有癫痫发作史患者的幻觉发生率与精神病理学意义_Journal of Epilepsy

Authors：

 KathrynYates , UllaLång , JordanDeVylder , 徐亭晚　译 , 韩雁冰　审

Corresponding author：

KathrynYates, Email: iankelleher@rcsi.ie

Keywords：

癫痫; 幻觉; 精神障碍; 自杀意念; 自杀企图

DOI：

10.7507/2096-0247.20210012

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癫痫发作活动已被证明与幻觉有关，而有癫痫发作史的患者产生幻觉的精神病理学意义尚不清楚。该研究的目的是评估有癫痫发作史的患者听幻觉和视幻觉的发生率，并调查它们与一些精神障碍、自杀意念和自杀企图之间的关系。这是一项基于人群的横断面调查，数据来自“成人精神疾病发病率调查”。采用精神病筛查问卷评估听幻觉和视幻觉，临床访谈表评估精神障碍，Logistic 回归评估幻觉经历与精神障碍、自杀意念和自杀企图之间的关系。共有 14 812 例成年患者［58% 为女性；平均年龄（51.8±0.15）岁］被纳入研究，1.39% 报告曾有癫痫发作（54% 为女性），8% 有癫痫发作史的患者述曾有幻觉［OR=2.05，95%CI（1.24，3.28）］。有癫痫发作史的患者出现精神障碍［OR=2.34，95%CI（1.73，3.16）］、自杀意念［OR=2.38，95%CI（1.77，3.20）］和自杀企图［OR=4.15，95%CI（2.91，5.92）］的几率增加。与有癫痫发作史但未曾述有幻觉的患者相比，有癫痫发作史合并幻觉经历的患者发生精神障碍［OR=3.47，95%CI（1.14，10.56）］、自杀意念［OR=2.58，95%CI（0.87，7.63）］和自杀企图［OR=4.61，95%CI（1.56，13.56）］的几率增加。总的来说，超过半数有癫痫发作史合并幻觉经历的患者至少有一次自杀企图。对精神病理的严重程度的校正并不能解释幻觉经历和自杀企图之间的关系。有癫痫发作史的患者合并幻觉经历是精神障碍和自杀行为的高风险标志。有癫痫发作史的患者出现幻觉与自杀企图之间有着尤其密切的关系。临床医生诊治有癫痫发作患者时，应该常规询问患者有无幻觉。

Citation： KathrynYates, UllaLång, JordanDeVylder, 徐亭晚　译, 韩雁冰　审. 有癫痫发作史患者的幻觉发生率与精神病理学意义. Journal of Epilepsy, 2021, 7(1): 71-76. doi: 10.7507/2096-0247.20210012 Copy

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17.	Brugha TS, Bebbington PE, Jenkins R, et al. Cross validation of a general population survey diagnostic interview: a comparison of CIS-R with SCAN ICD-10 diagnostic categories. Psychol Med, 1999, 29(5): 1029-1042.
18.	McManus S, Bebbington P, Jenkins R, et al. Mental health and wellbeing in England. Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital, 2016.
19.	Bernasconi N, Duchesne S, Janke A, et al. Whole-brain voxel-based statistical analysis of gray matter and white matter in temporal lobe epilepsy. NeuroImage, 2004, 23(2): 717-723.
20.	Witthaus H, Kaufmann C, Bohner G, et al. Gray matter abnormalities in subjects at ultra-high risk for schizophrenia and first-episode schizophrenic patients compared to healthy controls. Psychiatry Res Neuroimaging, 2009, 173(3): 163-169.
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22.	Korsnes MS, Hugdahl K, Nygard M, et al. An fMRI study of auditory hallucinations in patients with epilepsy. Epilepsia, 2010, 51(4): 610-617.
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24.	Harrisberger F, Buechler R, Smieskova R, et al. Alterations in the hippocampus and thalamus in individuals at high risk for psychosis. NpjSchizop, 2016, 2: 16033.
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26.	Saalmann YB, Kastner S. The cognitive thalamus. Front Syst Neurosci, 2015, 9(1): 39.
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28.	Bora E, Murray RM. Meta-analysis of cognitive deficits in ultra-high risk to psychosis and first-episode psychosis: do the cognitive deficits progress over, or after, the onset of psychosis? Schizophr Bull, 2014, 40(4): 744-755.
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31.	Hamiwka LD, Yu CG, Hamiwka LA, et al. Are children with epilepsy at greater risk for bullying than their peers? Epilepsy Behav, 2009, 15(4): 500-505.
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34.	Healy C, Coughlan H, Williams J, et al. Changes in self-concept and risk of psychotic experiences in adolescence: a longitudinal population-based cohort study. J Child Psychol Psychiatry, 2019, 60(11): 1164-1173.
35.	Moon HJ, Seo JG, Park SP. Perceived stress and its predictors in people with epilepsy. Epilepsy Behav, 2016, 62: 47-52.
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38.	Eisenlohr-Moul TA, Miller AB, Giletta M, et al. HPA axis response and psychosocial stress as interactive predictors of suicidal ideation and behavior in adolescent females: a multilevel diathesis-stress framework. Neuropsychopharmacology, 2018, 43(13): 2564-2571.
39.	Blanchard MM, Jacobson S, Clarke MC, et al. Language, motor and speed of processing deficits in adolescents with subclinical psychotic symptoms. Schizophr Res, 2010, 123(1): 71-76.
40.	Berg AT. Epilepsy, cognition, and behavior: the clinical picture. Epilepsia, 2011, 52(1): 7-12.
41.	Witt J-A, Helmstaedter C. Cognition in the early stages of adult epilepsy. Seizure, 2015, 26: 65-68.
42.	Fastenau PS, Johnson CS, Perkins SM, et al. Neuropsychological status at seizure onset in children: risk factors for early cognitive deficits. Neurology, 2009, 73(7): 526-534.
43.	Kessler RC, Lane MC, Shahly V, et al. Accounting for comorbidity in assessing the burden of epilepsy among US adults: results from the National Comorbidity Survey Replication (NCS-R). Mol Psychiatry, 2012, 17(7): 748-758.

