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Acute unstable depressive syndrome (AUDS) is associated more frequently with epilepsy than major depression

Vaaler, Arne; Morken, Gunnar; Iversen, Valentina Cabral; Kondziella, Daniel; Linaker, Olav Morten
Journal article, Peer reviewed
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1471-2377-10-67.pdf (210.2Kb)
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http://hdl.handle.net/11250/2353165
Utgivelsesdato
2010
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  • Institutt for nevromedisin og bevegelsesvitenskap [2260]
  • Publikasjoner fra CRIStin - NTNU [26591]
Originalversjon
BMC Neurology 2010, 10   10.1186/1471-2377-10-67
Sammendrag
Background: Depressive disorders are frequent in epilepsy and associated with reduced seizure control. Almost

50% of interictal depressive disorders have to be classified as atypical depressions according to DSM-4 criteria.

Research has mainly focused on depressive symptoms in defined populations with epilepsy (e.g., patients admitted

to tertiary epilepsy centers). We have chosen the opposite approach. We hypothesized that it is possible to define

by clinical means a subgroup of psychiatric patients with higher than expected prevalence of epilepsy and seizures.

We hypothesized further that these patients present with an Acute Unstable Depressive Syndrome (AUDS) that

does not meet DSM-IV criteria of a Major Depressive Episode (MDE). In a previous publication we have

documented that AUDS patients indeed have more often a history of epileptic seizures and abnormal EEG

recordings than MDE patients (Vaaler et al. 2009). This study aimed to further classify the differences of depressive

symptoms at admittance and follow-up of patients with AUDS and MDE.

Methods: 16 AUDS patients and 16 age- and sex-matched MDE patients were assessed using the Symptomatic

Organic Mental Disorder Assessment Scale (SOMAS), the Montgomery and Åsberg Depression Rating Scale

(MADRS), and the Mini-Mental State Test (MMST), at day 2, day 4-6, day 14-16 and 3 months after admittance to a

psychiatric emergency unit. Life events were assessed with The Social Readjustment Rating Scale (SRRS) and The

Life Experience Survey (LES). We also screened for medication serum levels and illicit drug metabolites in urine.

Results: AUDS patients had significantly higher SOMAS scores (average score at admission 6.6 ± 0.8), reflecting

increased symptom fluctuation and motor agitation, and decreased insight and concern compared to MDE

patients (2.9 ± 0.7; p < 0.001). Degree of mood depression, cognition, life events, drug abuse and medication did

not differ between the two groups.

Conclusions: AUDS patients present with rapidly fluctuating mood symptoms, motor agitation and relative lack of

insight and concern. Seizures, epilepsy and EEG abnormalities are overrepresented in AUDS patients compared to

MDE patients. We suggest that the study of AUDS patients may offer a new approach to better understanding

epilepsy and its association with depressive disorders.
Utgiver
BioMed Central
Tidsskrift
BMC Neurology

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