Increased suicide attempt risk in people with epilepsy in the presence of concurrent psychogenic nonepileptic seizures

Faiman, Irene; Hodsoll, John; Young, Allan H.; Shotbolt, Paul

doi:10.1136/jnnp-2022-329093

Cited by 6 publications

(6 citation statements)

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“…Inclusion criteria were a primary or secondary diagnosis of epilepsy (International Classification of Diseases, version 10 (ICD-10) code G40) or FDS (ICD-10 F44.5). We also extracted data for people with concurrent diagnosis of epilepsy and FDS, which were utilised in a previous study based on the same data[7]; however, the small sample size prevented us from investigating risk and protective factors for this group. Exclusion criteria were a primary or secondary diagnosis of psychotic disorder (ICD-10 F20-F29) or structural brain disease, including cerebral malignancy (ICD-10 C71, C79.3, D43.0-D43.2, D49.6), traumatic brain injury (ICD-10 S01, S02, S06, S07, S09), dementia or progressive neurodegenerative disease (ICD-10 F00-F03).…”

Section: Methodsmentioning

confidence: 99%

“…FDS are abrupt and observable episodes of altered behaviour or consciousness that superficially resemble epileptic seizures but are not associated with electroencephalography changes [5]. People with FDS have elevated suicide mortality rates (2.6-18.8%) as compared to the general population [6][7][8], and the presence of FDS has been found to increase the risk of suicide attempt-related hospitalisation in people with epilepsy [7].…”

Section: Introductionmentioning

confidence: 99%

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Sociodemographic and clinical risk factors for suicidal ideation and suicide attempt in functional/dissociative seizures and epilepsy: a large cohort study

Faiman,

Hodsoll,

Jasani

et al. 2023

Preprint

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ObjectiveTo identify risk factors for first episodes of suicidal ideation and suicide attempt in people with functional/dissociative seizures (FDS) or epilepsy.MethodsRetrospective cohort study from the UK’s largest tertiary mental health care provider, with linked national admission data from the Hospital Episode Statistics (HES). Participants were 2383 people with a primary or secondary diagnosis of FDS or epilepsy attending between 01/01/2007 and 18/06/2021. Outcomes were a first report of suicidal ideation and a first hospital admission for suicide attempt (ICD-10 X60-X84). Demographic and clinical risk factors were assessed using multivariable bias-reduced binomial-response generalised linear models.ResultsIn both groups, ethnic minorities had significantly reduced odds of hospitalisations following a suicide attempt (OR: 0.45 – 0.49). Disorder-specific risk factors were gender, age, and comorbidity profile. In FDS, both genders had similar risk of suicidality; younger age was a risk factor for both outcomes (OR: 0.16 – 1.91) and a diagnosis of Depression or Personality Disorders was associated with higher odds of reporting suicidal ideation (OR: 1.91 and 3.01 respectively). In epilepsy, females had higher odds of being hospitalised following suicide attempt (OR: 1.64). Age had a quadratic association with both outcomes (OR: 0.88 – 1.06). A Substance Abuse Disorder was associated to higher suicidal ideation (OR: 2.67) whilst Developmental Disorders lowered the risk (OR: 0.16 – 0.24).ConclusionsThis is the first study systematically reporting risk factors for suicidality in people with FDS. Results for the large epilepsy cohort complement previous studies and will be useful in future meta-analyses.KEY MESSAGE BOXWhat is already known on this topicPeople with epilepsy and people with functional/dissociative seizures (FDS) are at elevated risk of suicideIdentification of risk factors for suicidal ideation and suicide attempt in high-risk groups is essential to inform risk prevention strategiesWhat this study addsSeveral factors are associated with suicidality in FDS, including age, ethnicity, comorbid Depression and Personality Disorders.In epilepsy, suicidality is associated with age, gender, ethnicity, comorbid Substance Misuse Disorder and Developmental Disorders.How this study might affect research, practice or policyWhilst disorder-specific factors will be useful to identify groups at higher risk in clinical settings, general risk factors can be target of population-based preventive strategies.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sociodemographic and clinical risk factors for suicidal ideation and suicide attempt in functional/dissociative seizures and epilepsy: a large cohort study

Faiman,

Hodsoll,

Jasani

et al. 2023

Preprint

Self Cite

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“…Of all observed deaths in the observation period 1/118 (0.9%) was due to suicide in the epilepsy group and 1/38 (2.7%) in the PNES group. Suicide attempts were noted in the records of 6.1% of patients with epilepsy, 12.4% of patients with PNES and 15.6% of those with mixed seizure disorders [22]. Huepe-Artigas et al [23] determined that patients with PNES showed more suicidal behaviour and dissociative symptoms compared to patients with functional motor disorder (FMD).…”

