Abstracts

Psychiatric disorders in children with epilepsy remain underdiagnosed and undertreated. This study was designed to: (i) assess main psychiatric disorders in children/adolescents with epilepsy; (ii) verify the age of onset compared to the age of diagnosis and (iii) which factors are correlated with the kind of manifestation.
56 patients were referred from an epilepsy tertiary center to the Unit for Diagnosis and Treatment of Psychiatric Disorders in children with Epilepsy. These patients were evaluated by a multidisciplinary team in a one year period. Epileptic syndromes and seizures were classified according ILAE guidelines by an epileptologist. Neurophysiologic and neuroimaging studies were performed to determine etiological diagnosis. Psychiatric interview was performed and diagnosis was done according to DSM IV and CID-10. A neuropsychologist and a social worker also evaluated patients with a psychiatric disorder in order to assess cognitive and socio-economic status.
Thirty-eight (50%) patients had a psychiatric diagnosis. The main disorders were depression, occurring in 11 patients (29%) and ADHD in 12 (31.7%). Other disorders included: oppositional defiant disorder, somatoform disorder and conduct disorder in 7.9%, PDD in 5.2%, obsessive-compulsive disorder, anxiety, speech retardation/learning impairment and bipolar disorder in 2.6%. According to age, the main diagnosis at the moment of the first evaluation was ADHD (50%) under the age of 6y, ADHD (50%) and depression (27.3%) within the ages of 7 to 12y and depression (72.7%) from 13 to 17y. The median age for diagnosis of ADHD was 6y and for depression, 15y. Proper questioning of families and patients revealed that the onset of depressive symptoms occurred at the median age of 9y and ADHD at 3y. This difference was statistically significant for depression. Cognitive impairment, social-economic status and politheraphy did not present a significant correlation with the type of psychiatric disorder. Family history of depression was significantly higher in children with depression. Except for an earlier age of onset of seizures for children with ADHD, factors related with epilepsy type and severity were not important in determining the psychiatric disorder.
In this series, the most frequent disorders were depression and ADHD. Age was the most important factor for determining of the type of psychiatric disorder, with predominance of ADHD in children and depression in adolescents. Besides, analysis of these patients[rsquo] history revealed that depression remained underdiagnosed and untreated for a longer period of time. Although these patients had an age-related manifestation, it remains to be determined whether irritability-hyperactivity in early childhood and depression in adolescents represent disorders in the same spectrum with an age-related expression and what is the impact of early diagnosis and treatment.