1. Elliott B, Joyce E, Shorvon S. Delusions, illusions and hallucinations in epilepsy: 1. Elementary phenomena. Epilepsy Res, 2009, 85(2-3): 162-171.
2. Elliott B, Joyce E, Shorvon S. Delusions, illusions and hallucinations in epilepsy: 2. Complex phenomena and psychosis. Epilepsy Res, 2009, 85(2-3): 172-186.
3. Oh H, Waldman K, Stickley A, et al. Psychotic experiences and physical health conditions in the United States. Compr Psychiatry, 2019, 90(1): 1-6.
4. Flor-Henry P. Psychosis and temporal lobe epilepsy. A controlled investigation. Epilepsia, 1969, 10(3): 363-395.
5. Kanner AM, Balabanov A. Depression and epilepsy: how closely related are they? Neurology, 2002, 58(Suppl 5): S27-39.
6. Kanner AM. Depression in epilepsy: prevalence, clinical semiology, pathogenic mechanisms, and treatment. Biol Psychiatry, 2003, 54(3): 388-398.
7. Goldstein MA, Harden CL. Epilepsy and anxiety. Epilepsy Behav, 2000, 1(4): 228-234.
8. Christensen J, Vestergaard M, Mortensen PB, et al. Epilepsy and risk of suicide: a population-based case-control study. Lancet Neurol, 2007, 6(8): 693-698.
9. Pompili M, Girardi P, Ruberto A, et al. Suicide in the epilepsies: a meta-analytic investigation of 29 cohorts. Epilepsy Behav, 2005, 7(2): 305-310.
10. Nilsson L, Ahlbom A, Farahmand BY, et al. Risk factors for suicide in epilepsy: a case control study. Epilepsia, 2002, 43(6): 644-651.
11. McManus S, Meltzer H, Brugha TS, et al. Adult psychiatric morbidity in England, 2007: Results of a household survey. London: The NHS Information Centre for Health and Social Care, 2009.
12. Marwaha S, Broome MR, Bebbington PE, et al. Mood instability and psychosis: analyses of British national survey data. Schizophr Bull, 2014, 40(2): 269-277.
13. Bebbington P, Nayani T. The psychosis screening questionnaire. Int J Methods Psychiatr Res, 1995, 5(1): 11-19.
14. Kelleher I, Harley M, Murtagh A, et al. Are screening instruments valid for psychotic-like experiences? A validation study of screening questions for psychotic-like experiences using in-depth clinical interview. Schizophr Bull, 2011, 37(2): 362-369.
15. Johns LC, Cannon M, Singleton N, et al. Prevalence and correlates of self-reported psychotic symptoms in the British population. Br J Psychiatry J Ment Sci, 2004, 185: 298-305.
16. Koyanagi A, Stickley A, Haro JM. Subclinical psychosis and suicidal behavior in England: findings from the 2007 Adult Psychiatric Morbidity Survey. Schizophr Res, 2015, 168(1-2): 62-67.
17. Brugha TS, Bebbington PE, Jenkins R, et al. Cross validation of a general population survey diagnostic interview: a comparison of CIS-R with SCAN ICD-10 diagnostic categories. Psychol Med, 1999, 29(5): 1029-1042.
18. McManus S, Bebbington P, Jenkins R, et al. Mental health and wellbeing in England. Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital, 2016.
19. Bernasconi N, Duchesne S, Janke A, et al. Whole-brain voxel-based statistical analysis of gray matter and white matter in temporal lobe epilepsy. NeuroImage, 2004, 23(2): 717-723.
20. Witthaus H, Kaufmann C, Bohner G, et al. Gray matter abnormalities in subjects at ultra-high risk for schizophrenia and first-episode schizophrenic patients compared to healthy controls. Psychiatry Res Neuroimaging, 2009, 173(3): 163-169.
21. Canu E, Agosta F, Filippi M. A selective review of structural connectivity abnormalities of schizophrenic patients at different stages of the disease. Schizophr Res, 2015, 161(1): 19-28.
22. Korsnes MS, Hugdahl K, Nygard M, et al. An fMRI study of auditory hallucinations in patients with epilepsy. Epilepsia, 2010, 51(4): 610-617.
23. Pulsipher DT, Dabbs K, Tuchsherer V, et al. Thalamofrontal neurodevelopment in new-onset pediatric idiopathic generalized epilepsy. Neurology, 2011, 76(1): 28-33.
