Psykososiale aspekter hos ungdom

Transcription

1 Psykososiale aspekter hos ungdom Når det ikke er epilepsi hva da? 2018 Hilde Nordahl Karterud

2 Overview Psychiatric comorbidity Neurological comorbidity Psychosocial risk factors Psychosocial consequences of the condition

3 Psychogenic Non-epileptic Seizures: Children Are Not Miniature Adults

4 Common comorbidity and risk factors in adults Traumatic or adverse life experiences (including physical or sexual trauma) Medically unexplained symptoms (MUS) Epilepsy Psychiatric disorders, including depression, anxiety, post-traumatic stress disorder (PTSD) and/or personality disorders (Wiseman 2015, Reuber 2012, Reuber 2013, Jones 2010, Stoen 2005)

5 Common comorbidity and risk factors in young people Psychopathology, including anxiety, depression, post-traumatic stress disorder, ADHD Increased neurological comorbidity Other medically unexplained symptoms Social difficulties (Willis 2018, Doss 2017, Kette 2017 Sawchuk 2015,Morgan 2015, Wichaidit 2015, Rawat 2015, Plioplys 2014, Verrotti 2009, Irwin 2000)

6 The main differences between children and adults Psychiatric comorbidity, physical or sexual trauma School difficulties, bullying, family adversity (Dworetzky 2015,Reilly 2008, Patel 2007, Vincentijs 2006)

7 Psychiatric comorbidities in children and teenagers Psychiatric comorbidity: 35-72% (Alessi 2013, Yi YY 2014,Vincentiis 2006, Bhatia 2005, Katagal 2002) Psychiatric comorbidity more often in those older than 13 years (Patel 2007) Depression and anxiety most frequent (Kette 2015, Plioplys 2014, Vincentiis 2006)

8 PNES N=55 (8-18 years) Sibling N=35 (8-18 years) Anxiety 83% 34% Depression 43% 14% PTSD 25% 3% (Plioplys 2014)

9 Comorbid Depression Depression: most commonly associated psychiatric diagnosis (Kette 2015, Yi YY 2014, Vincentiis 2006) (9%) (27-35%) (Verrotti 2009, Patel 2007)

10 Comorbid anxiety Separation anxiety disorder 32% (N=50) Generalized anxiety disorder 6% (N=50) (Bhatia 2005)

11 Coexistence of abuse Physical or sexual abuse (12-21%) (Kette 2015, Patel 2007, Vincentiis 2006) Sexual abuse (4%-13%) (Kette 2015, Akdemir 2013, Verrotti 2009 Vincentiis 2006) Psychological abuse (39%) (Kette 2015) More common in youth than in young children (Patel 2007)

12 Increased neurological comorbidity Neurobiological factors may predispose to PNES (Reuber 2012, Bakvis 2010) Pathological findings on cerebral MRI and non-specific findings on EEG (Stone 2007, Reuber 2002, Pakalnis 2000). Psychogenic seizures after head injury in children (Pakalnis 2000)

13 Comorbid epilepsy Comorbid epilepsy (11-73%) ( Dhiman 2014, Alessi 2013, Kim 2012, Patel 2007 ) More common in younger children (Patel 2007) Epilepsy and PNES: (39%) N= 53 children Age range: 7-17 years

14 Coexistence of learning problems (LP) Learning problems risk factor in 50% (Plioplys 2014, Rawat 2015 Hemel 2010 ) Subtle undiagnosed learning difficulties (Doss 2017) Anxiety Bullying Specific risk factors for LP (Doss 2017)

15 60% av N=55 PNES N=55 (8-18years) Learning problems Parents recognized this concern Sibling N=35 (8-18 years) 60% (33/55) 49% (17/35) 21% (7/33) 12% (2/17) (Doss 2017)

16 Poorer ability to formulate sentences Poorer ability to use language to express thoughts (Doss 2017)

17 temporary learning difficulties PNES or the other way round A risk factor for PNES learning difficulties

18 I feel so overloaded

19 Social risk factors Dysfunctional family relationships Inter-personal conflicts Social stress Transition to adulthood (Kette 2017, Morgan 2015, Sawchuk 2015, Plioplys 2014, Reilly 2013, Patel 2007, Pakalnis 2000)

20 Processing emotions tendency to bottle up feelings, «switch off from emotions, concerns about being overwhelmed, acknowledged the benefits of opening up, Hilde Nordahl Karterud

21 Health-related quality of life in adults Poorer HRQoL than those with epilepsy ( LaFrance 2011, Testa 2007) Predictions may be: Depression (Brough 2015, Meyers 2012, Mitchell 2012, LaFrance 2011,Testa 2007) Illness perceptions (Rawlings 2017) Somatic symptoms (Meyers 2012 LaFrance 2011 Lawton 2009) Escape-avoidance coping strategies (Kuyk 2008 Conje 2013) Stigma (Roberts 2018).

22 Health-related quality of life in adults Poorer HRQoL than those with epilepsy ( LaFrance 2011, Testa 2007) Predictions may be: Depression (Brough 2015, Meyers 2012, Mitchell 2012, LaFrance 2011, Testa 2007) Illness perceptions (Rawlings 2017) Somatic symptoms (Meyers 2012 LaFrance 2011 Lawton 2009) Escape-avoidance coping strategies (Conje 2013,Kuyk 2008) Stigma (Roberts 2018).

23 Psychosocial challenges following the diagnosis depression Comorbidity somatic and symptoms risk factors bullying anxiety school pressure learning difficulties family problems social stress depression interpersonal problems

24 loss of social life stigma burdening others feelings of mistrust and shame threatened identity social isolation (Rawlings & Reuber 2016, Karterud 2010,2016) Psychosocial challenges following the diagnosis Comorbidity and risk factors depression somatic symptoms bullying anxiety school pressure learning difficulties family problems social stress depression interpersonal problems

25 Illness perception and social participation Poor illness perception Threatened identity Social isolation Good illness perception Perceived identity Increase social participation (Karterud 2015, 2016)

26 I have had both learning difficulties and ADHD since I was little, so if you think this is psychogenic you should come into my brain and take a look

27 Summing up Adults and children /young people with PNES differ in psychosocial comorbidity and risk factors Common psychosocial comorbidity and risk factors in children: Anxiety and depression Learning difficulties Interpersonal conflicts Social stress

28 Take-home message Individual treatment with the child and separate parenting sessions are recommended Obtain information about learning problems, bullying and anxiety from children and teenagers themselves (Mathew 2018)

29 Thank you for your attention Hilde Nordahl Karterud