Validation of diagnostic tests for depressive disorder in drug-resistant mesial temporal lobe epilepsy

Abstract Purpose This study aimed to evaluate the diagnostic accuracy of the Hamilton Rating Scale for Depression (HRSD), the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression Scale (HADS), and the Hospital Anxiety and Depression Scale-Depression subscale (HADS-D) as diagnostic te...

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Bibliographic Details
Published in:Epilepsy & behavior 2015-09, Vol.50, p.61-66
Main Authors: de Lemos Zingano, Bianca, Guarnieri, Ricardo, Diaz, Alexandre Paim, Schwarzbold, Marcelo Liborio, Bicalho, Maria Alice Horta, Claudino, Lucia Sukys, Markowitsch, Hans J, Wolf, Peter, Lin, Katia, Walz, Roger
Format: Article
Language:English
Subjects:
Adult
Depressive disorder
Depressive Disorder - diagnosis
Depressive Disorder - epidemiology
Depressive Disorder - psychology
Diagnostic accuracy
Diagnostic and Statistical Manual of Mental Disorders
Diagnostic tests
Diagnostic Tests, Routine - standards
Drug Resistant Epilepsy - diagnosis
Drug Resistant Epilepsy - epidemiology
Drug Resistant Epilepsy - psychology
Drug-resistant mesial temporal lobe epilepsy
Epilepsy, Temporal Lobe - diagnosis
Epilepsy, Temporal Lobe - epidemiology
Epilepsy, Temporal Lobe - psychology
Female
Hippocampal sclerosis
Humans
Male
Middle Aged
Neurology
Personality Inventory - standards
Psychiatric Status Rating Scales - standards
Reproducibility of Results
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Summary:Abstract Purpose This study aimed to evaluate the diagnostic accuracy of the Hamilton Rating Scale for Depression (HRSD), the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression Scale (HADS), and the Hospital Anxiety and Depression Scale-Depression subscale (HADS-D) as diagnostic tests for depressive disorder in drug-resistant mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). Methods One hundred three patients with drug-resistant MTLE-HS were enrolled. All patients underwent a neurological examination, interictal and ictal video-electroencephalogram (V-EEG) analyses, and magnetic resonance imaging (MRI). Psychiatric interviews were based on DSM-IV-TR criteria and ILAE Commission of Psychobiology classification as a gold standard; HRSD, BDI, HADS, and HADS-D were used as psychometric diagnostic tests, and receiver operating characteristic (ROC) curves were used to determine the optimal threshold scores. Results For all the scales, the areas under the curve (AUCs) were approximately 0.8, and they were able to identify depression in this sample. A threshold of ≥ 9 on the HRSD and a threshold of ≥ 8 on the HADS-D showed a sensitivity of 70% and specificity of 80%. A threshold of ≥ 19 on the BDI and HADS-D total showed a sensitivity of 55% and a specificity of approximately 90%. The instruments showed a negative predictive value of approximately 87% and a positive predictive value of approximately 65% for the BDI and HADS total and approximately 60% for the HRSD and HADS-D. Conclusions HRSD ≥ 9 and HADS-D ≥ 8 had the best balance between sensitivity (approximately 70%) and specificity (approximately 80%). However, with these thresholds, these diagnostic tests do not appear useful in identifying depressive disorder in this population with epilepsy, and their specificity (approximately 80%) and PPV (approximately 55%) were lower than those of the other scales. We believe that the BDI and HADS total are valid diagnostic tests for depressive disorder in patients with MTLE-HS, as both scales showed acceptable (though not high) specificity and PPV for this type of study.
ISSN:1525-5050
1525-5069
DOI:10.1016/j.yebeh.2015.06.004