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Psychopathology in people with epilepsy and intellectual disability
  1. F M C Besag
  1. Bedfordshire and Luton Community NHS Trust, Bedford MK41 6AT, UK and Centre for Epilepsy, The Maudsley Hospital, London, UK
  1. Correspondence to:
 Professor Frank M C Besag;
 FBesagaol.com

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Both behavioural and psychiatric disorders are common in people with learning disability and epilepsy

From the time of the Isle of Wight study1 it became evident that children with epilepsy who also had other brain problems had a high rate of behavioural disturbance. Although there is a lack of good epidemiological studies of behavioural/psychiatric disorders in adults with epilepsy and learning disability (intellectual disability, mental retardation), it appears that such disorders are common.2,3 Any serious attempt to determine the factors responsible for these associations is to be welcomed. The paper by Espie et al on p 0004 is in this category and the authors are to be congratulated on raising some important issues. Their results reflect, to some extent, the findings of earlier studies on people with learning disability, notably in the papers by Deb and Hunter,2,3 that neither behavioural nor psychiatric disorders are more common in those with epilepsy. However, Espie et al conclude that some epilepsy specific factors may be associated with psychiatric disorder.

When the aim of a study is to determine predictive factors for behavioural/psychiatric disorders by comparing populations, it is very important to ensure that the results are not confounded by selection bias in either the study group or comparison groups. It is also important to use measures that are valid and reliable. The statistical methods should be appropriate and overemphasis should not be placed on factors associated with only a relatively small proportion of the variance. Finally, there has been a tendency in publications in this field either to be anecdotal, with great relevance to everyday practice but with a weak scientific basis, or to present rather dry multiple statistical analyses (“statistical fishing trips”) that seem to bear little relation to real life.

In the study by Espie et al the authors declare the shortcomings of both the study and comparison groups. As a measure of psychiatric disorder, they use the PAS-ADD checklist, which is primarily intended as a screening schedule to indicate whether further mental health assessment may be required, rather than the full PAS-ADD (psychiatric assessment schedule for adults with developmental disability) or the mini PAS-ADD.

Espie et al have raised another matter which is too often ignored, namely the profound impact that caring for someone with learning disability can have on the carers. This aspect of their paper is particularly worthwhile.

The overall conclusions remain that both behavioural and psychiatric disorders, whatever reasonable definitions are used, are common in people with learning disability and epilepsy but that it is probably largely factors other than the epilepsy itself that are responsible for this high prevalence. The learning disability is of major relevance. Other factors that should be considered include sensory impairments and communication difficulties. Adverse drug effects and epilepsy related factors are probably causal in a relatively small proportion of this population but they are very important because they can often be rectified by correct management.5

There is still a great need for carefully designed and meticulously conducted large scale epidemiological studies of behavioural and psychiatric disturbance in people with learning disability and epilepsy. Such studies should inform us in our endeavours to reduce morbidity both in these individuals and in their carers.

Both behavioural and psychiatric disorders are common in people with learning disability and epilepsy

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