A link between mood disorders and epilepsy has been noted for more than 2,000 years. While we understand this association more today than in the past, much work needs to be done to more clearly clarify whether this is a causative association.
What is relatively clear, however, is the fact that depression adversely affects the quality of life of people with epilepsy, and it needs to be recognized and treated when appropriate. This article will cover definitions of mood disorders in people with epilepsy, as well as their incidence, recognition, causes and treatment options.
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There are a host of symptoms that point to treatable depression: sadness associated with a lack of pleasure in performing activities; problems with weight and sleep; tiredness; difficulty concentrating and making decisions; feelings of worthlessness or guilt; and frequent thoughts of suicide and death. If five or more of these symptoms persist for at least two weeks, that qualifies as major depressive disorder.
A dysthymic disorder is similar to major depressive disorder, but it is less intense and includes depression for most days for at least two years. During this interval, two or more of the following symptoms need to be present: change in appetite, lack of sleep, decreased energy, low self-esteem, poor concentration, difficulty making decisions and feelings of hopelessness.
Another common mood disorder in people with epilepsy is bipolar affective disorder. It is characterized by two types of symptoms: depression and mania. Bipolar disorder is also known as manic-depressive illness.
Symptoms of bipolar disorder may come and go. People typically exhibit depressed and manic symptoms separately, but both can occur simultaneously. Different subtypes of the disorder also exist. The depressed symptoms can be very severe and lead to problems at work or at school. They may also cause problems with relationships and even lead to thoughts of suicide. In addition, patients may sometimes lose touch with reality, which is referred to as psychosis.
Although some people with epilepsy may have depressive symptoms that fail to meet the criteria for a major depressive disorder, or a dysthymic disorder, they may still also have poor quality of life and respond positively to mood disorder treatment. Because of the irregular and pleomorphic nature of these symptoms, they may often be overlooked.
Mood changes may also occur up to 72 hours prior to a seizure and last upwards of three days afterwards. In addition, depressive symptoms may increase after a seizure and include suicidal ideation, hence the reason why systematic mood disorder screening of people with epilepsy by doctors is important. It will help ensure that affected patients receive needed treatment.
The intensity of depressive disorders in people with epilepsy may also be amplified. The history of a suicide attempt in one study appeared to be about five times higher than seen in the general population. Not all studies have found an elevated risk of suicide in people with epilepsy,but a pooled sample of reviews confirmed an elevated risk.
It is imperative that people with epilepsy experiencing mood disorders promptly receive effective treatment, especially after considering the relatively high frequency of depression, decreased quality of life and suicide. The most effective approach to recognizing depression in people with epilepsy is searching for easy-to-change causes, such as changes in antiepileptic drugs.
Many types of treatment are available for mood disorders in people with epilepsy, but psychotherapy and medication are the most common. These forms may be used separately or together, but the overriding goal is to eventually eliminate symptoms of depression.
The most frequently prescribed antidepressants for adults with epilepsy and depression are in the same class as Prozac. Prozac is also used to treat major depressive disorders in children. When antidepressants are used it is important for the patient with epilepsy to be closely monitored. This is to evaluate any potential side effects, such as worsening of depressive symptoms. Counseling for the adult or child may also help, and family therapy may be useful, as well, particularly if anyone else in the family has a mood disorder.
It is important to remember that mood disorder medications may require dose adjustments and may take several weeks to become fully effective. Just like antiepileptic drugs, sometimes more than one antidepressant may need to be tried before getting good results. For most individuals with epilepsy, depressive symptoms usually respond very well to treatment.
Martin Burney has two apparent mental disorders, the primary one being Borderline Personality Disorder and the second being Obsessive-Compulsive Disorder. Martin's OCD results in him following a strict routine (such as listening to the same song every time he made love), always keeping a neat and tidy house and putting everything away (such as the cans and towels) in a very specific way. While Martin has Obsessive-Compulsive Disorder, this is not what makes him an abusive, controlling, possessive and obsessive person.
