Psychiatric and behavioral effects of the antiepileptic drugs and their action as mood stabilizers

INTRODUCTION: The association between epilepsy, psychiatric disorders (PD) and antiepileptic drugs (AED) is among the most frequent and important aspects of epileptology. According to most recent data in literature, AED can act as protecting or predisposing to psychiatric disorders. OBJECTIVE: Data regarding the psychiatric and behavioral effects of AED and its action as mood stabilizers were reviewed. In addition, we discuss the relationship between AED effects in predisposing or protect against PD and its respective mechanism of action. CONCLUSION: AED do not have only antiepileptic properties, but may be associated to positive or negative behaviors. However, the appearance of PD is associated to both AED mechanism of action and the patient's individual predisposing.INTRODUÇÃO: Um dos aspectos mais estudados da epileptologia atual é a associação existente entre os transtornos psiquiátricos (TP) e as drogas antiepilépticas (DAE). De acordo com dados recentes na literatura, as DAE podem exercer um papel protetor ou de predisposição ao aparecimento de TP. OBJETIVO: O presente trabalho tem como objetivo fazer uma revisão dos efeitos psiquiátricos e comportamentais das DAE e de sua ação como estabilizadores do humor, bem como de relacionar seu papel protetor ou de predisposição ao aparecimento de TP com seus respectivos mecanismos de ação. CONCLUSÃO: As DAE não apresentam apenas propriedades antiepilépticas, possuindo também efeitos comportamentais positivos ou negativos. O aparecimento de TP, no entanto, está associado tanto ao mecanismo de ação da DAE como à predisposição individual e à condição emocional preexistente do paciente.Universidade Federal de São Paulo (UNIFESP) Departamento de Neurologia e NeurocirurgiaUNIFESP, Depto. de Neurologia e NeurocirurgiaSciEL

Psychiatric disorders in epilepsy: a proposal for classification by the ILAE commission on neuropsychiatry

INTRODUCTION: The relationship between psychiatric disorders (PD) and epilepsy is among the most frequent and important aspects of epileptology. PD are present in all epileptic syndromes and contribute to increase the difficulties in treating these patients. OBJECTIVE: We reviewed the classifications for the PD in epilepsy and highlighted the proposal by the ILAE Commission on Neuropsychiatry. CONCLUSION: The classification proposal by the ILAE attempted to separate disorders comorbid with epilepsy and those that reflect ongoing epileptiform activity from epilepsy-specific disorders and are based on clinical and descriptive symptoms rather than in etiological classification. It also presents clear and operational criteria that could be of greater utility for future studies of PD in epilepsy.INTRODUÇÃO: Um dos aspectos mais importantes da epileptologia é o da sua relação com as comorbidades psiquiátricas. Transtornos psiquiátricos (TP) são associados a praticamente todas as síndromes epilépticas e contribuem para uma maior dificuldade no manejo desses pacientes. OBJETIVO: O presente trabalho tem como objetivo fazer uma revisão das classificações dos TP na epilepsia e destacar a proposta elaborada pela Comissão de Neuropsiquiatria da ILAE. CONCLUSÃO: A proposta de classificação elaborada pela ILAE procurou diferenciar os TP que ocorrem em comorbidade daqueles que refletem atividade epileptiforme ou que ocorrem especificamente na epilepsia, sendo baseada em aspectos clínicos e descritivos mais do que em etiologias. Apresenta ainda critérios bastante claros e operacionais, constituindo-se de grande utilidade para futuros estudos dos quadros psiquiátricos na epilepsia.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) UNIPETEUNIFESP, EPM, UNIPETESciEL

Is disorganized schizophrenia a predictor of treatment resistance? Evidence from an observational study

Objective: To investigate whether inpatients with disorganized schizophrenia are more resistant to treatment. Method: Eighty-five inpatients were assessed at admission and at discharge for schizophrenia subtype, symptom severity, and treatment resistance criteria. Results: Disorganized patients were significantly more treatment-resistant than paranoid patients (60%, p = 0.001), and presented worse scores on the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression Scale (CGI-S), and the Global Assessment of Functioning Scale (GAF) (p < 0.001). Although the difference was not significant, 80% of treatment-resistant patients with disorganized schizophrenia responded to clozapine. Conclusion: Patients with the disorganized subtype of schizophrenia should benefit from clozapine as a second-line agent.Universidade Federal de São Paulo (UNIFESP) Schizophrenia ProgramAssociação Paulista para o Desenvolvimento da Medicina (SPDM) Hospital das Clínicas Luzia de Pinho Melo Department of PsychiatryUNIFESP Interdisciplinary Laboratory of Clinical NeurosciencesSão José do Rio Preto Medical School Department of Psychiatry and Medical PsychologyUNIFESP, Schizophrenia ProgramUNIFESP, Interdisciplinary Laboratory of Clinical NeurosciencesSciEL

