Longitudinal trajectory of quality of life and psychological outcomes following epilepsy surgery.

Objective: This study investigated self-reported longitudinal quality of life (QOL) and symptoms of depression and anxiety in patients who had resective surgery. The study characterized the extent, sustainability, and longitudinal trajectory of psychosocial postsurgical outcomes.

Methods: This retrospective study included adults who underwent resective epilepsy surgery in Cleveland Clinic Epilepsy Center between 2008 and 2013.

Polyallergy (Multiple Chemical Sensitivity) is Associated with Excessive Healthcare Utilization, Greater Psychotropic Use, and Greater Mental Health/Functional Somatic Syndrome Disorder Diagnoses: A Large Cohort Retrospective Study.

Background: Associations between the crude capture of polyallergy-also known as multiple chemical sensitivity or multiple drug intolerance syndrome-and mental health/functional somatic syndrome disorders, healthcare utilization, or other clinical phenomenon have not been examined extensively.

Methods: An IRB-approved retrospective chart review of all patients between age 18 and 70 who had a clinical encounter at a large medical center between 2009 and 2014. Patients were stratified into 4 categories based on the absolute number of chart-documented allergies: (1) no allergies; (2) normal allergy (1-4 allergies); (3) polyallergy (5-9 allergies); and (4) "ultrapolyallergy," (≥10 allergies), which were corroborated through a sensitivity analysis.

Assessment of depression in epilepsy: the utility of common and disease-specific self-report depression measures.

Objectives: Depression is common in epilepsy, with rates ranging from 20 to 55% in most samples and reports as high as 70% in patients with intractable epilepsy. However, some contend that depression may be over- and/or under-reported and treated in this population. This may be due to the use of common self-report depression measures that fail to take into account the overlap of disease and depressive symptoms and also the host of side effects associated with antiepileptic medication, which may also be construed as depression.

Valproate-Induced Hyperammonemic Encephalopathy in General Hospital Patients With One or More Psychiatric Disorders.

Background: Divalproex sodium/valproic acid (VPA) is an antiepileptic drug approved for use in epilepsy and bipolar disorder. Valproate-induced hyperammonemia occurs in up to 50% of VPA-treated patients, some of whom may become encephalopathic. Valproate-induced hyperammonemic encephalopathy (VHE) is thought to be rare, and for a variety of reasons, the diagnosis requires a high index of suspicion.

Bridging a clinical gap in psychogenic nonepileptic seizures: Mental health provider preferences of biopsychosocial assessment approaches.

Management of psychogenic nonepileptic seizures (PNES) is complex, requiring multidisciplinary care. A standardized assessment and formulation approach to PNES is lacking, yet use of a comprehensive model may alleviate problems such as mental health aftercare noncompliance. Although a biopsychosocial (BPS) approach to PNES balancing predisposing, precipitating, and perpetuating (PPP) variables has been described and has been recently tested in pilot form, it is unclear how this assessment style is perceived among community mental health practitioners such as psychotherapists (including psychologists, counselors, and social workers).

Biomarkers in the diagnosis and study of psychogenic nonepileptic seizures: A systematic review.

Objective: Video electroencephalography (vEEG) is the gold-standard method for diagnosing psychogenic nonepileptic seizures (PNES), but such assessment is expensive, unavailable in many centers, requires prolonged hospitalization, and many times is unable to capture an actual seizure episode. This paper systematically reviews other non-vEEG candidate biomarkers that may facilitate both diagnosis and study of PNES as differentiated from epileptic seizures (ES).

Methods: PubMed database was searched to identify articles between 1980 and 2015 (inclusion: adult PNES population with or without controls, English language; exclusion: review articles, meta-analyses, single case reports).

Diagnostic assessment and case formulation in psychogenic nonepileptic seizures: A pilot comparison of approaches.

Management of psychogenic nonepileptic seizures (PNES) is complex, requiring multidisciplinary care. A standardized assessment approach to PNES is lacking, yet use of a comprehensive model may alleviate problems such as mental health aftercare noncompliance. Although a biopsychosocial (BPS) approach to PNES balancing predisposing, precipitating, and perpetuating (PPP) variables has been described, it is unclear how this formulation style is perceived amongst clinicians.

Incorporating patient-reported outcome measures into the electronic health record for research: application using the Patient Health Questionnaire (PHQ-9).

