Anxiety Disorders: Kanner AM

García-Morales I, de la Peña Mayor P, Kanner AM. · Department of Neurology, San Carlos Clinical University Hospital, Madrid, Spain. · Neurologist. · Pubmed #19225366 No free full text.

Abstract: INTRODUCTION: The relationship between epilepsy and psychiatric disorders, as well as their reciprocal influence, has been confirmed in several studies. The diagnosis of these psychiatric comorbidities becomes particularly complex, for clinical manifestations vary and patients may not fulfil the criteria of traditional diagnostic classifications. RESULTS: Mood disorders are the more frequent conditions associated with epilepsy, followed by anxiety, attention-deficit, psychotic and personality disorders. Patients with focal epilepsies, and mainly those with temporal and frontal lobe epilepsy, have a greater incidence of depression, anxiety or psychosis, compared with the general population. For a long time, patients and physicians tended to focus solely on the control of epileptic seizures, while disregarding the presence of comorbid psychiatric symptoms and disorders. Recognition of their negative impact in the life of patients with epilepsy in recent years has highlighted the need for their early identification with a careful psychiatric history or, at the least, to screen for the presence of psychiatric symptoms with objective scales. Furthermore, the identification of psychiatric symptoms plays an important role in the choice of antiepileptic drugs as some are known to have positive or negative psychotropic effects. CONCLUSION: An early diagnosis of comorbid psychiatric disorders and a multidisciplinary approach in the evaluation and management of these patients result in the selection of an optimal comprehensive treatment.

Kanner AM, Gidal BE. · Rush University Medical Center, Chicago, Illinois, USA. · Int Rev Neurobiol. · Pubmed #18929094 No free full text.

Abstract: Co-morbid psychiatric disorders are relatively frequent in patients with epilepsy. The prevalence rates of mood and anxiety disorders, psychotic disorders and attention deficit/hyperactivity disorder have been found to be significantly higher in patients with epilepsy than in the general population. While co-morbid psychiatric disorders have frequently been considered as complications of the seizure disorder, there is an increasing body of literature that points to a complex relationship between psychiatric and seizure disorders. Because of this, it is crucial that clinicians consider the presence of co-morbid psychiatric disorders when planning the treatment of patients with epilepsy. Having a clear understanding of the pharmacodynamic and pharmacokinetic interactions between antiepileptic drugs and psychotropic drugs is of the essence to avert unnecessary adverse events and loss of efficacy of psychotropic drugs. This chapter provides a practical review on the use of psychotropic drugs for the treatment of these psychiatric co-morbidities in patients with epilepsy.

LaFrance WC, Kanner AM, Hermann B. · Brown Medical School, Rhode Island Hospital, Departments of Psychiatry and Neurology, Providence, Rhode Island 02903, USA. · Int Rev Neurobiol. · Pubmed #18929092 No free full text.

Abstract: Psychiatric disorders can be identified in 25-50% of patients with epilepsy, with higher prevalence among patients with poorly controlled seizures. These disturbances include depression, anxiety, psychotic disorders, cognitive, and personality changes occurring in the interictal or ictal/postictal states. In this chapter, we describe four areas of focus in women with epilepsy: comorbid primary psychiatric processes, integrated symptoms secondary to epilepsy, stigma and psychosocial consequences of epilepsy, and nonepileptic seizures.

Kanner AM. · Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois 60612, USA. · Semin Neurol. · Pubmed #18777484 No free full text.

Abstract: Psychiatric disorders, such as mood, anxiety, attention deficit, and psychotic disorders, are among the most frequent comorbidities experienced by patients with epilepsy. While these psychiatric disorders have typically been considered as one of its complications, there is increasing evidence of a bidirectional relationship between the seizure disorder and mood and ADHD. Indeed, not only are patients with epilepsy at greater risk of developing these two disorders, but patients with mood and attention deficit disorders are at greater risk of developing epilepsy. Comorbid psychiatric disorders have a negative impact on the quality of life of patients with epilepsy. For patients with pharmacoresistant epilepsy, mood disorders are a stronger predictor of a worse perception of their quality of life than is their seizure frequency and severity. Thus, the use of psychotropic drugs is often necessary in patients with epilepsy, be they children or adults. Unfortunately, there are many misconceptions regarding the safety of psychotropic drugs, particularly of antidepressants and central nervous system stimulants, which are often erroneously thought of as being "proconvulsant." Such misconceptions have resulted in the undertreatment of psychiatric comorbidities in patients with epilepsy. This article provides a practical review of the use of antidepressants, central nervous system stimulants, and antipsychotic drugs in patients with epilepsy.

