Download Project Care 4 Epilepsy Depression, Anxiety and Epilepsy

Project Care 4 Epilepsy
Depression, Anxiety and Epilepsy
Tatiana Falcone, M.D.
Jane Timmons-Mitchell, Ph.D.
December 16, 2014
Introduction
• Despite remarkable progress in diagnosis, treatment
and positive long term seizure outcome in children
with epilepsy, the high prevalence of mental health
problems has not changed in 30 years
• Population studies of children with epilepsy (CWE)
reported poor psychosocial outcomes in adulthood
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Davies et al. A population Survey of mental health problems in children with
epilepsy.Dev Med Child Neur 2003 45:292- 295
Rutter and Yule Neuropsychiatric study in Childhood 1970
Why do people develop mental
illness?
Many factors contribute to mental health
problems, including:
• Life experiences, such as trauma or a history
of abuse
• Biological factors, such as genes or chemical
imbalances in your brain (epilepsy)
• Family history of mental health problems
• Certain Medical problems- chronic medical
illness specially those that affect the brain
Psychiatric Comorbidities in Epilepsy
• Depression and anxiety are the most common
psychiatric comorbidities associated with
epilepsy
• They affect quality of life and how a patient
responds to poor seizure control, most cases
of depression go undiagnosed and untreated
in these patients
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Jacoby A et al. The clinical course of epilepsy and its psychosocial correlates, findings from a
UK community study. Epilepsia 1996; 37 :148 -61
Boylan L. Depression but not seizure frequency predicts quality of life in treatment resistant
epilepsy. Neurology 2004; 62 :258- 61
Epidemiologic data
• Lifetime prevalence of MDD 3.76.7 (general population)
• Lifetime prevalence in epilepsy
22.2%
• Higher rates of depression in
younger pts
• Lifetime suicidal ideation in
general population 13.3% (12.8 13.9 95% CI)
• Lifetime suicidal ideation in
epilepsy 25% (16.6-33.3% CI)
• Up to 40% of youth with epilepsy
experience anxiety
•
Tellez-Zenteno, et al psychiatric comorbidity in epilepsy a
population based analysis Epilepsia 2007
Predictors of mood disorder in children
and adolescents
• Gender effect, with more depression in adolescent girls with
epilepsy
• Age effect, more depression older than 12
• No association with seizure variables
• No studies on suicidal ideation and seizure variables
• More severe mood disorders in children with mental
retardation
• Increased family discord in children with epilepsy, increased
number of stressful life events
• Caplan (2005), Dunn (2005), Hessdorffer (2005), Jones (2008)
Mental Health Screening in the Pediatric
Epilepsy Clinic
• To improve access to services for patients with
epilepsy in a timely fashion, every family
during their outpatient appointment
• Every patient is screened at least one time
every six months (if the patient is coming for
an appointment)
• Screening measure severity of epilepsy, side
effects from the medications, impact on family
function and mental health screening
Mental health and Epilepsy
In 2007, a study of mental health problems in
children
• 16.7% epileptic children with psychiatric
diagnosis
Compared to:
• 6.4% in children with diabetes
• 4.2% in general population
Factors that Cause Mental Health
Issues
Internal Factors
– Biological Makeup
• Genetics
– Illnesses
• Disruption in brain function
(epilepsy) also affects mood
and behavior
External Factors
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Environmental Conditions- Bullying
Reactions from others to epilepsy
Lack of acceptance by others
Individuals own reaction and
acceptance of their condition
Bullying
20% of US high school students
were bullied on school property
16.2% electronically bullied ere
bullied on school property
(16)
Depression
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In general, there has been an increase in
stress and mental health issues during
childhood
1 in 33 children experience depression
1 in 8 adolescents are depressed
Clinical depression often 1st appears in
adolescence
Symptoms of Depression in Teens
• Teens may feel sad or cry a lot, for long periods of time.
• Feel guilty for no real reason; feel like they are no good;
or they have lost their confidence.
• Feel like life seems meaningless, or like nothing good will
ever happen again.
• Teens may have a negative attitude a lot of the time
(irritated), or seems like they have no feelings.
Depression and Epilepsy
• Teens don't feel like doing a lot of the things
they used to do, like music, sports, being with
friends, going out, and they want to be left
alone most of the time.
• Sleeping and eating more or less.
• Grades drop.
Extreme Symptoms of Depression
• Talk about death and suicide.
• Use drugs and/or alcohol.