What drives his actions is an extreme case of Borderline Personality Disorder, for which he meets nearly every symptom. This illness, also called Emotional Dysregulation Disorder, is a mental disorder characterized by unstable moods and relationships. He meets at least eight of the criteria for this disorder, including having intense relationships, mood swings, obsessions, splitting (black and white thinking), impulsive behaviors, paranoia and unjustified anger; though the most obvious is the main symptom of the disorder is frantic efforts to avoid real or imagined abandonment.
Since cavalry[11], dragoons or cuirassiers have horses much stronger than those of hussars, then they should avoid a frontal clash with them as much as possible, and send small groups around their flanks in order to force them to face right or left; and this should be the signal to strike them from all sides, in order to disorder them, in which case the hussars have all the advantages due to the agility of their horses.
Like schizophrenia, schizophreniform disorder is a type of "psychosis" in which a person cannot tell what is real from what is imagined. It also affects how people think, act, express emotions, and relate to others.
If the doctor finds no physical reason for the symptoms, they may refer the person to a psychiatrist or psychologist, mental health professionals who are trained to diagnose and treat mental illnesses. They use specially designed interview and assessment tools to see if someone has a psychotic disorder. For a diagnosis of schizophreniform disorder, the symptoms can only have lasted for less than 6 months.
Medication: Antipsychotic drugs are the main medications that doctors use to treat the psychotic symptoms of schizophreniform disorder, such as delusions, hallucinations, and disordered thinking.
Psychotherapy: The goal is to help the person recognize and learn about the illness and its treatment, set goals, and manage everyday problems related to the condition. It can also help the person handle the feelings of distress linked to the symptoms. Family therapy can help families deal more effectively with a loved one who has schizophreniform disorder.
BPD borderline personality disorder, CC clinical controls, GAF global assessment of functioning, NSSI nonsuicidal self-injury, NSSID nonsuicidal self-injury disorder, PD personality disorders, PTSD posttraumatic stress disorder, R-NSSI-Q Repetitive Non-Suicidal Self-Injury Questionnaire, higher score indicates more serious illness.
The French units advanced in a stacked formation toward a few Russian batteries. The Russian batteries distributed their offensive fire across three separate French units, maximizing the potential for multiple morale checks. Although directing their fire at the leading French battalion (the closest target) could have caused more French losses, however Napoleonic warfare was about breaking enemy morale and formations rather than annihilating the enemy. In line with this historical reality, the game favors targeting three separate units with lower Firepower (FP) over concentrating all (or even higher) FP on one unit. This fire discipline increases the chances of triggering multiple morale checks during offensive fire and determined by the morale check formula outlined in the manual. Regrettably, there were no prisoners to report, making it challenging to determine which specific battalions failed the morale check. Nevertheless, adjacent battalions were also subjected to morale checks, resulting in them either joining their comrades in routing or becoming disordered:
The result of the French assault was a massive rout, with the remaining units becoming combat ineffective due to disorder. None of the French units exposed to the fire had leaders within their stacks, which worsened the routing situation.In this specific case, the rearguard action was constrained in time. The failed assault essentially determined the battle's outcome, as there was no time for the French to regroup and attempt a second assault. Arguably, the aftermath of this assault significantly impacted the broader campaign dynamics. The Russian major victory in this rearguard action potentially had a domino effect, influencing a subsequent decisive battle scenario and forcing the French into an unfavorable position with limited options for maneuvering.Nonetheless, there are rare situations where forming attacking units into a large body can be justified.The most obvious advantage of this formation is the increased threat value it poses. This can lead to causing disorder or even routing among defenders of lesser disciplined units, particularly those below C quality. However, the argument of maximizing threat value might hold true only when the enemy is badly outnumbered and isn't expected to launch a strong counterattack and lacks the required Firepower (FP) to trigger multiple morale checks. These situations mostly fall under reargued actions. The enemy units increase the distance from the main attacking body and as they move it decreases FP by -50% due to movement penalty (if they conduct offensive fire). 589ccfa754
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