Neurological disorders like headache, stroke, and seizures are associated with many psychiatric comorbidities like anxiety, depression, psychosis, eating disorders, personality disorders, etc. In order to look for the association of psychiatric comorbidities in epilepsy, headache, and stroke, this study was undertaken as very few studies have been reported from this part of the country so that we can help patients in improving their quality of life.
Materials and methods
This study was done in Mahatma Gandhi Medical College and Hospital, Jaipur, India, by the Department of Neurology and the Department of Psychiatry at the time of 1st visit. Fifty patients each of proved epilepsy, stroke, and headache were enrolled after consent and they were put to screening using the Global Mental Health Assessment Tool (GMHAT) questionnaire and at the same time, Department of Psychiatry assessed comorbidities—depression and anxiety—and made diagnosis using Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D) scale respectively.
The GMHAT tool showed that 50% of the patients having headache, 80% of the patients who had stroke, and 72% of the patients suffering from epilepsy had psychiatric comorbidities. The HAM-A scale showed that 40% of the patients with headache, 16% of patients suffering from epilepsy, and 30% of patients with stroke had anxiety as psychiatric comorbidity. The HAM-D scale showed depression in 30% of the patients having headache, 36% of the patients with epilepsy, and 60% of the patients who had stroke.
Results of our study showed that depression and anxiety are the most frequently encountered psychiatric comorbidities in patients with epilepsy, headache, and stroke. In our study, it was seen that depression was more common as compared with anxiety in patients with epilepsy and stroke, and anxiety was more common as compared with depression in patients with headache. To confirm our findings further, larger multicenter studies are needed. Anxiety and depression should be evaluated by clinicians using these simple screening instruments that can rapidly detect symptoms of these comorbidities in their busy clinical settings.
How to cite this article
Chaturvedi S, Sureka RK, Rishika, Sharma A, Mandal M. Forgotten Psychiatric Comorbidity in Neurological Disorders. J Mahatma Gandhi Univ Med Sci Tech 2017;2(3):157-161.
Bragatti JA, Torres CM, Isolan GR, Bianchin MM. Psychiatric comorbidities of epilepsy: a review. J Neurol Neurophysiol 2011 Dec;S2:002.
Choi DH, Jeong BO, Kang HJ, Kim SW, Kim JM, Shin IS, Kim JT, Park MS, Cho KH, Yoon JS. Psychiatric comorbidity and quality of life in patients with post-stroke emotional incontinence. Psychiatry Investig 2013 Dec;10(4):382-387.
Alsaadi T, El Hammasi K, Shahrour TM, Shakra M, Turkawi L, Nasreddine W, Raoof M. Depression and anxiety among patients with epilepsy and multiple sclerosis: UAE comparative study. Behav Neurol 2015 Oct;2015:196373.
Zebenholzer K, Lechner A, Broessner G, Lampl C, Luthringshausen G, Wuschitz A, Obmann SM, Berek K, Wöber C. Impact of depression and anxiety on burden and management of episodic and chronic headaches—a cross-sectional multicentre study in eight Austrian headache centres. J Headache Pain 2016 Feb;17:15.
Sharma VK, Lepping P, Cummins AG, Copeland JR, Parhee R, Mottram P. The Global Mental Health Assessment Tool–Primary Care Version (GMHAT/PC). Development, reliability and validity. World Psychiatry 2004 Jun;3(2):115-119.
Tegegne MT, Mossie TB, Awoke AA, Assaye AM, Gebrie BT, Eshetu DA. Depression and anxiety disorder among epileptic people at Amanuel Specialized Mental Hospital, Addis Ababa, Ethiopia. BMC Psychiatry 2015 Sep;15:210.
Phabphal K, Sattawatcharawanich S, Sathirapunya P, Limapichart K. Anxiety and depression in Thai epileptic patients. J Med Assoc Thai 2007 Oct;90(10):2010-2015.
Kwan P, Yu E, Leung H, Leon T, Mychaskiw MA. Association of subjective anxiety, depression, and sleep disturbance with quality-of-life ratings in adults with epilepsy. Epilepsia 2009 May;50(5):1059-1066.
Stefanello S, Marín-Léon L, Fernandes PT, Li LM, Botega NJ. Depression and anxiety in a community sample with epilepsy in Brazil. Arq Neuropsiquiatr 2011 Apr;69(2-B):342-348.
Hamed SA, Metwaly NA, Hassan MM, Mohamed KA, Ahmad MA, Soliman AA, Elsaied AR. Depression in adults with epilepsy: relationship to psychobiological variables. World J Neurol 2012 Feb;2(1):1-10.