• Get into trouble with the law at school or in
the community.
Basic concepts –
• Did the symptoms of depression appear following
the introduction or increase of the AED?
• Did the symptoms follow the discontinuation of a
psychiatric medication?
• Did the symptoms occur after introduction of
enzyme inducing AED?
• Is the patient experiencing any other psychiatric
symptoms?
SUICIDE IN THE EPILEPSIES: A META-ANALYTIC
INVESTIGATION OF 29 COHORTS
M. Pompili et al. / Epilepsy & Behavior 7 (2005) 305–310
Symptoms of Anxiety
Anxiety affects the way a person thinks, but the
anxiety can lead to physical symptoms, as well.
Symptoms of anxiety can include:
• Excessive, ongoing worry and tension
• An unrealistic view of problems
• Restlessness or a feeling of being "edgy"
• Irritability
• Muscle tension
• Headaches
Symptoms of anxiety
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Choking, chest pains, distress
Fear, fright, afraid, anxious
Hot flashes, or sudden chills
Tingling in fingers or toes ('pins and needles')
Fearful that you're going to go crazy or are
about to die
Panic Attacks
Symptoms of a Panic Attack include:
• Racing heartbeat , lightheadedness or nausea
• Difficulty breathing, feeling as though you can't get
enough air
• Terror that is almost paralyzing , feeling of dread
• Nervous, shaking, dizziness,
• Trembling, sweating, shaking
TREATMENT
Do we have effective treatments?
What to do--Medication
• Medications for Anxiety and Depression
– SSRIs (selective serotonin reuptake inhibitors)
used most frequently
– Common brand names: Prozac, Zoloft, Celexa,
Lexapro, Paxil
– Common generic names: fluoxetine, sertraline,
citolopran, escitalopram, paroxetine
– Can improve symptoms of anxiety and depression
without increasing seizures
What to do --Psychotherapy
• Cognitive Behavioral Therapy (CBT) can be
effective.
• CBT helps youth interrupt and change
negative thoughts
• A behavioral health specialist is needed to
help youth learn specific strategies
Key components of CBT
• Learning how to recognize which thoughts are
not based in reality and how to change them.
• Learning relaxation and deep breathing.
• Making a plan to increase social and exercise
activities.
• Identifying things that cause fear or worry and
learning how to tolerate them in small steps.
• Talking with the entire family about the best way
to help your child.
• Including everyone who works with your child in
the plan.
Tools
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Charting, journaling
Homework
Family therapy
Group therapy
What to do about Depression
• Developing a positive attitude about epilepsy,
for both you and your child.
• Learning skills to support self-esteem.
• Challenging extreme, disasterizing thinking. (In
Australia, “warpy” thoughts)
• Learning to relax and manage stress
What to do--Bullying
Burden falls to parents to advocate for their children
and teach age appropriate self-advocacy skills.
Promote expectation that there is something positive
to do that child can participate in and adults can make
happen.
Attend school meeting; point out student’s strengths.
What to do about Bullying
• StandUp is a Bullying Prevention Program for
teens.
• We are enrolling for this free program, which
students complete on their own computer at their
convenience.
• If your child with epilepsy is in High School• Stand Up- Denise Hagen 216-444-0514
What is StandUp?
Stand Up is a computer-based program designed to help high school students
develop and use skills for relating to others in healthy ways.
Using the skills and ideas in this program can help teens to:
• Treat themselves and others with respect
• Avoid being a bully
• Get help if they’re a victim of bullying
• Stand up to stop bullying when they see it going on around them
This program is designed for all teens, no matter if...
• They’ve had any experience with bullying or not
• They’re ready to make changes in the way they relate to others or not
• They’re ready to take a stand against bullying or not
StandUp Teaches
Healthy Relationship Skills
1. Trying to understand and respect the other person’s feelings and needs
2. Using calm, nonviolent ways to deal with disagreements (for example,
leaving the room to cool down, offering solutions)
3. Respecting the other person’s boundaries (for example, how close they want to
get and what they’re comfortable and uncomfortable sharing with others)
4. Communicating your own feelings and needs clearly and respectfully
5. Making decisions that you know are right for you in social situations
6. Taking a stand to stop bullying when you see it (for example, by saying
something to the bully, or telling an adult)
Your Role as Parents/Caregivers
• Overcome Fears and Stigma
• Help your teenager to cope/manage illness
Self–esteem and a positive self-image are critical to the
success and happiness your teen experiences for the rest of
their life.