Conceptions about the Use of Cannabis among Medical Students from Public Universities

Background: Substance abuse is a public health concern given its high prevalence worldwide. The early onset of such abuse predicts greater severity of addiction, morbidity, and use of multiple drugs. The use of psychoactive substances among Brazilian university students is frequent and cannabis stands out as the most consumed illicit drug. This study aimed to assess the prevalence of cannabis use among medical students from public universities in the state of São Paulo, correlating it with socioeconomic data, perceptions, and conceptions about use, triggering factors and possible implications in academic performance.Methods: The data were collected using an anonymous online survey, which was sent to students attending public medical universities in the state of São Paulo in the year 2020.Findings: The survey was answered by 225 participants. Among all participants, 147 (65.3%) reported at least one episode of cannabis use during their study in university. 91 (61.9%) reported the first use before entering university, while 56 (38.1%) used it for the first time during the university years. The frequent group included 41 (27.9%) people and the sporadic group included 106 (72.1%) people.Conclusion: The present study indicated that the medical students in public universities in the state of São Paulo have higher cannabis use rates compared to the general Brazilian population and to other medical students worldwide. The users are aware of the possible damages caused by cannabis use, but this does not stop them from smoking

Impact of training in autism for primary care providers: a pilot study

Objective: To evaluate the impact of a training program on autism spectrum disorder (ASD) identification offered to Brazilian health professionals. Methods: Twenty-two primary care providers participated in five 3-hour weekly training sessions. Results: The trained providers significantly improved their ASD knowledge after training in comparison with pre-training (mean score, 6.73 vs. 9.18, p < 0.01). Clinical practice also changed: 4 months after the training program, the providers had referred six times as many suspected cases of ASD to a specialized mental health service in comparison with the previous 4 months. Conclusion: This pilot training model seems a promising, feasible, and inexpensive way to improve early identification of ASD in the primary care system.Universidade Federal de São Paulo (UNIFESP) Department of Psychiatry Child and Adolescent Psychiatry Unit (UPIA)Santa Casa de Misericórdia de São Paulo School of Medical Sciences Unit of Excellence in Autism Spectrum DisorderUniversidade Federal de São Paulo (UNIFESP) Department of PsychiatryFaculdade de Medicina de São José do Rio Preto Department of Psychiatry and Medical PsychologyUniversity of London King's College Institute of PsychiatryUniversidade Presbiteriana Mackenzie Graduate Program in Developmental DisordersUNIFESP, Department of Psychiatry Child and Adolescent Psychiatry Unit (UPIA)UNIFESP, Department of PsychiatrySciEL

Tratamento da epilepsia mioclônica juvenil com topiramato

OBJECTIVE: The aim of this study was to evaluate the efficacy and tolerability of topiramate (TPM) in juvenile myoclonic epilepsy (JME). METHOD: We assessed seizure control and adverse effects of TPM in 22 patients (18 females) aged 13 to 53 years. Target TPM dosage was up to 200 mg/day. The patients were subdivided into 3 groups: those treated with seizure control plus side effects (n=4); treated with non-controlled seizures (n=15) and with JME newly diagnosed (n=3). RESULTS: Sixteen patients completed the first year of the follow-up. Generalized tonic-clonic seizures were completely controlled in 10 (62.5%); more than 50% of reduction in 4 (25.0%) and less than 50% in 2 (12.5%). Myoclonia were controlled in 11 (68.8%) and persisted in 5 (31.2%) patients. Absence seizures were present in 5 (22.7%) of whom 2 (9.0%) showed more than 50% of seizure reduction while 3 (13.6%) presented worsening. Discontinuations were due to inadequate seizure control and adverse events (N=4), low compliance and loss of follow-up (N=2) and subject choice (N=1). CONCLUSION: TPM showed to be an effective and well-tolerated drug in the treatment of JME. Although frequently observed, TPM side effects were tolerable and the drug could be maintained in the majority of patients.OBJETIVO: Avaliar a eficácia e tolerabilidade do topiramato (TPM) na epilepsia mioclônica juvenil (EMJ). MÉTODO: Avaliamos a resposta terapêutica e efeitos colaterais do TPM em 22 pacientes (18 mulheres) com idades entre 13 e 53 anos. A dose alvo utilizada foi até 200 mg/dia. Os pacientes foram divididos em 3 grupos no início do tratamento: aqueles com controle das crises mas que apresentavam efeitos colaterais (n=4); com crises não controladas (n=15) e com EMJ recém diagnosticada (n=3). RESULTADOS: Dezesseis pacientes completaram o primeiro ano de acompanhamento. Crises tônico-clonicas generalizadas foram completamente controladas em 10 (62,5%), tiveram redução maior de 50% em 4 (25,0%) e menor de 50% em 2 (12,5%). Mioclonias foram controladas em 11 (68,8%) e persistiram em 5 (31.2%) pacientes. As crises de ausências, presentes em 5 (22,7%) pacientes, tiveram redução maior do que 50% em 2 (9,0%) e agravamento em 3 (13,6%). A retirada do estudo foi devida principalmente ao controle inadequado das crises e efeitos colaterais indesejáveis (n=4), pouca adesão e perda do seguimento (n=2) e escolha do paciente (n=1). CONCLUSÃO: TPM foi considerada droga eficaz e bem tolerada no tratamento da EMJ. Apesar de freqüentemente observados, os efeitos colaterais do TPM foram toleráveis e a medicação pode ser mantida na maioria dos pacientes.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Unidade de Pesquisa e Tratamento das EpilepsiasUNIFESP, EPM, Unidade de Pesquisa e Tratamento das EpilepsiasSciEL