Christensen J, Vestergaard M, Mortensen PB, Sidenius P, Agerbo E. Epilepsy and risk of suicide: a population-based case—control study. Lancet Neurol 2007 Aug;6(8):693-698.
Jones JE, Hermann BP, Barry JJ, Gilliam FG, Kanner AM, Meador KJ. Rates and risk factors for suicide, suicidal ideation, and suicide attempts in chronic epilepsy. Epilepsy Behav 2003 Oct;4(Suppl 3):S31-S38.
Ajiboye PO, Abiodun OA, Tunde-Ayinmode MF, Buhari OI, Sanya EO, Wahab KW. Psychiatric morbidity in stroke patients attending a neurology clinic in Nigeria. Afr Health Sci 2013 Sep;13(3):624-631.
Williams LS, Ghose SS, Swindle RW. Depression and other mental health diagnoses increase mortality risk after ischemic stroke. Am J Psychiatry 2004 Jun;161(6):1090-1095.
Beghi M, Cornaggia CM, Di Giacomo E, Primati C, Clerici M. Stroke and psychiatric disorders. Riv Psichiatr 2009 Jan-Feb;44(1):55-63.
Wang X, Chung MC, Hyland ME, Bahkeit M. Posttraumatic stress disorder and psychiatric co-morbidity following stroke: the role of alexithymia. Psychiatry Res 2011 Jun;188(1):51-57.
Robinson RG, Spalletta G. Poststroke depression: a review. Can J Psychiatry 2010 Jun;55(6):341-349.
Aström M, Adolfsson R, Asplund K. Major depression in stroke patients. A 3-year longitudinal study. Stroke 1993 Jul;24(7):976-982.
Hackett ML, Anderson CS. Predictors of depression after stroke: a systematic review of observational studies. Stroke 2005 Oct;36(10):2296-2301.
Castillo CS, Schultz SK, Robinson RG. Clinical correlates of early-onset and late-onset poststroke generalized anxiety. Am J Psychiatry 1995 Aug;152(8):1174-1179.
Aström M. Generalized anxiety disorder in stroke patients. A 3-year longitudinal study. Stroke 1996 Feb;27(2):270-275.
Oladiji JO, Akinbo SR, Aina OF, Aiyejusunle CB. Risk factors of post-stroke depression among stroke survivors in Lagos, Nigeria. Afr J Psychiatry (Johannesbg) 2009 Feb;12(1):47-51.
Chemerinski E, Robinson RG. The neuropsychiatry of stroke. Psychosomatics 2000 Jan-Feb;41(1):5-14.
Angelelli P, Paolucci S, Bivona U, Piccardi L, Ciurli P, Cantagallo A, Antonucci G, Fasotti L, Di Santantonio A, Grasso MG, et al. Development of neuropsychiatric symptoms in poststroke patients: a cross-sectional study. Acta Psychiatr Scand 2004 Jul;110(1):55-63.
Almeida OP, Xiao J. Mortality associated with incident mental health disorders after stroke. Aust N Z J Psychiatry 2007 Mar;41(3):274-281.
Smitherman, TA.; Baskin, SM. Depression and anxiety in migraine patients. Mount Royal (NJ): American Migraine Foundation; 2015.
Mehlsteibl D, Schankin C, Hering P, Sostak P, Straube A. Anxiety disorders in headache patients in a specialised clinic: prevalence and symptoms in comparison to patients in a general neurological clinic. J Headache Pain 2011 Jun;12(3):323-329.
Merikangas KR, Angst J, Isler H. Migraine and psychopathology. Results of the Zurich cohort study of young adults. Arch Gen Psychiatry 1990 Sep;47(9):849-853.
Beghi E, Bussone G, D'Amico D, Cortelli P, Cevoli S, Manzoni GC, Torelli P, Tonini MC, Allais G, De Simone R, et al. Headache, anxiety and depressive disorders: the HADAS study. J Headache Pain 2010 Apr;11(2):141-150.
Corchs F, Mercante JP, Guendler VZ, Vieira DS, Masruha MR, Moreira FR, Bernik M, Zukerman E, Peres MF. Phobias, other psychiatric comorbidities and chronic migraine. Arq Neuropsiquiatr 2006 Dec;64(4):950-953.
Song TJ, Cho SJ, Kim WJ, Yang KI, Yun CH, Chu MK. Anxiety and depression in tension-type headache: a population-based study. PLoS One 2016 Oct;11(10):e0165316.
Puca F, Genco S, Prudenzano MP, Savarese M, Bussone G, D'Amico D, Cerbo R, Gala C, Coppola MT, Gallai V, et al. Psychiatric comorbidity and psychosocial stress in patients with tension-type headache from headache centers in Italy. The Italian Collaborative Group for the Study of Psychopathological Factors in Primary Headaches. Cephalalgia 1999 Apr;19(3):159-164.