Section: Key Pointsmentioning

confidence: 99%

An update on psychogenic nonepileptic seizures

Vijay,

Reuber

2024

Current Opinion in Neurology

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Purpose of review The understanding of psychogenic nonepileptic seizures (PNES) has advanced steadily over recent decades. This update summarizes new insights from the last three years. Recent findings The process of diagnosing PNES has shifted from the exclusion of epilepsy to one based on the recognition of typical clinical features. While the diagnosis cannot rely on any single feature in isolation, a range of semiological features characterising PNES are now recognised and a number of studies hint at the potential for machine learning and AI to improve the diagnostic process. Advances in data processing and analysis may also help to make sense of the heterogeneity of PNES populations demonstrated by recent studies focussing on aetiology and patient subgroups. It is now clear that PNES are associated with high rates of mental and physical comorbidities and premature death, highlighting that they are only one manifestation of a complex disorder extending beyond the nervous system and the seizures themselves. Summary PNES are now understood as a manifestation of dysfunction in interacting brain networks. This understanding provides an explanation for the psychopathological and semiological heterogeneity of PNES patient populations. New insights into medical comorbidities and increased rates of premature death call for more research into associated pathological processes outside the nervous system.

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“…FDS are abrupt and observable episodes of altered behaviour or consciousness that superficially resemble epileptic seizures but are not associated with electroencephalography changes 5. People with FDS have elevated suicide mortality rates (2.6–18.8%) as compared with the general population,6–8 and the presence of FDS has been found to increase the risk of suicide attempt-related hospitalisation in people with epilepsy 7…”

Section: Introductionmentioning

confidence: 99%

“… 5 People with FDS have elevated suicide mortality rates (2.6–18.8%) as compared with the general population, 6–8 and the presence of FDS has been found to increase the risk of suicide attempt-related hospitalisation in people with epilepsy. 7 …”

Section: Introductionmentioning

confidence: 99%

Sociodemographic and clinical risk factors for suicidal ideation and suicide attempt in functional/dissociative seizures and epilepsy: a large cohort study

Faiman,

Hodsoll,

Jasani

et al. 2024

BMJ Ment Health

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BackgroundPeople with functional/dissociative seizures (FDS) are at elevated suicidality risk.ObjectiveTo identify risk factors for suicidality in FDS or epilepsy.MethodsRetrospective cohort study from the UK’s largest tertiary mental healthcare provider, with linked national admission data from the Hospital Episode Statistics. Participants were 2383 people with a primary or secondary diagnosis of FDS or epilepsy attending between 01 January 2007 and 18 June 2021. Outcomes were a first report of suicidal ideation and a first hospital admission for suicide attempt (International Classification of Diseases, version 10: X60–X84). Demographic and clinical risk factors were assessed using multivariable bias-reduced binomial-response generalised linear models.FindingsIn both groups, ethnic minorities had significantly reduced odds of hospitalisation following suicide attempt (OR: 0.45–0.49). Disorder-specific risk factors were gender, age and comorbidity profile. In FDS, both genders had similar suicidality risk; younger age was a risk factor for both outcomes (OR: 0.16–1.91). A diagnosis of depression or personality disorders was associated with higher odds of suicidal ideation (OR: 1.91–3.01). In epilepsy, females had higher odds of suicide attempt-related hospitalisation (OR: 1.64). Age had a quadratic association with both outcomes (OR: 0.88–1.06). A substance abuse disorder was associated with higher suicidal ideation (OR: 2.67). Developmental disorders lowered the risk (OR: 0.16–0.24).ConclusionsThis is the first study systematically reporting risk factors for suicidality in people with FDS. Results for the large epilepsy cohort complement previous studies and will be useful in future meta-analyses.Clinical implicationsRisk factors identified will help identify higher-risk groups in clinical settings.

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Increased suicide attempt risk in people with epilepsy in the presence of concurrent psychogenic nonepileptic seizures

Cited by 6 publications

References 32 publications

Sociodemographic and clinical risk factors for suicidal ideation and suicide attempt in functional/dissociative seizures and epilepsy: a large cohort study

Sociodemographic and clinical risk factors for suicidal ideation and suicide attempt in functional/dissociative seizures and epilepsy: a large cohort study

An update on psychogenic nonepileptic seizures

Sociodemographic and clinical risk factors for suicidal ideation and suicide attempt in functional/dissociative seizures and epilepsy: a large cohort study

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