Mood and Anxiety Disorders and Suicidality in Patients With Newly Diagnosed Focal Epilepsy

Abstract

Rationale and aim of the study:Mood, anxiety disorders and suicidality are more frequent in people with epilepsy than in the general population. Yet, their prevalence and the types of mood and anxiety disorders associated with suicidality at the time of the epilepsy diagnosis is not established. We sought to answer these questions in patients with newly diagnosed focal epilepsy and to assess their association with suicidal ideation and attempts.Methods:The data were derived from the Human Epilepsy Project study. A total of 347 consecutive adults aged 18 to 60 years old with newly diagnosed focal epilepsy were enrolled within 4 months of starting treatment. The types of mood and anxiety disorders were identified with the MINI International Neuropsychiatric Interview, while suicidal ideation (lifetime, current, active and passive) and suicidal attempts (lifetime, current) were established with the Columbia Suicidality Severity Rating Scale (CSSRS). Statistical analyses included T-test, Chi-square statistics and logistic regression analyses.Results:A total of 151 (43.5%) subjects had a psychiatric diagnosis; 134 (38.6%) met criteria for a mood and / or anxiety disorder and 75 (21.6%) reported suicidal ideation with or without attempts. Mood (23.6%) and anxiety (27.4%) disorders had comparable prevalence rates, while both disorders occurred together in 43 patients (12.4%). Major depressive disorders (MDD) had a slightly higher prevalence than bipolar disorders (BPD) (9.5% vs 6.9%, respectively). Explanatory variables of suicidality included MDD, BPD, panic disorders and agoraphobia, with BPD and panic disorders being the strongest variables, particularly for active suicidal ideation and suicidal attempts.Conclusions:In patients with newly diagnosed focal epilepsy, the prevalence of mood, anxiety disorders and suicidality are higher than in the general population and comparable to those of patients with established epilepsy. Their recognition at the time of the initial epilepsy evaluation is of the essence.

Epilepsy and Depression

“…This study supports the same observations that were made in national studies conducted in Canada and Sweden. 2 One big difference with this study was the sample size: this study looked at this association in a much larger group of people with chronic medical illnesses than previous studies did. In addition, this study was conducted over almost 4 decades, much longer than many other studies.…”

“…Of note, 13%–37% of people with epilepsy experience depression also. 2 This is 2–5 times higher than the rate of depression in people without epilepsy. To better understand this connection, the authors looked at registry data on a very large group of people (more than 8 million), collected over 35 years (from January 1, 1980, to December 31, 2016).…”

Evidence based noninvasive presurgical evaluation for patients with drug resistant epilepsies

“…Epilepsies are a group of heterogenous disorders affecting more than 50 million people worldwide ranking fifth among all neurological disorders in terms of standardized disability-adjusted life-years (DALYs) [1,2 ▪ ] with an overall annual cost estimated at $119.27 billion per year, globally [3]. Despite more than 30 antiseizure medications (ASM) one third of patients remain drug resistant, which carries a high risk of premature mortality due to sudden unexpected death (SUDEP), accidents, and suicide [4] with overall reduced life expectancy [5], high morbidity including cardio- and cerebrovascular diseases [6], mental comorbidities [7 ▪ ] and cognitive dysfunction, in particular in the young and the elderly population with epilepsies [8].…”

Text mining of electronic health records can validate a register‐based diagnosis of epilepsy and subgroup into focal and generalized epilepsy

“…2 In the group of epilepsy patients with genetic/presumed genetic etiology, most patients appear to have a polygenic etiology, but how multiple gene variants and environmental factors contribute to the pathogenesis of epilepsy is largely unknown. 3 Likewise, how genetic and environmental factors contribute both individually and in combination to antiseizure drug efficacy, 4,5 psychiatric disease, 6,7 and cognitive dysfunction 8 is widely unknown in epilepsy. Access to large data sources such as electronic health records (EHRs) and population-based administrative registry data promises the generation of large retrospective cohorts in tens of thousands of phenotyped and genotyped patients that will pave the way for developing therapy and preventive strategies tailored to individual patients or clusters of patients with identical phenotypes, 9 that is, the development of precision medicine in epilepsy.…”