24. Harrisberger F, Buechler R, Smieskova R, et al. Alterations in the hippocampus and thalamus in individuals at high risk for psychosis. NpjSchizop, 2016, 2: 16033.
25. Neckelmann G, Specht K, Lund A, et al. Mr morphometry analysis of grey matter volume reduction in schizophrenia: association with hallucinations. Int J Neurosci, 2006, 116(1): 9-23.
26. Saalmann YB, Kastner S. The cognitive thalamus. Front Syst Neurosci, 2015, 9(1): 39.
27. Cho KIK, Shenton ME, Kubicki M, et al. Altered thalamo-cortical white matter connectivity: probabilistic tractography study in clinical-high risk for psychosis and first-episode psychosis. Schizophr Bull, 2016, 42(3): 723-731.
28. Bora E, Murray RM. Meta-analysis of cognitive deficits in ultra-high risk to psychosis and first-episode psychosis: do the cognitive deficits progress over, or after, the onset of psychosis? Schizophr Bull, 2014, 40(4): 744-755.
29. Jager-Hyman S, Cunningham A, Wenzel A, et al. Cognitive distortions and suicide attempts. Cognit Ther Res, 2014, 38(4): 369-374.
30. Hoehne A, Richard-Devantoy S, Ding Y, et al. First-degree relatives of suicide completers may have impaired decision-making but functional cognitive control. J Psychiatr Res, 2015, 68: 192-197.
31. Hamiwka LD, Yu CG, Hamiwka LA, et al. Are children with epilepsy at greater risk for bullying than their peers? Epilepsy Behav, 2009, 15(4): 500-505.
32. Jacoby A, Gorry J, Gamble C, et al. Public knowledge, private grief: a study of public attitudes to epilepsy in the United Kingdom and implications for stigma. Epilepsia, 2004, 45(11): 1405-1415.
33. Pinquart M. Self-esteem of children and adolescents with chronic illness: a meta-analysis. Child Care Health Dev, 2013, 39(2): 153-161.
34. Healy C, Coughlan H, Williams J, et al. Changes in self-concept and risk of psychotic experiences in adolescence: a longitudinal population-based cohort study. J Child Psychol Psychiatry, 2019, 60(11): 1164-1173.
35. Moon HJ, Seo JG, Park SP. Perceived stress and its predictors in people with epilepsy. Epilepsy Behav, 2016, 62: 47-52.
36. Novakova B, Harris PR, Ponnusamy A, et al. The role of stress as a trigger for epileptic seizures: a narrative review of evidence from human and animal studies. Epilepsia, 2013, 54(11): 1866-1876.
37. Föcking M, Sabherwal S, Cates HM, et al. Complement pathway changes at age 12 are associated with psychotic experiences at age 18 in a longitudinal population-based study: evidence for a role of stress. Mol Psychiatry. 2019. [Epub ahead of print].
38. Eisenlohr-Moul TA, Miller AB, Giletta M, et al. HPA axis response and psychosocial stress as interactive predictors of suicidal ideation and behavior in adolescent females: a multilevel diathesis-stress framework. Neuropsychopharmacology, 2018, 43(13): 2564-2571.
39. Blanchard MM, Jacobson S, Clarke MC, et al. Language, motor and speed of processing deficits in adolescents with subclinical psychotic symptoms. Schizophr Res, 2010, 123(1): 71-76.
40. Berg AT. Epilepsy, cognition, and behavior: the clinical picture. Epilepsia, 2011, 52(1): 7-12.
41. Witt J-A, Helmstaedter C. Cognition in the early stages of adult epilepsy. Seizure, 2015, 26: 65-68.
42. Fastenau PS, Johnson CS, Perkins SM, et al. Neuropsychological status at seizure onset in children: risk factors for early cognitive deficits. Neurology, 2009, 73(7): 526-534.
43. Kessler RC, Lane MC, Shahly V, et al. Accounting for comorbidity in assessing the burden of epilepsy among US adults: results from the National Comorbidity Survey Replication (NCS-R). Mol Psychiatry, 2012, 17(7): 748-758.

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