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20 results

  • Is there a hierarchy in mental health stigma?

  • Marco Mula
  • Journal: BJPsych Open / Volume 9 / Issue 1 / January 2023
  • Published online by Cambridge University Press: 12 December 2022, e4
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  • People with mental illness fight not just against their condition but also against stigma, discrimination and inequalities. Research into stigma in mental illness has increased over time, but data on transdiagnostic stigma are still very limited. This commentary focuses on this topic alongside a recently published article in BJPsych Open.

  • Chapter 11 - Post-traumatic Epilepsy and Post-traumatic Stress Disorder

  • Edited by Marco Mula, St George's Hospital Medical School, University of London
  • Book: Post-traumatic Epilepsy
  • Published online: 10 August 2021
  • Print publication: 26 August 2021, pp 149-156

  • Summary

    People with traumatic brain injury (TBI) can develop a variety of behavioural changes and psychiatric problems as a consequence of the TBI but the relationship with post-traumatic stress disorder (PTSD) has received increasing attention only recently.

    The aim of this chapter is to discuss current literature on the relationship between PTSD and epilepsy in terms of neurobiology and clinical correlates and the potential relationship with TBI. As shown for other psychiatric disorders, people with PTSD seem to have a 3 to 6 times increased risk of developing epilepsy and this can be explained by a number of shared neurobiological mechanisms in addition to the role of brain damage when PTSD is associated with TBI. However, psychogenic-non-epileptic seizures (PNES) seem to be even more closely associated with PTSD, carrying sometimes substantial challenges in terms of differential diagnosis.

    Data on treatment of PTSD are also reviewed, discussing specific issues of people with epilepsy, namely interactions and seizure risk.

Post-traumatic Epilepsy
  • Part 1
  • Edited by Marco Mula
  • Published online: 10 August 2021
  • Print publication: 26 August 2021
  • Epilepsy is one of the most common neurological conditions, affecting up to seventy million people worldwide, with post-traumatic epilepsy (PTE) accounting for up to 20% of symptomatic cases. Despite this, there is a dearth of information about PTE available for clinicians. This book will guide readers through the neurobiology of PTE and the long-term consequences and rehabilitation needs of patients. Emerging topics such as concussive convulsions in sports are examined and a chapter dedicated to PTE in children ensures readers have the latest knowledge for treating this high-risk subpopulation. Managing PTE in medium and low-income countries where access to appropriate treatment, and even diagnostic equipment, is often poor, is covered in depth. This book is an up-to-date, comprehensive overview of PTE by active international authorities in the field of epilepsy and traumatic brain injury, with an emphasis on epidemiology, neurobiology, clinical problems as well as management issues.

  • Demographic and clinical phenotypic differences between people with dissociative seizures and those with other psychiatric disorders

  • Abigail Smakowski, Jacob S. Bird, Megan Pritchard, Marco Mula
  • Journal: BJPsych Open / Volume 7 / Issue 2 / March 2021
  • Published online by Cambridge University Press: 24 February 2021, e61
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  • Background

    A large amount of literature surrounds the differences between dissociative neurological symptom disorder with non-epileptic seizures (DNSD-S) and epilepsy.

    Aims

    To explore the research gap on phenotypic differences between DNSD-S and other psychiatric disorders.

    Method

    We conducted a case–control study of 1860 patients (620 patients with DNSD-S and 1240 controls with other psychiatric disorders) seen at the South London and Maudsley Hospital NHS Trust between 2007 and 2019.

    Results

    Compared with the controls, the patients with DNSD-S were more likely to be female (76 v. 47%, P < 0.001), of White ethnicity (77 v. 60%, P < 0.001), married (34 v. 14%, P < 0.001) and living in areas of lower socioeconomic status (−3.79, 95% CI −2.62 to −4.96, P < 0.001). Two peaks for age at diagnosis were observed for DNSD-S: the early 20s and late 40s. After 31 years of age, men's chance of being diagnosed with DNSD-S increased from 19 to 28% (P = 0.009). People with DNSD-S presented more commonly with a history of a neurological episodic or paroxysmal disorder (OR = 12, 95% CI 7.82–20.26), another dissociative disorder (OR = 10, 95% CI 1.64– 65.95) or unclassified signs or symptoms (OR = 4, 95% CI 2.61–6.43). Neither anxiety, depression nor other somatoform disorders predicted subsequent diagnosis of DNSD-S, and controls had a larger proportion of preceding psychiatric diagnoses than patients with DNSD-S (65 v. 49%, P < 0.001).

    Conclusions

    This is the first study comparing demographic and phenotypic correlates of patients with DNSD-S against a large cohort of psychiatric patients. These data will inform development and drive service needs in psychiatry for people with DNSD-S.

  • Double stigma in mental health: epilepsy and mental illness

  • Marco Mula, Kenneth R. Kaufman
  • Journal: BJPsych Open / Volume 6 / Issue 4 / July 2020
  • Published online by Cambridge University Press: 13 July 2020, e72
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  • Background

    Epilepsy and mental illness share similar problems in terms of stigma, as a result of centuries of superstition, ignorance and misbeliefs. Stigma leads not only to discrimination and civil and human rights violations but also to poor access to healthcare and non-adherence or decreased adherence to treatment, ultimately increasing morbidity and mortality. Despite continuous efforts in fighting stigma in these conditions, there is very limited knowledge on the phenomenon of double stigma, meaning the impact of having two stigmatised conditions at the same time.

