PDF(Pubmed)
Abstract：
BACKGROUND: Experts agree that there is a need for protocols to guide health professionals on how to best manage psychiatric comorbidities in patients with epilepsy (PWE). We aimed to develop practical recommendations for key issues in the management of depression in PWE.
METHODS: This was a qualitative study conducted in four steps: (1) development of a questionnaire on the management of depression in PWE to be answered; (2) literature review and, if evidence from guidelines/consensus or systematic reviews was available, drafting initial recommendations; (3) a nominal group methodology for reviewing initial recommendations and formulating new recommendations on those issues without available evidence; and (4) drafting and approving the final recommendations. A scientific committee (one neurologist and one psychiatrist) was responsible for the development of the project and its scientific integrity. The scientific committee selected a panel of experts (nine neurologists and nine psychiatrists with experience in this field) to be involved in the nominal group meetings and to formulate final recommendations.
RESULTS: Fifteen recommendations were formulated. Four on the screening and diagnosis: screening and diagnosis of depression, evaluation of the risk of suicide, and diagnosis of depression secondary to epilepsy; nine on the management of depression: referral to a psychiatrist, selection of the antiseizure medication, change of antiseizure medication, antidepressant treatment initiation, selection of antidepressant, use of antidepressants during pregnancy, use of psychotherapy, antidepressant treatment duration, and discontinuation of antidepressant treatment; two on the follow-up: duration of the follow-up under usual conditions, and follow-up of patients at risk of suicide.
CONCLUSIONS: We provide recommendations based on expert opinion consensus to help healthcare professionals assess depression in PWE. The detection and treatment of major depressive disorders are key factors in improving epilepsy outcomes and avoiding suicide risk.
METHODS: This was a qualitative study conducted in four steps: (1) development of a questionnaire on the management of depression in PWE to be answered; (2) literature review and, if evidence from guidelines/consensus or systematic reviews was available, drafting initial recommendations; (3) a nominal group methodology for reviewing initial recommendations and formulating new recommendations on those issues without available evidence; and (4) drafting and approving the final recommendations. A scientific committee (one neurologist and one psychiatrist) was responsible for the development of the project and its scientific integrity. The scientific committee selected a panel of experts (nine neurologists and nine psychiatrists with experience in this field) to be involved in the nominal group meetings and to formulate final recommendations.
RESULTS: Fifteen recommendations were formulated. Four on the screening and diagnosis: screening and diagnosis of depression, evaluation of the risk of suicide, and diagnosis of depression secondary to epilepsy; nine on the management of depression: referral to a psychiatrist, selection of the antiseizure medication, change of antiseizure medication, antidepressant treatment initiation, selection of antidepressant, use of antidepressants during pregnancy, use of psychotherapy, antidepressant treatment duration, and discontinuation of antidepressant treatment; two on the follow-up: duration of the follow-up under usual conditions, and follow-up of patients at risk of suicide.
CONCLUSIONS: We provide recommendations based on expert opinion consensus to help healthcare professionals assess depression in PWE. The detection and treatment of major depressive disorders are key factors in improving epilepsy outcomes and avoiding suicide risk.
摘要：
背景：专家们一致认为，有必要制定方案来指导卫生专业人员如何最好地管理癫痫患者的精神病合并症（PWE）。我们旨在针对PWE抑郁症管理中的关键问题提出实用建议。
方法：这是一项定性研究，分四个步骤进行：（1）制定有关PWE抑郁症管理的问卷，以回答；（2）文献综述和，如果有来自指南/共识或系统评价的证据，起草初步建议；(3)在没有现有证据的情况下，审查初步建议并就这些问题制定新建议的名义小组方法；(4)起草和批准最终建议。一个科学委员会（一名神经科医生和一名精神科医生）负责该项目的开发及其科学完整性。科学委员会选择了一个专家小组（在该领域具有经验的九名神经科医生和九名精神科医生）参加名义小组会议并制定最终建议。
结果：制定了15项建议。四论筛查和诊断：抑郁症的筛查和诊断，评估自杀风险，并诊断为继发于癫痫的抑郁症；关于抑郁症的治疗的九项：转诊给精神科医生，抗癫痫药物的选择，改变抗癫痫药物，开始抗抑郁治疗，抗抑郁药的选择，在怀孕期间使用抗抑郁药，使用心理治疗，抗抑郁治疗持续时间，和停止抗抑郁治疗；两个随访：通常情况下的随访持续时间，并对有自杀风险的患者进行随访。
结论：我们提供基于专家意见共识的建议，以帮助医疗保健专业人员评估PWE中的抑郁症。重度抑郁症的检测和治疗是改善癫痫预后和避免自杀风险的关键因素。
方法：这是一项定性研究，分四个步骤进行：（1）制定有关PWE抑郁症管理的问卷，以回答；（2）文献综述和，如果有来自指南/共识或系统评价的证据，起草初步建议；(3)在没有现有证据的情况下，审查初步建议并就这些问题制定新建议的名义小组方法；(4)起草和批准最终建议。一个科学委员会（一名神经科医生和一名精神科医生）负责该项目的开发及其科学完整性。科学委员会选择了一个专家小组（在该领域具有经验的九名神经科医生和九名精神科医生）参加名义小组会议并制定最终建议。
结果：制定了15项建议。四论筛查和诊断：抑郁症的筛查和诊断，评估自杀风险，并诊断为继发于癫痫的抑郁症；关于抑郁症的治疗的九项：转诊给精神科医生，抗癫痫药物的选择，改变抗癫痫药物，开始抗抑郁治疗，抗抑郁药的选择，在怀孕期间使用抗抑郁药，使用心理治疗，抗抑郁治疗持续时间，和停止抗抑郁治疗；两个随访：通常情况下的随访持续时间，并对有自杀风险的患者进行随访。
结论：我们提供基于专家意见共识的建议，以帮助医疗保健专业人员评估PWE中的抑郁症。重度抑郁症的检测和治疗是改善癫痫预后和避免自杀风险的关键因素。
