Journal of AdvancedMedical and Dental Sciences Research

Background: In trigeminal neuralgia (TN) the frequency and severity of pain plus the patients continuous medication at multiple times and its side effects has direct negative impact on quality of life, high prevalence of anxiety disorders, limitations of daily activity due to fear of pain attacks and due to regular daily intake of medication, inconvenience disliking and dependence on daily intake of medication, unfavourable long term response to medication and its severe side effects with time, fear of stimulation of trigger zones. This all leads to subsequent psychiatric disorders. Present study aimed to evaluate psychiatric morbidities in patients with TN under medical treatment with different medical specialities and cross examination by a psychiatrist to rule out if patient with TN is being reviewed and evaluated routinely for any depressive or anxiety disorder by other specialists. Methods: Two groups of patients were evaluated and included in this study with total sample size of 147 patients. 47 patients who are known diagnosed cases of TN had responded well to pharmacological treatment with anti-epileptic drugs and non-epileptic drugs form group A and are treated by 6 different psychiatrists for TN since 3 years and regular follow-up. Further these patients are evaluated for depressive disorder through case history, clinical examination and psychiatric examination by Hamilton Depression Rating Scale (HAM-D scale).  Group B has 100 patients undergoing treatment for past 3 years with confirm diagnosis of TN treated by other related medical specialities routinely treating TN are cross examined and evaluated for psychiatric illness and depressive disorder by psychiatrist and are classified into different sub-groups like: 1) Patients responding well to medication with no residual symptoms; 2) Patients responding less with residual symptoms; 3) Patients who have other psychiatric disorders due to TN. Results: In group A, the medical management is as follows: 17 patients are on Carbamazepine, 11 patients are on combined Carbamazepine with Gabapentin, 8 patients have Gabapentin with Methylcobalmin, 5 patients are on Oxcarbazepine and other 6 patients have both Carbamazepine and Baclofen. After applying HAM-D scale and routine questionnaire to assess psychiatric illness 25 patients are identified with symptoms of depressive disorder present for more than 8 months with 17 out of these 25 being treated simultaneously for depressive disorder as well. In group B consisting of 100 patients 75 settled with medication are responding well and have less depression while as remaining 25 patients are with residual symptoms and are less responsive. After applying HAM-D scale and routine questionnaire to both these sub-groups of 75 and 25 patients to assess psychiatric illness; among 75 patients 40-42 (56%) have mild depression with 13-18 score, 25-27 (36%) have moderate depression with 18-23 score, and 8-10 (13.33%) have severe depression with >23 score while as among remaining 25 patients, 5-7 (28%) have moderate depression, 9-11 (44%) have severe depression and 8-10 (40%) show very severe bitter form of depression. This overall statistical analysis shows more percentage of severe depression in 25 patients with residual symptoms who are less responsive. The further outcome of these values signifies unresponsiveness, severity of depression, duration of illness in long duration of TN and thus causing symptoms and intensity of depression severe in them. And due to less hope for recovery these patients feel for such a long time, they further get depressed. Upon comparing group A consisting of 47 patients being treated by psychiatrists with group B consisting of 100 patients being treated by other related medical specialities routinely treating TN, it is found that 53.19% patients from group A do have related psychiatric illness mainly depression and anxiety disorder due to TN and 68% of them are being treated for their psychiatric illness by the same psychiatrists simultaneously while as in group B with 100 patients all treated for TN by other related medical specialities routinely treating TN, the overall percentage of mild form of psychiatric illness is 42%, moderate form is 34%, severe form is 21% and very severe better form is 10% suggesting overall percentage of depressive illness is high among group B and none of the patients is being treated for any psychiatric illness simultaneously as compared to group A where overall 36.17% patients are being treated simultaneously for psychiatric illness. Conclusion: Recognising the psychological impact due to acute recurrent pain in trigeminal neuralgia is critical. Patients with TN should always being evaluated, consulted and treated by psychiatrists simultaneously along with other concerned specialities as there is higher prevalence of psychiatric co-morbidities as the follow-up proceeds. Reason being increased frequency of acute pain attacks in TN with time, disturbed life style due to apprehension of pain, anxiety, medication to be taken more than 3 times a day for long time span, and patients getting less responsive with time to the same medication.
Key words: trigeminal neuralgia, pharmacological treatment, psychiatric illness.                
                                                                                                                                                           
Received: 13 April, 2019                                  Revised:  25 June 2019                   Accepted: 27 June 2019

Corresponding author: Dr. Abdul Rahman Al-Atram, Associate Professor, Department of Psychiatry, College of Medicine, Majmaah University, Majmaah, Saudi Arabia.

                                                                                 
This article may be cited as: Al-Atram AR. Prevalence of psychiatric illness in trigeminal neuralgia and prognosis of its treatment by psychiatrists or other medical specialities. J Adv Med Dent Scie Res 2019;7(7): 86-89.