Major Finding: SPI-positive patients were significantly more likely than were SPI-negative patients to have a depressive disorder diagnosis (80% vs. 19%, respectively), previous psychiatric history (90% vs. 27%), and to currently use psychotropic medications (50% vs. 13%), all risk factors for suicide.
Data Source: Analysis of 58 consecutive adults at an inpatient epilepsy service.
Disclosures: The authors disclosed no conflicts of interest.
CHICAGO – A past psychiatric history, depressive disorder diagnosis, and current use of psychotropic medications were significantly associated with a higher potential for suicidal behavior.
“Suicide risk in patients with epilepsy reflects the higher incidence of psychiatric comorbidity in this population rather than any neurologic or demographic factor,” reported Robert C. Doss, Psy.D., and Dr. Patricia E. Penovich, of the Minnesota Epilepsy Group in St. Paul. This finding confirms what has been established in previous research.
About 30% of people with epilepsy have a major depressive disorder, and research suggests that about 50% of the time they are never treated for the problem, according to the Epilepsy Foundation.
Moreover, the suicide rate in persons with epilepsy is on average 12%, compared with about 1% in the general population (Epilepsy Behav. 2003;4:[Suppl. 3]S31–8). Given the prevalence of this problem and the 2008 warning by the Food and Drug Administration regarding the association between suicidality and antiepileptic drugs, further understanding of this matter is urgently needed, Dr. Doss and Dr. Penovich reported in a poster at the conference.
Upon admission, the 58 patients in the sample underwent long-term video-EEG, neuropsychological testing, personality assessment using the Personality Assessment Inventory, social work evaluation, and if indicated, psychology and/or psychiatry consultation.
Ten patients (mean age, 36 years) showed clinical elevations on the inventory's Suicide Potential Index (SPI) and 48 patients (mean age, 38 years) did not. The SPI consists of 20 features on the inventory that tap what are described as key risk factors for completed suicide in the suicidality literature.
Patients with a positive SPI were significantly more likely than were those with a negative SPI to have a depressive disorder diagnosis (80% vs. 19%, respectively), to have a previous psychiatric history (90% vs. 27%), and to currently use psychotropic medications (50% vs. 13%), Dr. Doss and Dr. Penovich reported.
No other variables, including age, gender, education, duration of epilepsy, temporal lobe epilepsy, complex partial seizures, other neurologic history, epilepsy surgery, number of anti-epileptic drugs, seizure frequency, anxiety disorder diagnosis, or cognitive status were found to significantly differentiate the two groups.
The lifetime prevalence rate of suicide and suicide attempts has been reported to be particularly high in patients with temporal lobe epilepsy and those who have had epilepsy surgery when compared with the general population, but neither risk factor stood out in the current analysis. Temporal lobe epilepsy was present in 30% of the SPI-positive group, compared with 55% of the SPI-negative group, and epilepsy surgery in 20%, compared with 10%.
Also, the number of antiepileptic drugs was similar in both groups at 2.0 and 1.8.
“Routine care of persons with epilepsy should include screening for both current and past psychiatric symptoms,” the authors concluded. “Particular attention should be paid to persons with epilepsy with a clear psychiatric history.”
The conference was jointly sponsored by the EDDC and the office of continuing education of Elsevier, which owns this news organization.