Safety of video-EEG monitoring and surgical outcome in patients with mesial temporal sclerosis and psychosis of epilepsy

Purpose: Cortico-amygdalohippocampectomy (CAH) has become an important treatment option for patients with refractory temporal lobe epilepsy and mesial temporal sclerosis (TLE-MTS); it has resulted in a 60-70% seizure remission rate and significant quality of life (QOL) improvements. Video-electroencephalography (VEEG) monitoring has been widely used in epilepsy centers for pre-surgical evaluation. A major concern in epilepsy surgery is whether to consider CAH treatment in patients with psychosis of epilepsy (POE). This study analyzed the safety and adverse events (AEs) of VEEG monitoring and the post-surgical outcomes of patients with refractory TLE-MTS and POE who underwent CAH.Method: Clinical, sociodemographic and VEEG data from 18 patients with TLE-MTS and POE were analyzed. Psychiatric evaluations were performed using DSM-IV and ILAE criteria. the seizure outcome was evaluated using Engel's criteria.Results: Two patients (11.2%) presented AEs that did not result in increased lengths of hospitalization. of the 10 patients (55.5%) who underwent CAH, 6 (60%) became free of disabling seizures (Engel I). the psychiatric and QOL evaluations revealed improvements of psychotic symptoms (p = 0.01) and in Physical Health (p = 0.01) following surgery.Conclusion: These data reinforce that VEEG monitoring is a safe method to evaluate patients with refractory TLE-MTS and POE in epilepsy centers. (C) 2012 British Epilepsy Association. Published by Elsevier B.V. All rights reserved.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo UNIFESP, Dept Neurol & Neurosurg, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Psychiat, LiNC, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Neurol & Neurosurg, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Psychiat, LiNC, São Paulo, BrazilWeb of Scienc

Prevalência de transtornos psiquiátricos em pacientes com esclerose mesial temporal

OBJECTIVE: Behavioral changes in patients with epilepsy can range from depression, anxiety to psychosis and personality traits. We evaluated the frequency of psychiatric disorders (PD) in a homogenous series of patients with refractory temporal lobe epilepsy (TLE) related to mesial temporal sclerosis (MTS) aiming at determining the frequency of PD and possible correlations to clinical variables and to laterality of MTS. METHODS: Data from 106 refractory TLE patients were reviewed. Psychiatric evaluation was based on DSM-IV criteria. Statistical analysis was performed through the chi-square (chi&sup2;), Student's t test and Fisher's exact test. P value considered significant was < 0.05. RESULTS: PD were found in 65 patients (61.3%). Among them, mood disorders were the most frequent (32 patients; 30%), followed by interictal (15 patients; 14%) and postictal (10 patients; 9.4%) psychosis. Postictal and interictal psychosis were significantly associated with left side MTS (p < 0.05), while PD in general and mood disorders were not associated to any side. CONCLUSION: There was a high prevalence of PD in patients with refractory TLE associated to MTS. The most common were mood and psychotic disorders. Psychosis was significantly associated to left side. These findings are concordant with data in literature, confirming the existence of anatomic alterations, and also a possible left laterality effect in the mesial temporal lobe structures in patients with epileptic psychosis.OBJETIVOS: Foi avaliada a freqüência de transtornos psiquiátricos (TP) em uma série homogênea de pacientes com epilepsia do lobo temporal (ELT) associada à esclerose mesial temporal (EMT), com o objetivo de verificar a prevalência e os tipos de TP nessa população e de correlacionar tais transtornos a aspectos clínicos e à lateralidade da EMT. METODOLOGIA: Dados de 106 pacientes com ELT refratária associada a EMT foram revisados. A avaliação psiquiátrica foi baseada nos critérios diagnósticos do DSM-IV. A análise estatística foi realizada através do teste do qui-quadrado (chi&sup2;), do teste t de Student e do teste exato de Fisher. O valor de P considerado significante foi < 0,05. RESULTADOS: TP foram diagnosticados em 65 pacientes (61,3%). Transtornos do humor foram os mais freqüentemente encontrados (32 pacientes; 30%), seguidos por psicose interictal (15 pacientes; 14%) e por psicose pós-ictal (10 pacientes; 9.4%). Tanto a psicose interictal como a psicose pós-ictal foram associadas a EMT à esquerda (p < 0,05), enquanto TP em geral e transtornos do humor não foram correlacionados a nenhum lado. CONCLUSÃO: HOUVE uma elevada prevalência de TP em pacientes com ELT refratária associada a EMT. Os mais freqüentemente encontrados foram transtornos do humor e psicóticos. Quadros psicóticos foram associados a EMT à esquerda. Tais achados são concordantes com dados da literatura atual em relação à prevalência de TP na ELT, confirmando a existência de alterações anatômicas e uma possível associação da EMT à esquerda com quadros psicóticos na ELT.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo (UNIFESP) Unidade de Pesquisa e Tratamento das EpilepsiasUNIFESP, Unidade de Pesquisa e Tratamento das EpilepsiasSciEL