Holroyd KA, Stensland M, Lipchik GL, Hill KR, O'Donnell FS, Cordingley G. Psychosocial correlates and impact of chronic tension-type headaches. Headache 2000 Jan;40(1):3-16.
Borkovec, TD.; Alcaine, O.; Behar. E. Avoidance theory of worry and generalized anxiety disorder. In: Heimberg RG, Turk CL, Mennin DS, editors. Generalized anxiety disorder in research and practice. New York: Guilford Press; 2004. pp. 77-108.
Behar E, DiMarco ID, Hekler EB, Mohlman J, Staples AM. Current theoretical models of generalized anxiety disorders (GAD): conceptual review and treatment implications. J Anxiety Disord 2009 Dec;23(8):1011-1023.
McWiliams LA, Goodwin RD, Cox BJ. Depression and anxiety associated with three pain conditions: results from a nationally representative sample. Pain 2004 Sep;111(1-2):77-83.
Daniali S, Azadbakht L, Mostafavi F. Relationship between body satisfaction with self esteem and unhealthy body weight management. J Educ Health Promot 2013 Jul;2:29.
Huang JS, Norman GJ, Zabinski MF, Calfas K, Patrick K. Body image and self-esteem among adolescents undergoing an intervention targeting dietary and physical activity behaviors. J Adolesc Health 2007 Mar;40(3):245-251.
Wang, Y.; Wu, Y.; Wilson, RF.; Bleich, S.; Cheskin, L.; Weston, C.; Showell, N.; Fawole, O.; Lau, B.; Segal, J. Childhood obesity prevention programs: comparative effectiveness review and meta-analysis. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013. [cited 2013 Jun]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK148737/.
Khan MA, Mahomed MF, Ashshi AM, Faiz A. Drug resistance patterns of Acinetobacter baumannii in Makkah, Saudi Arabia. Pak J Med Res 2012 Oct-Dec;51(4):127-131.
Shields RK, Clancy CJ, Gillis LM, Kwak EJ, Silveira FP, Massih RC, Eschenauer GA, Potoski BA, Nguyen MH. Epidemiology, clinical characteristics and outcomes of extensively drug-resistant Acinetobacter baumannii infections among solid organ transplant recipients. PLoS One 2012 Dec;7(12):e52349.
Prashanth K, Badrinath S. In vitro susceptibility pattern of Acinetobacter species to commonly used cephalosporins, quinolones and aminoglycosides. Indian J Med Microbiol 2004 Apr-Jun;22(2):97-103.
Armin S, Karimi A, Fallah F, Tabatabaii RS, Alfatemi SM, Khiabanirad P, Shiva F, Fahimzad A, Rahbar M, Mansoorghanaii R, et al Antimicrobial resistance pattern of Acinetobacter baumannii, Pseudomonas aeruginosa and Staphylococcus aureus isolated from patients with nosocomial infection admitted to Tehran hospitals. Arch Pediatr Infect Dis 2015 Oct;3(4):e32554.
Qureshi ZA, Abbasi SA, Mirza IA, Malik N, Amjad A, Sattar A, Ikram A. Antimicrobial susceptibility pattern of Acinetobacter species-one year experience in a tertiary care setting. Infect Dis J 2011 Mar;20(1):269-272.
Spencer L, Bubner T, Bain E, Middleton P. Screening and subsequent management for thyroid dysfunction pre-pregnancy and during pregnancy for improving maternal and infant health. Cochrane Database Syst Rev 2015 Sep;9:CD011263.
Li M, Yao Q, Xing A. A clinical analysis of 188 cases of pregnancy complicated with critical heart disease. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2014 Nov;39(11):1145-1150.
Bhatla N, Lal S, Behera G, Kriplani A, Mittal S, Agarwal N, Talwar KK. Cardiac disease in pregnancy. Int J Gynaecol Obstet 2003 Aug;82(2):153-159.
Gelson E, Curry R, Gatzoulis MA, Swan L, Lupton M, Steer P, Johnson M. Effect of maternal heart disease on fetal growth. Obstet Gynecol 2011 Apr;117(4):886-891.
Arora N, Kausar H, Jana N, Mandal S, Mukherjee D, Mukherjee R. Congenital heart disease in pregnancy in a low-income country. Int J Gynaecol Obstet 2015 Jan;128(1):30-32.
Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000 Jul;183(1):S1-S22.
Agency for Healthcare Research and Quality. Management of chronic hypertension during pregnancy. Evidence Report/Technology Assessment no.14. AHRQ publication no. 00-E011. Rockville, MD: Agency for Healthcare Research and Quality; 2000.
