BackgroundPsychiatric comorbidities in epilepsy impose significant burdens on patients and their families. It affects their quality of life and medical care and results in cost increases. This study reports the impact of various psychiatric comorbidities in epilepsy patients regarding hospital outcomes and in-hospital mortality.MethodsWe used the Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP) from years 2013-2014. We identified epilepsy as the primary diagnosis and psychiatric comorbidities, namely, alcohol abuse, depression, drug abuse, and psychosis, using validated International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. The differences in comorbidities were quantified using chi-square (χ2) tests and the multinomial logistic regression model was used to quantify associations among comorbidities using the adjusted Odds Ratio (aOR). ResultsWe analyzed 397,440 hospitalizations with epilepsy as the primary diagnosis. The most prevalent psychiatric comorbidities present in epilepsy were depression (13%) followed by psychosis (10.4%). The risk of inpatient death was only seen in epilepsy with comorbid alcohol abuse (aOR 1.164; 95%CI 1.043 – 1.300; p-value =0.007). Epilepsy with comorbid depression (aOR 1.473; 95% CI 1.391 – 1.559; p-value <0.001) was associated with a higher risk of a length of stay of more than three days (median), followed by comorbid psychosis (aOR 1.290; 95% CI 1.258 – 1.322; p-value <0.001). Epilepsy with comorbid depression (aOR 1.242; 95% CI 1.172 – 1.317; p-value <0.001) was associated with a higher risk of inpatient total charge of more than $21,000 (median), followed by comorbid psychosis (aOR 1.071; 95% CI 1.045 – 1.098; p-value <0.001).ConclusionPsychiatric comorbidities are influential factors that must be considered in models of Health-Related Quality of Life (HRQOL) in epilepsy. Further, efforts to improve HRQOL and reduce the burden of epilepsy require greater emphasis on the early diagnosis and treatment of comorbid psychopathology.
Both hypertension and depression are common disorders which may both involve components of the hypothalamic-pituitary-adrenal axis system and the Renin-Angiotensin-Aldosterone System (RAAS). These observations, coupled with growing evidence that RAAS-active drugs may have anti-depressant properties prompted us to study the frequency of anti-depressant medication usage in the patients receiving RAAS-active agents. A chart review was performed on 378 patients who were seen during a 3-month period in a primary care clinic and who were diagnosed with hypertension. Demographic information and data on the rates of co-administration of antihypertensive and anti-depressant medications was collected. Overall, 23.7% of the sample was on an antidepressant. 20% of the patients taking a RAAS-modifying medication were on an antidepressant, compared to 34% of those not taking a RAAS-modifying medication (Χ(2) = 8.88, P = 0.003). The patients taking a beta-blocker alone had the highest rate of antidepressant usage (40%). The use of RAAS-modifying medications was associated with an even lower rate of anti-depressant usage in males compared with females. It was also observed that the patients taking an additional diuretic had a significantly lower rate of antidepressant use (17.6%, Χ(2) = 5.81, P = 0.016) compared with the patients not taking a diuretic. The patients being treated with an ACE inhibitor or ARB showed significantly lower rates of antidepressant usage. The data is supportive of the hypothesis that these agents may possess anti-depressant effects.
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