Purpose: Electronic health records (EHRs) present an opportunity to access large stores of data for research, but mapping raw EHR data to clinical phenotypes is complex. We propose adding patient-reported data to the EHR to improve phenotyping performance and describe a retrospective cohort study demonstrating a test case in depressive disorder.

Methods: We compared four EHR-phenotyping methods based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, medication records, and the Patient Health Questionnaire 9 (PHQ-9) regarding the ability to identify cases with depression and characteristics of patients identified with depression.

Valproate-induced hyperammonemic encephalopathy: a brief review.

Background: This brief review presents a comprehensive evaluation of valproate-induced encephalopathy (VHE) and also discusses potential mechanisms of the condition.

Scope: Sodium valproate (VPA) is an effective antiepileptic drug used in neurology as well as in psychiatry, in adults and children. VHE requires early diagnosis and management.

Role of cortisol in mood and memory in patients with intractable temporal lobe epilepsy.

Objective: This study prospectively examined the relationships among late night salivary cortisol (NSC) levels and depressive symptoms, memory performance, and hippocampal volumes in patients with medically intractable temporal lobe epilepsy (TLE) and the potential mediating effects of cortisol in the relationships between these variables.

Methods: Participants included 24 adults with well-characterized medically refractory TLE (right = 11; left = 12; bitemporal = 1). All patients provided saliva samples and completed measures of mood, anxiety, and memory (objective and subjective).

Quality of life in 1931 adult patients with epilepsy: seizures do not tell the whole story.

Objective: The aim of the work described here was to characterize quality of life (QOL) and its determinants in a large cohort of adult patients with epilepsy.

Methods: Validated measures reflecting disease severity and psychosocial functioning were electronically collected on all outpatients seen during 2009. Multivariate regression adjusting for repeated measures identified determinants of QOL, as defined by the Quality of Life in Epilepsy Questionnaire-10 (QOLIE-10).

Comparison of personality traits in patients with frontal and temporal lobe epilepsies.

The current study sought to characterize and compare personality traits of patients with temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE). Ninety-seven adults with medically intractable epilepsy (TLE n=58, FLE n=39) completed the Personality Assessment Inventory (PAI) as part of routine preoperative investigations. Not surprisingly, both epilepsy groups endorsed significantly more symptoms across PAI clinical scales than the normative sample, most notably on scales assessing Depression and Somatic Complaints.

Depression and heart disease: what do we know, and where are we headed?

Depression and heart disease have an intricate association and perhaps a causal relationship. We review the current status of depression and heart disease and provide an algorithm for diagnosing and treating depression in cardiac patients that internists and cardiologists can use in their daily patient encounters.

Whither hospital and academic psychiatry?

If psychiatrists are to bring value to the health care team, training a renewable force of such psychiatrists is essential. Have psychiatrists been trained to bring maximal value to the health care team? Is such training being provided now? Given the current health care climate, will sufficient funding be available to train this renewable force optimally? This article addresses these questions from an historical-developmental perspective, identifies current challenges, and outlines opportunities for further growth and development.

Treating depression in a mother of five: what to do when the first step fails.

What should one do with a depressed patient who does not get better? If depression does not respond to an antidepressant given in adequate doses for an adequate time, logical next steps include increasing the dose, adding a different medication, or adding a nonpharmacologic therapy. Or one can reconsider the diagnosis.

Heart disease and depression: don't ignore the relationship.

Evidence is mounting that depression is a risk factor for the development of cardiovascular disease and portends a worse outcome in cardiac patients. Depression can be easily diagnosed and safely treated in cardiac patients, but it is undertreated.

A primer on referring patients for psychotherapy.

Forty percent of the mental health care in this country is provided by primary care practitioners alone, and another 20% is provided by primary care practitioners working with mental health professionals. Primary care physicians can serve a valuable role by educating their patients about various forms of psychotherapy. Finding a good "fit" between patient and therapist is crucial to a good outcome.

The relationship between depression and cardiovascular disorders.

Expanding scientific evidence supports a long-recognized link between cardiovascular disease and depression. As an independent risk factor, depression increases patient vulnerability to both cardiac events and mortality. Several important pathophysiologic mechanisms have been proposed, including hypothalamic-pituitary axis hyperactivity, autonomic nervous system dysfunction, and increased platelet reactivity, among others.