Kanner AM. · Department of Neurological Sciences, Rush Medical College, Rush University Medical Center, Chicago, Illinois 60612, USA. · Epilepsia. · Pubmed #18047595 No free full text.

Abstract: Mood disorders (MD) are a frequent comorbidity of epilepsy with a negative impact on quality of life. The higher prevalence of MD in people with epilepsy (PWE) is most likely a reflection of a bidirectional relation between the two conditions, and common pathogenic mechanisms. Treatment of MD in PWE is safe with selective serotonin reuptake inhibitor (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), but nonpsychiatrists need to know when to refer these patients to a psychiatrist for further evaluation and treatment.

Kanner AM. · Department of Neurological Sciences, Rush Medical College, Rush Epilepsy Center at Rush University Medical Center, Chicago, Illinois 60612, USA. · Epilepsia. · Pubmed #15186341 No free full text.

Abstract: Anxiety, psychosis, and aggressive behavior are among the frequent comorbid psychiatric disorders identified in patients with epilepsy. Often the clinical manifestations of these disorders vary according to their temporal relation relative to seizure occurrence. Thus, postictal symptoms of anxiety or psychosis differ in severity, duration, and response to treatment with interictal symptomatology. Psychiatric symptomatology in epilepsy can appear concurrently with the seizure disorder and improve or remit on the abolition of epileptic activity. We refer to these as paraictal psychiatric phenomena. Such is the case of aggressive disturbances associated with gelastic seizures caused by hypothalamic hamartomas. In this article, three case studies are presented to illustrate the importance of distinguishing psychiatric symptoms of anxiety, psychosis, and aggression, with respect to their temporal relation with seizure occurrence.

Kanner AM, Nieto JC. · Department of Neurological Sciences, Rush Medical College and Rush Epilepsy Center, Rush Presbyterian St. Luke's Medical Center, Chicago, Illinois 60612, USA. · Neurology. · Pubmed #10496231 No free full text.

Abstract: Depression is a common occurrence among epileptic patients and constitutes, along with anxiety disorders, the most frequent psychiatric condition in these patients. The relationship between depression and epilepsy is two-directional, because patients with major depression also have a higher frequency of epilepsy. In epileptic patients, depressive disorders can present as unipolar, bipolar, or dysthymic disorders. More characteristically, however, they present as an atypical depression, which can often go unrecognized for long periods of time. In the diagnostic evaluation of these patients, clinicians must rule out the possibility that the depressive disorder resulted from the administration of antiepileptic drugs (AEDs; e.g., barbiturates) or from the discontinuation of an AED with mood-stabilizing properties that were masking an underlying affective disorder. Although antidepressant drugs have been used in epileptic patients for a long time, to date there has only been one controlled study. The antidepressants of the family of selective serotonin reuptake inhibitors (SSRIs) should be considered as initial therapy for depressive disorders in these patients.

Jones JE, Hermann BP, Barry JJ, Gilliam F, Kanner AM, Meador KJ. · Department of Neurology, University of Wisconsin-Madison, 53792-6180, USA. · J Neuropsychiatry Clin Neurosci. · Pubmed #15939970 links to  free full text

Abstract: This study characterizes the rate of current Axis I DSM-IV disorders using a brief standardized psychiatric interview procedure, the Mini International Neuropsychiatric Interview (v5.0) (MINI), and determined the validity of MINI diagnoses of current depressive episodes to the research standard (Structured Clinical Interview for DSM-IV Disorders [SCID]). One hundred seventy-four patients with chronic epilepsy from five tertiary medical centers were interviewed using the MINI and the mood disorders module of the SCID. Current Axis I disorders were evident in one-half the sample (49%), with prevalent anxiety (30.4%) and mood (21.8%) disorders. Major depressive episode was the most common individual diagnosis (17.2%). Concordance was high between the MINI and SCID for diagnoses of current depression, especially for major depression. Of those with current major depression, less than one-half were treated with antidepressant medications. Current Axis I DSM-IV diagnoses can be effectively and accurately identified in clinical settings using shorter standardized psychiatric interview techniques. Issues regarding recognition and treatment of psychiatric morbidity in epilepsy are discussed.

Kanner AM, Byrne R, Chicharro A, Wuu J, Frey M. · Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA. · Neurology. · Pubmed #19255406 No free full text.

