Psychiatric Comorbidities and Outcomes in Epilepsy Patients: An Insight from a Nationwide Inpatient Analysis in the United States

Patel, Rikinkumar S; Elmaadawi, Ahmed Z.; Mansuri, Zeeshan; Kaur, Mandeep; Shah, Ketul; Nasr, Suhayl

doi:10.7759/cureus.1686

Cited by 36 publications

(41 citation statements)

References 18 publications

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“…As per the 2015 National Health Interview Survey, epilepsy prevalence is about 1.2% in the United States general population, and our study patients with a primary diagnosis of epilepsy constituted 0.97% of the total inpatient admissions. A nationwide inpatient study estimated 7.8% prevalence of drug abuse in epilepsy patients, which was similar to that seen in our study population (7%). Younger male and non‐Hispanic Black had a higher prevalence of epilepsy hospitalization.…”

Section: Discussionsupporting

confidence: 90%

Cannabis Use Disorder and Epilepsy: A Cross‐National Analysis of 657 072 Hospitalized Patients

2019

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Background and Objectives Recent evidence has suggested that cannabis use precipitates cerebrovascular events. We investigated the relationship between cannabis use disorder (CUD) and hospitalization for epilepsy. Methods Nationwide inpatient sample (NIS) was analyzed from 2010 to 2014 for patients (age 15‐54) with a primary diagnosis of epilepsy (N = 657 072) and comparison was made between patients with ICD‐9 classification of CUD and without CUD. We utilized logistic regression to study the association (odds ratio [OR]) between CUD and epilepsy. Results The incidence of CUD in epilepsy patients was 5.77%, and patients with CUD had a threefold higher likelihood of emergency admissions. Patients with CUD were younger (25‐34 years), male and African American. In regression analysis, adjusted for confounders, cannabis (OR, 1.56), tobacco (OR, 1.20), and alcohol (OR, 1.63) use disorders were found to be associated with higher odds of epilepsy hospitalization, but lower odds with cocaine (OR, 0.953), amphetamine (OR, 0.893), and opioid (OR, 0.828) use disorders. Conclusions and Scientific Significance With the increasing prevalence of medical marijuana legalization, there is increased use of medicinal marijuana. Studies of cannabidiol and marijuana for epilepsy have been highly publicized, leading to its off‐label use for treatment. There is limited evidence to suggest that the cannabinoids may also induce a seizure. This study found that CUD is independently associated with a 56% increased likelihood of epilepsy hospitalization and this association persists even after adjusting for other substance use disorders and confounders. (Am J Addict 2019;28:353–360)

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Section: Discussionsupporting

confidence: 90%

Cannabis Use Disorder and Epilepsy: A Cross‐National Analysis of 657 072 Hospitalized Patients

2019

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“…16 in one more study done by Patel et al ,depression is the most prevalent psychiatric comorbidity in epilepsy. 20…”

Section: Discussionmentioning

confidence: 99%

Prevalence of psychiatric comorbidities among the patients of epilepsy attending general hospital psychiatric unit

Rani¹,

Arora²,

Garg³

et al. 2018

Int. J. Curr. Res. Med. Sci.

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Background: Depression is most common psychiatric disorder in patients with epilepsy and it is the significant cause of morbidity. 1 Upto 50-60 percent of patients with epilepsy may develop psychiatric complications, particularly depression, anxiety, and psychotic disorders. 2 There is growing evidence of biological link between depression and epilepsy, and significant factors involved are the biological amines and gamma amino butyric acid (GABA) 3 along with other neurobiological and psychosocial factors. This study assess the symptoms and severity of psychiatric comorbidities in patients diagnosed with epilepsy. Methods and Findings: This study was conducted on patients attending psychiatric outpatient epilepsy clinic in psychiatry department, government medical college, Amritsar. A total of 40 patients were studied to find out the prevalence and severity of depression by using self applicable questionnaire, Beck depression inventory (BDI), 4 and MINI, in patients who are diagnosed with epilepsy by clinical interview and examination by senior psychiatrist consultant. In the results of our study 50% patients had psychiatric co-morbidities.40% had depressive disorder. Depression is found to be more among females in our study. 22.5 % were females and 17.5% were males. Among depressed patients, 22.5% had severe depression. Prevalence of moderate depression was 15% , and 2.5 % had borderline clinical depression, 5% had psychosis, and 5% had substance dependence. Conclusion: Diagnosing psychiatric co-morbidities can be difficult in patients with epilepsy. The treatment of both epilepsy and depression need for close collaboration. Patient taking antiepileptic medication may have symptoms of depression as a result of their treatment. Sadly, data from drug trials are often helpful. The antiepileptic medications most closely associated with acute depression on initiation of treatment are vigabatrin, phenobarbitone, and topiramate. Depression with topiramate may be due to abrupt cessation of seizures or drug toxicity. Patients starting tiagabine may develop symptoms of agitation, withdrawal, and mood disturbance suggestive of depression;. Thus good awareness and recognition of psychiatric conditions can help a long way in improving the quality of care of patients with epilepsy.

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“…21 A recent study using national US data found that epilepsy patients with comorbid depression or psychosis contributed to higher total hospitalization charges. 26 Psychiatric comorbidities are not only associated with a lack of response to antiseizure Note: Unadjusted model tests association between discharge disposition and epilepsy without controlling for any other factors and without accounting for IPTW.…”

Section: Discussionmentioning

confidence: 99%

Nonelective hospital admissions, discharge disposition, and health services utilization in epilepsy patients: A population‐based study

et al. 2020

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Identifying adverse outcomes and examining trends and causes of nonelective admissions among persons with epilepsy would be beneficial to optimize patient care and reduce health services utilization. We examined the association of epilepsy with discharge status, in-hospital mortality, length-of-stay, and charges. We also examined 10-year trends and causes of hospital admissions among those with and without epilepsy. Methods: Nonelective hospital admission in persons with epilepsy was identified in the 2005-2014 National Inpatient Sample (NIS) using a validated International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) case definition. The NIS is the largest US all-payer database including patient and hospitallevel variables, and represents hospitalizations in the general population. Descriptive statistics on trends and causes of admissions and multivariable regression analysis summarizing the association of epilepsy with the outcomes of interest are presented.

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Psychiatric Comorbidities and Outcomes in Epilepsy Patients: An Insight from a Nationwide Inpatient Analysis in the United States

Cited by 36 publications

References 18 publications

Cannabis Use Disorder and Epilepsy: A Cross‐National Analysis of 657 072 Hospitalized Patients

Cannabis Use Disorder and Epilepsy: A Cross‐National Analysis of 657 072 Hospitalized Patients

Prevalence of psychiatric comorbidities among the patients of epilepsy attending general hospital psychiatric unit

Nonelective hospital admissions, discharge disposition, and health services utilization in epilepsy patients: A population‐based study

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