Ferrer RL, Sibai BM, Mulrow CD, Chiquette E, Stevens KR, Cornell J. Management of mild chronic hypertension during pregnancy: a review. Obstet Gynecol 2000 Nov;96(5 Pt 2):849-860.
Sridharan R, Murthy BN. Prevalence and pattern of epilepsy in India. Epilepsia 1999 May;40(5):631-636.
Viale L, Allotey J, Cheong-See F, Arroyo-Manzano D, McCorry D, Bagary M, Mignini L, Khan KS, Zamora J, Thangaratinam S, et al. Epilepsy in pregnancy and reproductive outcomes: a systematic review and meta-analysis. Lancet 2015 Nov;386(10006):1845-1852.
Smyth A, Oliveira GH, Lahr BD, Bailey KR, Norby SM, Garovic VD. A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. Clin J Am Soc Nephrol 2010 Nov;5(11):2060-2068.
Hazes JM, Coulie PG, Geenen V, Vermeire S, Carbonnel F, Louis E, Masson P, De Keyser F. Rheumatoid arthritis and pregnancy: evolution of disease activity and pathophysiological considerations for drug use. Rheumatology (Oxford) 2011 Nov;50(11):1955-1968.
Velu PP, Gravett CA, Roberts TK, Wagner TA, Zhang JS, Rubens CE, Gravett MG, Campbell H, Rudan I. Epidemiology and aetiology of maternal bacterial and viral infections in low- and middle-income countries. J Glob Health 2011 Dec;1(2):171-188.
UNAIDS: UNAIDS report on the global AIDS epidemic. 2010. Available from http://www.unaids.org/globalreport/Global_report.htm
Ioannidis JP, Abrams EJ, Ammann A, Bulterys M, Goedert JJ, Gray L, Korber BT, Mayaux MJ, Mofenson LM, Newell ML, et al. Perinatal transmission of human immunodeficiency virus type 1 by pregnant women with RNA virus loads <1000 copies/ml. J Infect Dis 2001 Feb;183(4):539-545.
Anglemyer A, Rutherford GW, Horvath T, Baggaley RC, Egger M, Siegfried N. Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples. Cochrane Database Syst Rev 2013 Apr;4:CD009153.
Rimoin DL, Connor JM, Pyeritz RE, Korf BR. Emery and Rimoin's principles and practice of medical genetics. Churchill Livingstone Elsevier; 2007.
Verma IC, Puri RD. Global burden of genetic disease and the role of genetic screening. Semin Fetal Neonatal Med 2015 Oct;20(5):354-363.
White SJ, Boldt KL, Holditch SJ, Poland GA, Jacobson RM. Measles, mumps, and rubella. Clin Obstet Gynecol 2012 Jun;55(2):550-559.
American College of Obstetricians and Gynecologists. ACOG educational bulletin: viral hepatitis in pregnancy. Int J Gynaecol Obstet 1998 Nov;63:195-202.
Geeta MG, Riyaz A. Prevention of mother to child transmission of hepatitis B infection. Indian Pediatr 2013;50:189-192.
Swamy GK, Beigi RH. Maternal benefits of immunization during pregnancy. Vaccine 2015 Nov;33(47):6436-6440.
Sukumaran L, McCarthy NL, Kharbanda EO, McNeil MM, Naleway AL, Klein NP, Jackson ML, Hambidge SJ, Lugg MM, Li R, et al. Association of Tdap vaccination with acute events and adverse birth outcomes among pregnant women with prior tetanus-containing immunizations. JAMA 2015 Oct;314(15):1581-1587.
Singru SA, Tilak VW, Gandham N, Bhawalkar JS, Jadhav SL, Pandve HT. Study of susceptibility towards Varicella by screening for the presence of IgG antibodies among nursing and medical students of a Tertiary Care Teaching Hospital in Pune, India. J Glob Infect Dis 2011 Jan-Mar;3(1):37-41.
Nathwani D, Maclean A, Conway S, Carrington D. Varicella infections in pregnancy and the newborn. A review prepared for the UK Advisory Group on Chickenpox on behalf of the British Society for the Study of Infection. J Infect 1998;36 (Suppl 1):59-71.
Michaan N, Amzallag S, Laskov I, Cohen Y, Fried M, Lessing JB, Many A. Maternal and neonatal outcome of pregnant women infected with H1N1 influenza virus (swine flu). J Matern Fetal Neonatal Med 2012 Feb;25(2):130-132.
Smith NM, Bresee JS, Shay DK, Uyeki TM, Cox NJ, Strikas RA. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2006 Jul;55(RR-10):1-42.