Abstracts

RATIONALE: Existing studies in children and adults report an overrepresentation of anxiety and depression in epilepsy patients. Still the characterization of such symptoms has eluded specific description, and particularly in pediatric epilepsy, fewer studies exist overall. At the end of this activity, participants will better understand the nature of anxiety and depressive symptoms present in chronic pediatric epilepsy patients.
METHODS: 35 chronic epilepsy patients (18 male, 17 female) were consecutively recruited to participate. Ages ranged from 8 to 16 (average 11.7), estimated IQ was above 70, and estimated reading ability was at least fair. None had received psychiatric treatment or assessment in the past. Patients completed standardized questionnaires including the Multidimensional Anxiety Scale for Children (MASC) and the Children[ssquote]s Depression Inventory (CDI). The MASC is a 39 item questionnaire that asks for one of four symptom severity ratings per item. MASC profiles include overall scores as well as subscale scores for specific anxiety symptoms including physical symptoms (tense/restless, somatic/autonomic), harm avoidance (perfectionism, anxious/coping), social anxiety (humiliation/rejection, performance fears), and separation/panic. The CDI contains 27 items and asks for one of three symptom severity ratings per item. CDI profiles include overall scores and subscores of negative mood, interpersonal problems, ineffectiveness, anhedonia, and negative self-esteem. Overall scores and subscores were tabulated for each measure. Cinically significant levels were defined as t scores of at least 65, reflecting levels one and one half standard deviations or more above the normative mean for the measures.
RESULTS: 28.6% (10/35) had overall significant scores on the MASC. Additionally, 60% (21/35) had at least one significant subscore elevation on the MASC. Significant symptom subcategories included 37.1% (13/35) with separation/panic, 22.9% (8/35) with somatic/autonomic, 17.1% (6/35) with humiliation/rejection, 14.3% (5/35) with tense/restless, 14.3% (5/35) with performance fears, 2/35 (5.7%) with anxious/coping, and 1/35 (2.9%) with perfectionism. 2/35 (5.7%) had overall significant scores on the CDI, and 6/35 (17.1%) had at least one significant subscore elevation. No CDI subcategory had more than 2/35 respondants indicating significant symptoms.
CONCLUSIONS: Anxiety symptoms were very common in this sample of pediatric epilepsy patients who had not previously been referred to psychiatry. The majority of patients had at least one elevated anxiety subscore. The subcategory of separation/panic was particularly common, and notable well beyond the next most common subcategory elevation of somatic/autonomic symptoms. Symptoms of harm avoidance (perfectionism, anxious/coping) were notable for their lack of prominence. The preferential anxiety symptom profile may have some specific relevance to epilepsy patients. Depressive symptoms were neither prominent in overall scores nor in subcategory scores. It is possible that such patients were already referred to psychiatry and thus not a part of the sample. Further study is important in order to appropriately provide comprehensive care and reduce potential morbidity among pediatric epilepsy patients.
[Supported by: Children[ssquote]s Research Institute, Children[ssquote]s National Medical Center, Washington, DC 20010]