filled out anonymously and in the presence of the teachers after illustrating their validity and purpose. Results: In 23% females and 18% males, depressive symptoms were above the norm, with a slight increase in the prevalence of depressive symptoms in high school students compared to middle school ones. Suicidal intentionality was expressed in 4% of the total sample, with no differences between males and females. Suicidal ideation was present in 14% of the total sample, with a higher prevalence in females than in males (17% vs 10%). We found a significant positive relationship between the depressive symptoms and the hours spent on Social Media, in both males and females. A significant relationship was also found between hours on Social Media and suicidal ideation/intentionality.Conclusions: Our study showed a high prevalence of depressive symptoms in adolescents, in keeping with previous studies. Our study also showed a significant association between the use of social networks and the development of depressive symptoms, as well as suicidal ideation and intentionality. Further studies are needed to investigate the nature of this relationship.</p

Social Media Use and Mood, Suicidal Ideation and Self-Harm in Adolescents

Objective: The aim of our observational study was to evaluate depressive symptoms in adolescent population, focusing on suicidal ideation and intentionality, and to establish the relationship between depressive symptoms/self-harm and the average time spent in social media. Methods: Our study was an observational cross-sectional study that involved three Middle Schools and three High Schools in the Campania region of Italy. One thousand three hundred sixty-five students 11-19 years of age were recruited (mean age=15 years; female=51%, male=49%). Percentage of adhesion was 95%. All the subjects were administered three self-report questionnaires, filled out anonymously and in the presence of the teachers after illustrating their validity and purpose. Results: In 23% females and 18% males, depressive symptoms were above the norm, with a slight increase in the prevalence of depressive symptoms in high school students compared to middle school ones. Suicidal intentionality was expressed in 4% of the total sample, with no differences between males and females. Suicidal ideation was present in 14% of the total sample, with a higher prevalence in females than in males (17% vs 10%). We found a significant positive relationship between the depressive symptoms and the hours spent on Social Media, in both males and females. A significant relationship was also found between hours on Social Media and suicidal ideation/intentionality. Conclusions: Our study showed a high prevalence of depressive symptoms in adolescents, in keeping with previous studies. Our study also showed a significant association between the use of social networks and the development of depressive symptoms, as well as suicidal ideation and intentionality. Further studies are needed to investigate the nature of this relationship

Psychogenic Seizures in Adolescents: An "Evergreen" Diagnostic Challenge

Paroxysmal events are classified as non-epileptic or epileptic symptoms. The first ones are distinguished in psychogenic and organic/physiological paroxysmal events (Lüders et al., 2019). In organic and physiological disorders there are several symptoms: inattention, daydreaming, staring, sleep myoclonus, stereotyped movements, hypnotic spasms, tonic postures, parasomnia, movement disorders. Psychogenic non-epileptic seizures (PNES) are not associated with abnormal brain EEG activity and cannot be explained by other neurological disorders. PNES are also defined as functional neurological disorders and are included among the Conversion Disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013). This disorder is characterized by symptoms of impaired voluntary or sensorimotor function without the presence of other neurological or clinical conditions

Psychogenic Seizures in Adolescents: An “Evergreen” Diagnostic Challenge

Psychogenic non-epileptic seizures (PNES) are not associated with abnormal brain EEG activity and cannot be explained by other neurological disorders. PNES are also defined as functional neurological disorders and are included among the Conversion Disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). There is no doubt about the importance of an early and correct diagnosis of PNES. Diagnostic process is first based on an accurate clinical history. Video-EEG is considered the gold standard for the diagnosis, though it is often time consuming and it does not always allow to record an ictal event. When PNES is diagnosed, because it is not a seizure and no emergency treatment is required, the first goal is to ensure acceptance of the diagnosis. Initially, putative precipitating stressors need to be identified and addressed so that PNES can be contained and managed. Possible interventions for patients with PNES include psychotherapy, family counseling interventions, changes in the school environment and drug treatment. The latter may include anxyolytics and/or antidepressants; in case of a comorbid ADHD disorder, methylphenidate may be also considered.</em

Social Cognition in Neuropsychiatric Disorders in Pediatric Age

Objective: The purpose of our study was to assess social cognition in ad-olescents and children with epilepsy or Specific Learning Disorder (SLD) compared to typical individuals. It was verified whether the age of onset, duration and drug therapy of epileptics can influence this ability and if there is a correlation between Social Cognition, intelligence and executive functions.Methods: This is an observational cross-sectional study that included a total of 125 subjects between 7 and 16 years (62 with focal epilepsy and 63 with SLD). The control group included 32 healthy subjects. Study sub-jects were evaluated with neuropsychological tools to evaluate executive functions (EpiTrack Junior), Social Cognition (NEPSY-II), and intelli-gence; a nonverbal cognitive test (Raven's Matrices) was used in subjects with Epilepsy, while WISC-IV was administered to SLDs.Results: the groups of subjects scored significantly lower than the con-trols in Social Cognition. The results showed a positive correlation be-tween affect recognition scores and executive function in both groups. In patients with epilepsy the deficit in Affect Recognition appeared to be linked with early age of onset of epilepsy, long term of disease and lack of non-verbal intelligence; a high frequency of seizures, on the other hand, was related to poor performance in the Theory of Mind (ToM). In the SLD group there was no correlation between social cognition and in-tellectual level.Conclusions: The results of our study suggest that individuals with focal epilepsy or SLD have deficits in the recognition of facial emotions and ToM compared to their peers.In epilepsy group, the Social Cognition deficit seems to be linked to char-acteristics of epilepsy, particularly the deficits in the recognition of facial emotions seems linked to problems in nonverbal intelligence and in exec-utive function.In the SLD group, however, the ability to recognize emotions was corre-lated only with executive functions.</p

Social Cognition in Neuropsychiatric Disorders in Pediatric Age

Objective: The purpose of our study was to assess social cognition in adolescents and children with epilepsy or Specific Learning Disorder (SLD) compared to typical individuals. It was verified whether the age of onset, duration and drug therapy of epileptics can influence this ability and if there is a correlation between Social Cognition, intelligence and executive functions. Methods: This is an observational cross-sectional study that included a total of 125 subjects between 7 and 16 years (62 with focal epilepsy and 63 with SLD). The control group included 32 healthy subjects. Study subjects were evaluated with neuropsychological tools to evaluate executive functions (EpiTrack Junior), Social Cognition (NEPSY-II), and intelligence; a nonverbal cognitive test (Raven's Matrices) was used in subjects with Epilepsy, while WISC-IV was administered to SLDs. Results: the groups of subjects scored significantly lower than the controls in Social Cognition. The results showed a positive correlation between affect recognition scores and executive function in both groups. In patients with epilepsy the deficit in Affect Recognition appeared to be linked with early age of onset of epilepsy, long term of disease and lack of non-verbal intelligence; a high frequency of seizures, on the other hand, was related to poor performance in the Theory of Mind (ToM). In the SLD group there was no correlation between social cognition and intellectual level. Conclusions: The results of our study suggest that individuals with focal epilepsy or SLD have deficits in the recognition of facial emotions and ToM compared to their peers. In epilepsy group, the Social Cognition deficit seems to be linked to characteristics of epilepsy, particularly the deficits in the recognition of facial emotions seems linked to problems in nonverbal intelligence and in executive function. In the SLD group, however, the ability to recognize emotions was correlated only with executive functions