    Aims

    To discuss double stigma in mental health with special reference to epilepsy.

    Method

    Articles were identified through searches in PubMed up to 31 October 2019 using the search terms ‘epilepsy’, ‘psychiatric disorders’, ‘stigma’ and additional material was identified from the authors’ own files and from chosen bibliographies.

    Results

    Double stigma is gaining attention for other stigmatised medical conditions, such as HIV, however, the literature on epilepsy is almost non-existent and this is quite astonishing given that one in three people with epilepsy have a lifetime diagnosis of a psychiatric condition. Felt (perceived) stigma and psychiatric disorders, particularly depression, create a vicious circle in epilepsy maintaining both, as depression correlates with stigma and vice versa as well as epilepsy and depression serving as bidirectional risk factors. This phenomenon has no geographical and economic boundaries as similar data have been reported for low-income and high-income countries.

    Conclusions

    Governments and policymakers as well as health services, patients’ organisations, families and the general public need to be aware of the phenomenon of double stigma in order to develop campaigns and interventions tailored for these patients.

  • Psychosocial aspects of epilepsy: a wider approach

  • Marco Mula, Josemir W. Sander
  • Journal: BJPsych Open / Volume 2 / Issue 4 / July 2016
  • Published online by Cambridge University Press: 02 January 2018, pp. 270-274
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  • Epilepsy is one of the most serious neurological conditions and has an impact not only on the affected individual but also on the family and, indirectly, on the community. A global approach to the individual must take into account cognitive problems, psychiatric comorbidities and all psychosocial complications that often accompany epilepsy. We discuss psychosocial issues in epilepsy with special focus on the relationship between stigma and psychiatric comorbidities. Social barriers to optimal care and health outcomes for people with epilepsy result in huge disparities, and the public health system needs to invest in awareness programmes to increase public knowledge and reduce stigma in order to minimise such disparities.

  • The neurophilosophy of epileptic experiences

  • Francesco Monaco, Marco Mula, Andrea E. Cavanna
  • Journal: Acta Neuropsychiatrica / Volume 23 / Issue 4 / August 2011
  • Published online by Cambridge University Press: 24 June 2014, pp. 184-187

  • Monaco F, Mula M, Cavanna AE. The neurophilosophy of epileptic experiences.

    Background: Specific alterations of consciousness have a central role in the phenomenological description of epileptic seizures and in the patient's subjective reports.

    Methods: This article discusses the use of philosophical methodology within a neurological framework to understand consciousness.

    Results: How the alterations in consciousness are experienced by patients with epilepsy depends largely on the localization of the underlying neurophysiological dysfuntion.

    Discussion: Rigorous conceptual analysis of ictal experience reports can help to illuminate the study of consciousness.

  • Chapter 9 - The interictal dysphoric disorder

  • Edited by Michael R. Trimble, Institute of Neurology, London, Bettina Schmitz
  • Book: The Neuropsychiatry of Epilepsy
  • Published online: 07 October 2011
  • Print publication: 09 June 2011, pp 80-89

  • Summary

    This chapter looks at the management of epilepsy in people with an intellectual disability, which has gained increasing importance over recent years, and the interface between the genotype causing the intellectual disability and potential behavioral and epilepsy phenotypes associated with this genotype. It uses a working definition of the pattern of seizure type, seizure syndrome and treatment response characterized by a specific genotype. An evaluation of a population of individuals with an intellectual disability, or global developmental delay, is likely to yield a potential diagnostic category in approximately 40-60%. The prevalence of epilepsy amongst the population of people with an intellectual disability varies between studies from as low as 13% to as high as 40%. The chapter also gives some examples of common genetic causes of intellectual disability, and outlines the physical, behavioral, and epileptic phenotypes associated with them.

  • 19 - Antiepileptic drug interactions in patients requiring psychiatric drug treatment

  • from Part IV - Drug interactions in specific patient populations and special conditions
    • By Michael R. Trimble, The National Hospital for Neurology and Neurosurgery, Institute of Neurology, Queen, Square, London, UK, Marco Mula, Amadeo Avogadro University, Novara, Italy
  • Edited by Jerzy Majkowski, Blaise F. D. Bourgeois, Harvard University, Massachusetts, Philip N. Patsalos, Institute of Neurology, London, Richard H. Mattson, Yale University, Connecticut
  • Book: Antiepileptic Drugs
  • Published online: 07 September 2009
  • Print publication: 26 May 2005, pp 350-368

  • Summary

    In recent years a number of newer antidepressant drugs have been introduced into clinical practice. The new generation of antipsychotic drugs essentially fall into two categories; those that are clozapine related, which included olanzapine and quetiapine, and others such as risperidone. It is also known that many patients with epilepsy receive psychotropic drugs, sometimes but not always on account of psychiatric symptoms. Neuroleptics, such as phenothiazines, are metabolized by intestinal sulfoxidases, although CYP2D6 plays an important role in chlorpromazine and thioridazine metabolism. Antidepressants have been extensively evaluated in relation to the general problem of their proconvulsant activity. Historically, antipsychotic drugs have been considered proconvulsants possibly because of their D2-receptor blocking activity. As far as antidepressant drugs are concerned, fluoxetine and nefazodone interactions are probably the most relevant in epilepsy from a clinical point of view.