Download PDF
CC BY-NC-ND 4.0 · International Journal of Epilepsy 2017; 04(01): 026-030
DOI: 10.1016/j.ijep.2016.12.002
Original article
Thieme Medical and Scientific Publishers Private Ltd.

Psychiatric comorbidity in African patients with epilepsy – Experience from Sierra Leone

Tenema M’bayo  
a   College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
,
Michal Tomek  
b   Department of Medicine, Basildon & Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
,
Clifford Kamara
a   College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
,
Durodami Radcliffe Lisk
a   College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
› Author Affiliations
Further Information

Publication History

Received: 29 June 2016

Accepted: 05 December 2016

Publication Date:
06 May 2018 (online)

   Permissions and Reprints

Abstract

Objective Epilepsy is associated with a significant burden of psychiatric comorbidity, including depression and anxiety disorders. However, paucity of data exists regarding the impact of epilepsy on mental health of patients in the setting of sub-Saharan Africa, where these comorbidities are under-recognized and under-treated. We carried out a cross-sectional descriptive study to investigate the prevalence and determinants of depression and anxiety among people with epilepsy in Sierra Leone.

Method A screening tool previously validated in the primary healthcare setting in Zambia was administered to adult patients in our epilepsy clinics in Freetown and Kenema, Sierra Leone. In addition, various socio-demographic and clinical characteristics were recorded for each patient.

Results A total of 142 patients were included. The mean screening score was 16.3 out of 40, with 39 (27.5%) patients scoring above the diagnostic cut-off point for anxiety and/or depression. Variables showing a significant association with the presence of psychiatric comorbidity included female gender (p = 0.015), seizure frequency of >2 per month (p = 0.001), and self-reporting of sedation and/or dizziness as side effects of anti-epileptic medications (p = 0.006).

Conclusion Symptoms of anxiety and depression are common in epilepsy patients in Sierra Leone. Given the significant negative impacts of such comorbidity on those affected, primary healthcare workers in sub-Saharan countries should be trained to inquire about anxiety and depression symptoms in epilepsy patients, and implementation of screening programs should be considered.

Keywords

Epilepsy - Seizure - Depression and/or anxiety - Sub-Saharan Africa

1Shared First Authorship.


 

