Abstracts

Rationale: Pediatric NES is a difficult to diagnose condition with prevalent comorbid psychopathology. Since psychiatric disorders run in families, this study examined the prevalence, number, type and specificity of psychiatric diagnoses (i.e., conversion, anxiety, depression diagnoses) in NES children compared to their siblings. Among the NES subjects, it determined if the severity of psychopathology was related to age, age of onset of NES, and comorbid epilepsy. Methods: This multisite study includes NES children and their siblings, aged 8-18 years, recruited from five US sites. A video EEG (vEEG) confirmed an NES diagnosis. A structured psychiatric interview, administered to each subject and parent, separately yielded DSM-IV diagnoses. Chi-square analyses examined differences in distribution of diagnoses. Fisher s exact test was used for measures with frequencies <5 in each cell. Probands and siblings were compared on the number of diagnoses using a mixed model with family as a random effect. Within NES subjects, non-parametric analyses were conducted.Results: 22 NES youth (Age = 15.7 years (SD=2.4); 7 males) and 22 siblings (Age=13.3 years (SD=2.4); 11 males) completed assessment. 14 were Caucasian, 3 African-American, 3 Latino, and 1 other. 68.2% NES cases and 31.8 % siblings had epilepsy. DSM-IV diagnoses were more prevalent in the NES (95.5%) than the sibling subjects (72.7%) (p=0.04), who, in turn, had higher rates than the general child population (10%). Significantly more probands than siblings (95.5% vs. 36.4%, p= 0.0005) had multiple diagnoses and a higher number of diagnosis (4.1 (SD=1.6) vs. 1.5 (SD=1.3), p< 0.0001). The type of diagnoses differed across groups with significantly higher rates in the NES group of Conversion Disorder (86.4% vs. 4.6%, p < 0.0001) followed by Anxiety Disorders (81.8% vs. 27.3%, p=0.0003) and Depression (63.6% vs. 9.1%, p=0.0002). The groups did not differ in rate of Disruptive, including Attention Deficit Hyperactivity Disorder, Post Traumatic Stress Disorder, Eating, Learning, Substance Abuse, Tic, and Bipolar Disorders. Although Anxiety Disorders were more prevalent in probands than siblings, types of anxiety were similar in both groups. Within the NES group, the number of psychiatric diagnoses was positively related to age (p = 0.05), but not age of NES onset. Comorbid epilepsy in NES was unrelated to age of first psychiatric diagnosis, the number and type of diagnosis. Conclusions: Prevalent, severe, and specific psychopathology in NES children underscore their mental health needs. The lack of an association of psychopathology severity with comorbid epilepsy (which is independently related to high rates and a wide range of DSM-IV diagnoses) and prevalent conversion disorders also supports a specific psychopathology profile in NES children. The sibling psychopathology findings emphasize the mental health needs of these families and the need for studies on family functioning and psychopathology.