Factors influencing psychiatric outcome in children with neurological conditions: focus on acquired brain injury and epilepsy
- Autores: Maria Teresa Lax Pericall
- Directores de la Tesis: Eric Taylor (dir. tes.)
- Lectura: En la Universitat Autònoma de Barcelona ( España ) en 2016
- Idioma: español
- Tribunal Calificador de la Tesis: Frank Besag (presid.), Alfons Macaya Ruiz (secret.), Regina Sala Cassola (voc.)
- Programa de doctorado: Programa de Doctorado en Psiquiatría por la Universidad Autónoma de Barcelona
- Materias:
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- Resumen
The rate of psychiatric disorder in children with neurological conditions is reported to be between 30% and 50%, with some studies reporting even higher rates.
The aim of this thesis was to look at factors associated with psychiatric disorder in children suffering from epilepsy and following traumatic brain injury.
A systematic study of the literature was conducted on family function and its relationship to injury severity and psychiatric outcome in children with acquired brain injury. The results have already been published. Severity is an important predictor of psychiatric outcome, particularly in the first two years. Family function before injury affects psychiatric outcome possibly up to two years after a head injury and also affects recovery. The effects of family function may, at times, be overshadowed by the catastrophic effect of a severe injury, but this does not mean that family function is not important in helping recovery.
A separate study was made of mental health in young people with seizure disorders. A systematic review of the literature was undertaken, focusing on risk factors for psychiatric disorder in children with epilepsy. This review was extended with a meta-analysis of the effects of gender on psychiatric disorder in children with epilepsy. In addition, factors associated with psychiatric disorder were analysed in a sample of 87 consecutive referrals of children evaluated for epilepsy surgery in two hospitals.
The results of the systematic review confirm prior findings in the literature of psychiatric disorders in children with epilepsy; low IQ seems to be related to Autistic Spectrum Disorder, certain types of epilepsy syndromes are associated with particular psychiatric disorders; for example, West syndrome is associated with autism. The effect of seizure frequency on psychiatric outcome was found to be inconstant. From the point of view of environmental factors, family history of psychiatric disorder is associated with psychiatric disorder in children with epilepsy; however, contrary to studies in the general population, socio-economic status was not significantly related to psychiatric disorder in this systematic review. In the general population, attention deficit/ hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are between 4 to 6 times more frequent in males than in females. This systematic review showed that the effect of gender was different in children with epilepsy than in the general population; a meta-analysis found that the male/ female risk for ASD in children with epilepsy was 1.6 and for ADHD was 1.5, which is substantially lower than in community studies of the general child population. Nevertheless, girls with epilepsy seem to be at much higher risk for ASD and ADHD than girls without epilepsy The 87 children assessed for epilepsy surgery had a psychiatric assessment and 52 had a psychiatric diagnosis. The most frequent diagnoses were ADHD (n=20), anxiety disorder (n=19) and ASD (n=16). Co-morbidity of two diagnoses occurred in 12 children. The diagnoses were known in only 6 children prior to the assessment. Comparing children with psychiatric diagnosis to children with no psychiatric diagnosis, the only significant factor was a psychiatric disorder in a first-degree relative; while gender, seizure frequency and socio-economic status did not achieve significance. The location of seizure focus showed a trend towards significance. Many children with central nervous system (CNS) disorders have an unrecognised psychiatric disorder, therefore is important that all children with CNS disorders are screened for psychiatric disorders. It is also important to enquire into the family history of psychiatric disorder and family function, as these factors are related to psychiatric outcome in the child.
