Emotional and affective disturbances in patients with epilepsy EttoreBeghi, a,d, * PaolaSpagnoli, a LarissaAiroldi, a EbeFiordelli, a IldebrandoAppollonio, a Graziella Bogliun, a,b Anna Zardi, a Felice Paleari, c Pierluigi Gamba, b Lodovico Frattola, a,e and Luca Da Prada c a Epilepsy Center, Monza, Italy b Neurologic Clinic, Diabetes Outpatient Unit, Monza, Italy c Hematology Service, Ospedale ‘‘San Gerardo,’’ Monza, Italy d Istituto di Ricerche Farmacologiche ‘‘Mario Negri,’’ Via Eritrea 62, 20157 Milan, Italy e IRCSS ‘‘Don Gnocchi,’’ Milan, Italy Received 26 December 2001; received in revised form 8 March 2002; accepted 29 March 2002 Abstract We sought to assess whether epilepsy is associated with a higher risk of emotional reactions to frustrating stimuli, aggressive behavior, apathy, and depression, and whether these psychiatric patterns are specific to the epileptic condition. The study popu- lation consisted of referral patients 17 years and older with idiopathic or cryptogenic epilepsy (i.e., epilepsy not caused by a de- tectable brain lesion) without significant cognitive dysfunction. A first control was selected for each patient among patients with insulin-dependent diabetes and a second among normal blood donors. Aggressiveness in response to stressful stimuli was assessed withthePictureFrustrationStudy(PFS).DepressionwastestedbytheBeckDepressionInventory.TheAggressiveBehaviorScale (assessingirritabilityandrumination)andtheApathyScalewerealsoused.OddsRatios(ORs)with95%ConfidenceIntervals(95% CI)wereusedastheriskmeasure.Statisticalanalysisincludedbetween-groupcomparisons.Inpatientswithepilepsy,thetestscores were correlated to the main demographic (age, sex, education, marital status, and occupation) and clinical features (seizure types, disease duration, seizure control, and treatments). The sample included 55 patients with epilepsy, 56 diabetics, and 59 normal in- dividuals. Patients with epilepsy and the two control groups had similar PFS scores and similar aggressiveness. Scores were also similar for the Aggressive Behavior and Apathy Scales, with similar numbers of individuals with aggressive conduct and excess rumination.Patientswithepilepsyhadhigherdepressionscores.Moderatetoseveredepressionwaspresentin9cases(diabetes,2; blooddonors,1)(P ¼ 0:004).Relativetoblooddonors,theORformoderatetoseveredepression(95%CI)was2.1(0.1–61.7)for diabetes and 11.3 (1.4–247.8) for epilepsy. No significant correlation was detectable between test scores and patient and disease characteristics. Ó 2002 Elsevier Science (USA). All rights reserved. Keywords: Epilepsy; Irritability; Aggressiveness; Apathy; Complications; Diabetes 1. Introduction It is widely accepted that epilepsy carries a high risk of psychiatric and behavioral complications. However, the extent of that risk cannot be correctly estimated because the published reports have several method- ological inconsistencies. First, the overall prevalence of psychiatricdisturbancesinthegeneralpopulationhasin factbeenfoundtorangefrom10to47%dependingon how the diagnostic assessment is made [1,2]. Second, psychiatricmorbidityinepilepsyvariesaccordingtothe characteristics of the disease and the type and intensity of the psychiatric investigation. Most reports refer to patients with temporal lobe epilepsy or more severe disease varieties [3–6], in whom the prevalence of psy- chiatriccomplicationsmaybehigherthanintheoverall epileptic population. Even in community studies, the prevalence of psychiatric morbidity varies widely [7–13] depending on the type of psychopathology and the sensitivity and specificity of the screening instruments. Psychiatric complications attributable to epilepsy have been better investigated by studies comparing patients with epilepsy and other chronic (neurological and non- Epilepsy & Behavior 3 (2002) 255–261 www.academicpress.com Epilepsy & Behavior * Corresponding author. Fax: +39-02-33200231. E-mail address: beghi@marionegri.it (E. Beghi). 1525-5050/02/$ - see front matter Ó 2002 Elsevier Science (USA). All rights reserved. PII:S1525-5050(02)00008-2