title: Validation of diagnostic tests for depressive disorder in drug-resistant mesial temporal lobe epilepsy.
abstract: OBJECTIVE
  This study aimed to evaluate the diagnostic accuracy of the Hamilton Rating Scale for Depression (HRSD), the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression Scale (HADS), and the Hospital Anxiety and Depression Scale-Depression subscale (HADS-D) as diagnostic tests for depressive disorder in drug-resistant mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS).
  
  
  METHODS
  One hundred three patients with drug-resistant MTLE-HS were enrolled. All patients underwent a neurological examination, interictal and ictal video-electroencephalogram (V-EEG) analyses, and magnetic resonance imaging (MRI). Psychiatric interviews were based on DSM-IV-TR criteria and ILAE Commission of Psychobiology classification as a gold standard; HRSD, BDI, HADS, and HADS-D were used as psychometric diagnostic tests, and receiver operating characteristic (ROC) curves were used to determine the optimal threshold scores.
  
  
  RESULTS
  For all the scales, the areas under the curve (AUCs) were approximately 0.8, and they were able to identify depression in this sample. A threshold of ≥9 on the HRSD and a threshold of ≥8 on the HADS-D showed a sensitivity of 70% and specificity of 80%. A threshold of ≥19 on the BDI and HADS-D total showed a sensitivity of 55% and a specificity of approximately 90%. The instruments showed a negative predictive value of approximately 87% and a positive predictive value of approximately 65% for the BDI and HADS total and approximately 60% for the HRSD and HADS-D.
  
  
  CONCLUSIONS
  HRSD≥9 and HADS-D≥8 had the best balance between sensitivity (approximately 70%) and specificity (approximately 80%). However, with these thresholds, these diagnostic tests do not appear useful in identifying depressive disorder in this population with epilepsy, and their specificity (approximately 80%) and PPV (approximately 55%) were lower than those of the other scales. We believe that the BDI and HADS total are valid diagnostic tests for depressive disorder in patients with MTLE-HS, as both scales showed acceptable (though not high) specificity and PPV for this type of study.
authors.affiliation: Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Governador Celso Ramos (HGCR), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil. Electronic address: bizingano@yahoo.com.br.
authors.forename: Bianca
authors.initials: B
authors.lastname: de Lemos Zingano
authors.affiliation: Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Governador Celso Ramos (HGCR), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Serviço de Psiquiatria, HU-UFSC, Florianópolis, SC, Brazil.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Guarnieri
authors.affiliation: Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Governador Celso Ramos (HGCR), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.
authors.forename: Alexandre Paim
authors.initials: AP
authors.lastname: Diaz
authors.affiliation: Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Governador Celso Ramos (HGCR), Florianópolis, SC, Brazil; Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.
authors.forename: Marcelo Liborio
authors.initials: ML
authors.lastname: Schwarzbold
authors.affiliation: Centro de Epilepsia de Santa Catarina (CEPESC), Hospital Governador Celso Ramos (HGCR), Florianópolis, SC, Brazil.
authors.forename: Maria Alice Horta
authors.initials: MA
authors.lastname: Bicalho
authors.affiliation: Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Serviço de Neurologia, HU-UFSC, Florianópolis, SC, Brazil.
authors.forename: Lucia Sukys
authors.initials: LS
authors.lastname: Claudino
authors.affiliation: Physiological Psychology, University of Bielefeld, Bielefeld, Germany.
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Markowitsch
authors.affiliation: Serviço de Neurologia, HU-UFSC, Florianópolis, SC, Brazil; Danish Epilepsy Center Filadelfia, Dianalund, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Wolf
authors.affiliation: Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Serviço de Neurologia, HU-UFSC, Florianópolis, SC, Brazil; Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil.
authors.forename: Katia
authors.initials: K
authors.lastname: Lin
authors.affiliation: Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Departamento de Cirurgia, HU-UFSC, Florianópolis, SC, Brazil; Departamento de Clínica Médica, HU-UFSC, Florianópolis, SC, Brazil.
authors.forename: Roger
authors.initials: R
authors.lastname: Walz
mesh_terms: D000328:Adult; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D003955:Diagnostic Tests, Routine / Q000592:standards; D039721:Diagnostic and Statistical Manual of Mental Disorders; D000069279:Drug Resistant Epilepsy / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory / Q000592:standards; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D015203:Reproducibility of Results
keywords: Depressive disorder; Diagnostic accuracy; Diagnostic tests; Drug-resistant mesial temporal lobe epilepsy; Hippocampal sclerosis