title: Psychiatric comorbidity in children and youth with epilepsy: An association with executive dysfunction?
abstract: OBJECTIVE
  Psychopathology in children and youth with epilepsy has previously been related to executive dysfunction, but the nature of the association is uncertain. We sought to explore risk factors for psychiatric disorders in children and youth with epilepsy, with emphasis on executive dysfunction, along with seizure-related and psychosocial factors.
  
  
  METHODS
  The cohort consisted of one hundred and one consecutive patients aged 10-19 years with focal (n=52) or genetic generalized (n=49) epilepsy. All were screened for psychiatric symptoms, using part of an extensive questionnaire, the Strengths and Difficulties Questionnaire (SDQ) for both patients and their parents. Participants scoring in the borderline or abnormal range on the SDQ received a psychiatric interview (Kiddie-SADS-PL). All participants underwent a neuropsychological examination, and those with general cognitive abilities (IQ)<70 were excluded.
  
  
  RESULTS
  Forty-seven of 101 participants (46.5%) had a SDQ score in the borderline or abnormal range and underwent a psychiatric evaluation. Of these, 44 (93.6%) met the criteria for a psychiatric diagnosis, the most common being ADHD and anxiety. An executive deficit was identified in 26.8% of the participants with a psychiatric diagnosis, but in only 5.4% of those without such a diagnosis (p=0.003). Multivariate logistic regression analysis showed that executive dysfunction was an independent risk factor for having a psychiatric disorder (OR 8.2, CI 1.8-37.2, p=0.006), along with male gender (OR 2.9, CI 1.2-7.3, p=0.02), and early seizure onset (0.86-that is one year older equals risk of psychiatric disorder reduced by 14%-CI 0.77-0.96, p=0.01). Other epilepsy-related or psychosocial factors were not significantly associated with psychiatric disorders.
  
  
  CONCLUSIONS
  Multiple factors are associated with psychiatric problems in children and youth with epilepsy. In this study, executive dysfunction, male gender, and early epilepsy onset were independent risk factors for having a psychiatric disorder. An evaluation of psychiatric and cognitive problems is important to enable a positive long-term outcome in childhood epilepsy.
authors: National Centre for Epilepsy, Division for Surgery and Clinical Neuroscience, Oslo University Hospital, Norway. Electronic address: kristina@ous-hf.no.
authors: Kristin Å
authors: KÅ
authors: Alfstad
authors: National Centre for Epilepsy, Division for Surgery and Clinical Neuroscience, Oslo University Hospital, Norway.
authors: Halvor
authors: H
authors: Torgersen
authors: Department of Pediatrics and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway.
authors: Betty
authors: B
authors: Van Roy
authors: National Centre for Epilepsy, Division for Surgery and Clinical Neuroscience, Oslo University Hospital, Norway; Department of Neurology, Akershus University Hospital, Lørenskog, Norway; Department of Psychology, University of Oslo, Norway.
authors: Erik
authors: E
authors: Hessen
authors: Division of Mental Health, Akershus University Hospital, Lørenskog, Norway.
authors: Berit Hjelde
authors: BH
authors: Hansen
authors: National Centre for Epilepsy, Division for Surgery and Clinical Neuroscience, Oslo University Hospital, Norway.
authors: Oliver
authors: O
authors: Henning
authors: The National Institute of Health, Department of Mental Health, Norway.
authors: Jocelyne
authors: J
authors: Clench-Aas
authors: Department of Paediatrics, Oslo University Hospital, Norway.
authors: Petter
authors: P
authors: Mowinckel
authors: Department of Neurology, Division for Surgery and Clinical Neuroscience, Oslo University Hospital, Norway; Faculty of Medicine, University of Oslo, Norway.
authors: Leif
authors: L
authors: Gjerstad
authors: National Centre for Epilepsy, Division for Surgery and Clinical Neuroscience, Oslo University Hospital, Norway.
authors: Morten I
authors: MI
authors: Lossius
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D002648:Child; D015331:Cohort Studies; D015897:Comorbidity; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D056344:Executive Function; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D009483:Neuropsychological Tests; D010290:Parents / Q000523:psychology; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Children; Epilepsy; Executive function; Psychiatry