title: Psychological trajectories in the year after a newly diagnosed seizure.
abstract: OBJECTIVE
  Underdiagnosed depression and anxiety are well-recognized issues in chronic epilepsy, but the evolution of these symptoms after diagnosis is not well understood. We aimed to identify mood trajectories after a first seizure, and to examine factors impacting these trajectories.
  
  
  METHODS
  Seventy-four patients were evaluated at 1, 3, and 12 months with (1) the Hospital Anxiety and Depression Scale, and (2) a semistructured interview assessing patients' initial psychological reaction to the seizure at 1 month (limited vs. pervasive loss of control). The SAS Institute's TRAJ data modelling procedure was employed to delineate trajectories.
  
  
  RESULTS
  Two depression and three anxiety trajectories were identified, with significant overlap. The majority of patients (≈ 74%) followed a trajectory with low depression throughout the study, and either low or moderate anxiety. A minority followed trajectories with high depression and anxiety from diagnosis (≈ 16%). Patients with high levels of distress were adversely affected by seizure recurrence and antiepileptic drugs (AEDs), whereas those with low levels were not. Trajectories were predicted by the patient's sense of loss of control early after diagnosis and were weakly related to demographic and medical variables (age, gender, education, relationship status, psychiatric history, and prior epileptic events).
  
  
  CONCLUSIONS
  Methods that account for heterogeneity in patient responses are critical for developing a clinically relevant understanding of adjustment after a newly diagnosed seizure. Most patients appear to be resilient in the face of early seizures, whereas those at risk of longer-term psychological difficulties may be evident from diagnosis. Early screening for depression and anxiety is warranted.
authors.affiliation: Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Velissaris
authors.forename: Michael M
authors.initials: MM
authors.lastname: Saling
authors.forename: Mark R
authors.initials: MR
authors.lastname: Newton
authors.forename: Samuel F
authors.initials: SF
authors.lastname: Berkovic
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Wilson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001526:Behavioral Symptoms / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011336:Probability; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012640:Seizures / Q000150:complications* / Q000175:diagnosis* / Q000523:psychology; D012919:Social Behavior; D055815:Young Adult