Abstract: Purpose: To identify the psychiatric and epilepsy variables predictive of postsurgical seizure outcome after anterotemporal lobectomy (ATL). METHODS: Retrospective study of 100 consecutive patients with temporal lobe epilepsy (TLE) who underwent ATL. The mean (+/- SD) follow-up period was 8.3 (+/- 3.1) years. Three types of surgical outcomes were examined at 2 years after surgery and at last contact: class IA (no disabling seizures no auras), class IA + IB (no disabling seizures), and class IA + IB + IC (no or rare disabling seizures in the first postsurgical year). Logistic regression analyses were performed separately for the three types of surgical outcomes. The epilepsy-related independent variables included age at onset, cause of TLE (mesial temporal sclerosis, lesional and cryptogenic TLE), extent of resection of mesial structures, neuropathologic abnormalities, having only complex partial seizures, and duration of the seizure disorder. The psychiatric independent variables included a postsurgical and presurgical lifetime history of mood, anxiety, attention deficit hyperactivity, and psychotic disorders. RESULTS: The absence of a psychiatric history was an independent predictor of all three types of surgical outcomes. In addition, a larger resection of mesial structures was a predictor for class IA outcome, and having only complex partial seizures (vs generalized tonic-clonic seizures) was a predictor for class IA + IB and IA + IB + IC. Having mesial temporal sclerosis (vs other causes of TLE) was a predictor for class IA + IB + IC as well. CONCLUSIONS: These data indicate that a lifetime psychiatric history may be predictive of a worse postsurgical seizure outcome after an anterotemporal lobectomy.

Kanner AM. · Department of Neurological Sciences, Rush Medical College, 1653 West Congress Parkway, Chicago, IL, USA. · Epilepsy Behav. · Pubmed #19245845 No free full text.

Abstract: The comorbid psychiatric disorders in patients with epilepsy have been neglected for a long time. And yet, epidemiological studies have demonstrated a relatively high prevalence of mood, anxiety, and attention deficit hyperactivity disorders. Furthermore, the relation between psychiatric disorders and epilepsy is complex, as illustrated by the relation between mood disorders and epilepsy. The aim of this article is to summarize the most relevant data on the complex relation between mood disorders and epilepsy, which extends to anxiety disorders and which can be explained by the existence of common pathogenic mechanisms shared by these three conditions. The significance of such a relation is not only theoretical, but has a marked impact on the response to pharmacological and surgical treatment of seizure disorders.

Kanner AM, Soto A, Gross-Kanner H. · Division of Epilepsy, Department of Neurological Sciences, Rush Medical College, Rush University Medical Center, Chicago, IL, USA. · Neurology. · Pubmed #15007118 No free full text.

Abstract: OBJECTIVE:S: To identify the prevalence and clinical characteristics of postictal psychiatric (PPS) and cognitive (PCS) symptoms in patients with refractory partial epilepsy and to investigate whether interictal psychiatric and cognitive symptoms worsened in severity during the postictal period. METHODS: Using a 42-item questionnaire, the authors determined the prevalence and clinical characteristics of PPS and PCS that occurred after >50% of seizures in 100 of 114 consecutive patients with refractory partial epilepsy during a 3-month period. The postictal period was defined as the 72 hours that followed a seizure. The prevalence of all interictal psychiatric and cognitive symptoms was identified and the frequency with which they worsened postictally determined. RESULTS: A mean of 2.8 +/- 1.8 PCS (median = 3) and 5.9 +/- 5.3 PPS (median = 5) was identified, which included postictal symptoms of depression (PSD) in 43 patients, anxiety (PSA) in 45, postictal psychotic symptoms (PIP) in 7, hypomanic symptoms in 22, neurovegetative symptoms in 52, and fatigue in 37. Most patients experienced more than one type of PPS. Independently of the occurrence of PPS, 38 patients reported a worsening of interictal psychiatric and cognitive symptoms postictally. A history of depression and anxiety significantly increased the number of PSD, PSA, and PIP. CONCLUSIONS: Postictal psychiatric symptoms are common among patients with refractory partial epilepsy, and the severity of interictal psychiatric and cognitive symptoms commonly worsens during the postictal period.

Kanner AM. · Department of Neurological Sciences, Rush Medical College, Chicago, IL, USA. · Epilepsy Behav. · Pubmed #14698691 No free full text.

Abstract: Patients with epilepsy have a significantly higher prevalence of psychiatric comorbid disorders involving depression, anxiety, psychotic, and attention deficit disorders. Accordingly, one would expect that psychiatrists would be actively involved in the evaluation and management of these patients. This, however, is hardly the case. Patients who undergo temporal lobectomies, for example, are known to experience postsurgical depression and occasionally psychotic disorders. Yet, most epilepsy centers in North America do not include a psychiatric evaluation as part of the presurgical work-up. Collaboration between epileptologists and psychiatrists is often sparse, despite the intimate relationship between psychiatric comorbidities and epilepsy. The purpose of this paper is to highlight this bizarre phenomenon and to identify some of the reasons behind it.