Psychiatric comorbidity in patients with two prototypes of focal versus generalized epilepsy syndromes

The frequency of psychiatric disorders (PD) in a homogeneous series of patients with temporal lobe epilepsy with mesial temporal sclerosis (TLE-MTS) compared to patients with juvenile myoclonic epilepsy (JME) was evaluated, aiming to determine the frequency of PD and possible differences in psychiatric diagnoses between these two epileptic syndromes. Data from 248 patients with refractory TLE-MTS and from 124 JME patients were reviewed and compared. There was a high prevalence of PD in both groups of epilepsy patients, present in 100 TLE-MTS (41%) and in 58 JME patients (46.7%). Mood (23.7%), anxiety (13.7%) and psychotic (11.6%) disorders were the most frequent diagnoses in TLE-MTS group, while mood and anxiety disorders (25% and 21%, respectively) were the most common PD among JME. Psychoses were significantly associated with TLE-MTS (p = 0.01). These observations are concordant with our previous study, reforcing the existence of a possible anatomic correlation of PD and brain structures involved in both epilepsy syndromes. (C) 2011 British Epilepsy Association. Published by Elsevier B.V. All rights reserved.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo UNIFESP, Dept Neurol & Neurosurg, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Psychiat, Lab Interdisciplinar Neurociencias Clin LiNC, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Neurol & Neurosurg, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Psychiat, Lab Interdisciplinar Neurociencias Clin LiNC, São Paulo, BrazilWeb of Scienc

Prognosis of juvenile myoclonic epilepsy is related to endophenotypes

Purpose: To investigate if phenotypic variations have prognostic implications in juvenile myoclonic epilepsy (JME).Methods: Sixty-five consecutive JME patients had video-EEG recording and were followed for at least three years. Reflex traits were defined as seizures and/or EEG discharges induction by eye-closure, photic stimulation, language, praxis or calculation. Patients had psychiatric evaluation and answered to STAI (State-Trait Anxiety Inventory). Seizure control was classified according to Prasad et al. (2003).(24) Patients were divided into Group 1: good seizure control and Group 2: moderate or poor seizure control. Video-EEG/EEG evaluation was repeated in 21 patients.Results: Forty of 65 (61.5%) patients reached good seizure control, 25(38.5%) of whom became seizure free. Group 2 patients had longer epilepsy duration (13.9 +/- 9.0 vs. 8.7 +/- 8.2; p = 0.019); higher prevalence of the combination of all three seizure types (72.0% vs. 30.0%; p = 0.003); discharges in baseline EEG (56.0% vs. 22.5%; p = 0.008); seizure recording (68% vs. 20%; p < 0.001) and sensitivity to praxis (63.6% vs. 29.6%; p = 0.023). Compared to seizure-free patients, those with persistent seizures presented younger age at epilepsy onset (12.6 +/- 3.33 years vs. 15.4 +/- 5.47 years; p = 0.015); higher prevalence of personality disorders (25% vs. 4%; p = 0.029); higher scores in STAI-T (45.9 +/- 11.31 vs. 36.6 +/- 11.43; p = 0.011) and higher incidence of sensitivity to praxis (58.6% vs. 25.0%; p = 0.04) and to language (53.8 vs. 16.7%; p = 0.026) tasks. Repetition of EEG/video-EEG revealed a parallel evolution of reflex traits disappearance and seizure control.Discussion: Clinical features and reflex traits have prognosis implications in JME. (C) 2010 British Epilepsy Association. Published by Elsevier B.V. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Escola Paulista Med, Dept Neurol & Neurosurg, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Neurol & Neurosurg, São Paulo, BrazilWeb of Scienc