  • References

  • 1 Ngugi AK, Bottomley C, Kleinschmidt I, Sander JW, Newton CR. Estimation of the burden of active and life-time epilepsy: a meta-analytic approach. Epilepsia 51 2010; 883-890
    CrossrefPubMedGoogle Scholar
  • 2 International League Against Epilepsy. Epilepsy – out of the shadows: European declaration on epilepsy. Epilepsia 44 suppl (06) 2003; 2-3
    CrossrefPubMedGoogle Scholar
  • 3 International League Against Epilepsy. Quality of life: general considerations. Epilepsia 44 suppl (06) 2003; 57-58
    CrossrefPubMedGoogle Scholar
  • 4 World Health Organisation. Epilepsy in the WHO African Region: Bridging the Gap. 2004. WHO; Geneva:
    Google Scholar
  • 5 World Health Organisation. Neurological Disorders. Public Health Challenges. 2006. WHO; Geneva:
    Google Scholar
  • 6 Gilliam F, Mendiratta A, Pack M, Basil W. Epilepsy and common comorbidities: improving the outpatient epilepsy encounter. Epileptic Disord 7 2005; S27-S33
    PubMedGoogle Scholar
  • 7 Jacoby A, Baker GA, Steen N, Potts P, Chadwick DW. The clinical course of epilepsy and its psychosocial correlates: findings from a U.K. Community study. Epilepsia 37 1996; 148-161
    CrossrefPubMedGoogle Scholar
  • 8 Kondziella D, Asztely F. Don’t be afraid to treat depression in patients with epilepsy!. Acta Neurol Scand 119 2009; 75-80
    CrossrefPubMedGoogle Scholar
  • 9 Wiegartz P, Seidenberg M, Woodard A, Gidal B, Hermann B. Co-morbid psychiatric disorder in chronic epilepsy: recognition and etiology of depression. Neurology 53 1999; S3-S8
    CrossrefPubMedGoogle Scholar
  • 10 Gilliam F, Kuzniecky R, Faught E, Black L, Carpenter G, Schrodt R. Patient-validated content of epilepsy-specific quality of life measurement. Epilepsia 38 1997; 233-236
    CrossrefPubMedGoogle Scholar
  • 11 Cramer JA, Blum D, Reed M, Fanning K. The influence of comorbid depression on seizure severity. Epilepsia 44 2003; 1578-1584
    CrossrefPubMedGoogle Scholar
  • 12 Jackson M, Turkington D. Depression and anxiety in epilepsy. J Neurol Neurosurg Psychiatry 76 2005; i45-i47
    CrossrefPubMedGoogle Scholar
  • 13 Cramer JA, Blum D, Fanning K, Reed M. The impact of comorbid depression on health resource utilization in a community sample of people with epilepsy. Epilepsy Behav 5 2004; 337-342
    CrossrefPubMedGoogle Scholar
  • 14 Hitiris N, Mohanraj R, Norrie J, Sills GJ, Brodie MJ. Predictors of pharmacoresistant epilepsy. Epilepsy Res 75 2007; 192-196
    CrossrefPubMedGoogle Scholar
  • 15 Nuhu FT, Lasisi MD, Yusuf AJ, Aremu SB. Suicide risk among adults with epilepsy in Kaduna, Nigeria. Gen Hosp Psychiatry 35 (05) 2013; 517-520
    CrossrefPubMedGoogle Scholar
  • 16 Verrotti A, Ciconetti A, Scorrano B, Ferro F. Epilepsy and suicide: pathogenesis, risk factors and prevention. Neuropsychiatr Disord Treat 4 2008; 367-370
    PubMedGoogle Scholar
  • 17 Fatoye F, Mosaku KS, Komolafe M, Adewuya AO. Interictal anxiety and depression symptoms in Nigerians with epilepsy: a controlled study. Epilepsy Behav 9 (02) 2006; 312-316
    CrossrefPubMedGoogle Scholar
  • 18 Okubadejo NU, Danesi MA, Aina OF, Ojini FI, Adeyemi JD, Olorunshola DA. Prospective case–control study of interictal depression and suicidal ideation in Nigerians with epilepsy. Niger Postgrad Med J 14 (03) 2007; 204-208
    PubMedGoogle Scholar
  • 19 Mbewe EK, Uys LR, Birbeck GL. Detection and management of depression and/or anxiety for people with epilepsy in primary health care settings in Zambia. Seizure 22 (05) 2013; 401-402
    CrossrefPubMedGoogle Scholar
  • 20 Mbewe EK, Uys LR, Nkwanyana NM, Birbeck GL. A primary healthcare screening tool to identify depression and anxiety disorders among people with epilepsy in Zambia. Epilepsy Behav 27 (02) 2013; 296-300
    CrossrefPubMedGoogle Scholar
  • 21 Mendez MF, Cummings JL, Benson DF. Depression in epilepsy: significance and phenomenon. Arch Neurol 43 1986; 766-770
    CrossrefPubMedGoogle Scholar
  • 22 Ogunrin OA, Obiabo YO. Depressive symptoms in patients with epilepsy: analysis of self-rating and physician's assessment. Neurol India 58 (04) 2010; 565-570
    CrossrefPubMedGoogle Scholar
  • 23 Harter MC, Conway KP, Merikangas KR. Association between anxiety disorders and physical illness. Eur Arch Psychiatry Clin Neurosci 253 2003; 313-320
    CrossrefPubMedGoogle Scholar
  • 24 Edeh J, Toone BK. Relationship between interictal psychopathology and the types of epilepsy: results of a survey in general practise. Br J Psychiatry 151 1987; 95-101
    CrossrefPubMedGoogle Scholar
  • 25 Mendez MF, Cummings JL, Benson DF. Depression in epilepsy: significance and phenomenology. Arch Neurol 43 1986; 766-770
    CrossrefPubMedGoogle Scholar
  • 26 Mula M, Sander JW. Negative effects of antiepileptic drugs on mood in patients with epilepsy. Drug Saf 30 (07) 2007; 55-569
    PubMedGoogle Scholar
  • 27 Adewuya AO, Ola BA. Prevalence of and risk factors for anxiety and depressive disorders in Nigerian adolescents with epilepsy. Epilepsy Behav 6 (03) 2005; 342-347
    CrossrefPubMedGoogle Scholar
  • 28 Fong CG, Hung A. Public awareness, attitude and understanding of epilepsy in Hong Kong special administrative region, China. Epilepsia 43 2002; 311-316
    CrossrefPubMedGoogle Scholar
  • 29 Nubukpo P, Houinato D, Preux PM, Avode G, Clement JP. Anxiety and depression among the epileptics in general population in Benin (Western Africa). Encephale 30 2004; 214-219
    CrossrefPubMedGoogle Scholar
  • 30 Kanner AM. Depression in epilepsy: a neurobiologic perspective. Epilepsy Curr 5 2005; 21-27
    CrossrefPubMedGoogle Scholar