Screening for Psychiatric Comorbidities and Psychotherapeutic Assessment in Inpatient Epilepsy Care: Preliminary Results of an Implementation Study

Abstract

Background: Anxiety and depression remain underdiagnosed in routine clinical practice in up to two thirds of epilepsy patients despite significant impact on medical and psychosocial outcome. Barriers to adequate mental health care for epilepsy and/or psychogenic non-epileptic seizures (PNES) include a lack of integrated mental health specialists and standardized procedures. This naturalistic study outlines the procedures and outcome of a recently established psychotherapeutic service.Methods: Routine screening included the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E, cut-off value > 13) and Generalized Anxiety Disorder scale (GAD-7, cut-off value > 5). Positively (above cut-off in at least one questionnaire) screened patients were seen for a standardized interview for mental health disorders and the development of a personalized treatment plan. PNES patients were seen irrespective of their screening score. Resources were provided to support self-help and access to psychotherapy. Patients were contacted 1 month after discharge to evaluate adherence to therapeutic recommendations.Results: 120 patients were screened. Overall, 56 of 77 positively screened patients (77%) were found to have a psychiatric diagnosis through standardized interview. More epilepsy patients with an anxiety disorder had previously been undiagnosed compared to those with a depressive episode (63% vs. 30%); 24 epilepsy patients (62%) with a psychiatric comorbidity and 10 PNES patients (59%) were not receiving any mental health care. At follow-up, 16/17 (94%) epilepsy patients and 7/7 PNES patients without prior psychiatric treatment were adhering to therapeutic recommendations.Conclusion: Integrating mental health specialists and establishing standardized screening and follow-up procedures improve adherence to mental health care recommendations in epilepsy and PNES patients.

Cannabinoid 1/2 Receptor Activation Induces Strain-Dependent Behavioral and Neurochemical Changes in Genetic Absence Epilepsy Rats From Strasbourg and Non-epileptic Control Rats

“…Nearly 30% of people with convulsive epilepsy suffer from comorbid neuropsychiatric disorders, with the predominance of anxiety and depression ( Mula et al, 2021 ). The presence of psychiatric comorbidities is a negative prognostic marker that is associated with a worse response to treatment, increased morbidity, mortality, and adverse clinical outcome ( Michaelis et al, 2021 ). The burden of the commodities is even higher in people with non-convulsive epilepsy.…”

Integrated psychological care services within seizure settings: Key components and implementation factors among example services in four ILAE regions: A report by the ILAE Psychiatry Commission

“…In this service, all seizure inpatients are given measures for depression and anxiety (Table S1). Those scoring above clinical cutoffs, and all FDS patients regardless of scores, are allocated to members of the psychotherapy team to arrange further assessment 45 …”

“…Across several publications, the RHH/EN has demonstrated that patients attending the service experience significant improvements in their mental health symptoms (e.g., trauma, depression) that remain at follow‐up 32,40,41 . The UKB/DE recently published data demonstrating that >95% of consenting participants adhered to mental health treatment plan recommendations 1 month after discharge 45 . The UKB/DE is actively collecting follow‐up data on depressive and anxiety symptoms, as well as QOL, which is currently unpublished.…”

“…Those scoring above clinical cutoffs, and all FDS patients regardless of scores, are allocated to members of the psychotherapy team to arrange further assessment. 45 All other adult services were allocated patients directly from concerned practitioners' referrals, usually in relation to concerns about depression, anxiety, posttraumatic distress, and poor adjustment to seizures/epilepsy. The RHH/EN service and the neuropsychiatry pathway at the RIH/USA primarily serve FDS or mixed epilepsy/FDS patient presentations.…”

“…32,40,41 The UKB/DE recently published data demonstrating that >95% of consenting participants adhered to mental health treatment plan recommendations 1 month after discharge. 45 The UKB/ DE is actively collecting follow-up data on depressive and anxiety symptoms, as well as QOL, which is currently unpublished. One service, the RIH/USA neuropsychiatry division, is in the process (under review) of publishing data on PWE using NBT, which demonstrates reduction in epileptic seizures and improvements in neuropsychiatric aspects of epilepsy.…”