Abstracts

The SCL-90-R is a self-report inventory that assesses the severity of a number of different types of psychiatric symptoms. We have previously shown that patients with psychogenic, non-epileptic attacks (PNEA) have higher scores on somatization and anxiety indices as measured by this inventory compared to patients with epilepsy. There were no differences between these two groups on measures of paranoia (PA) and psychoticism (PS). These differences may have been underestimated because of the degree of symptom reporting. Patients with epilepsy may have higher scores on these indices, as peri-ictal symptoms may mimic psychiatric disease in select patients., We retrospectively identified consecutive, adult patients ([gt]17 years of age) who were evaluated at the Strong Epilepsy Center. Two hundred and ninety-two patients completed the SCL-90-R prior to an initial clinic visit between 2001 and 2004 and underwent subsequent video-EEG monitoring. All patients were interviewed by a psychiatrist or psychologist during the admission. One hundred and sixty-six patients were female. One hundred and seventy-six (63.7%) patients were diagnosed with epilepsy and 94 (32.2%) with PNEA. Patients with other non-epileptic events or both PNEA and seizures were excluded. To control for patients who reported multiple somatic symptoms, patients with high positive symptoms total (PST) scores ([gt]65) were excluded from this analysis., One hundred and twenty-four patients with epilepsy and 56 patients with PNEA were identified. Of the psychogenic patients, 6 (10.7%) had an elevated ([ge]65) PS score, 3 (5.4%) had an elevated ([ge]65) PA score and in 3 (5.4%) patients, both were elevated. Nineteen (15.3%) epilepsy patients had an elevated PS score and 10 (8.1%) had an elevated PA score. In 4 (3.2%) patients, both indices were elevated. All of the patients with an elevated PS score had partial onset seizures with 14/19 (73.7%) having temporal lobe epilepsy, 1 (5.3%) with frontal lobe epilepsy and 4 (21.1%) with hemispheric onset seizures without further localization. Three patients had ictal hallucinations, 2 had fear as a prominent component of the aura and 2 had post-ictal psychiatric symptoms including hallucinations and aggression., No statistically significant differences between patients with epilepsy and PNEA were seen on psychoticism and paranoia indices when patients with high symptoms reporting were excluded. Care must be taken in patients with epilepsy when administering psychiatric batteries, as associated ictal and peri-ictal symptoms may be mistaken for underlying psychiatric disease.,