Psychiatric Disorders after Epilepsy Diagnosis: A Population-Based Retrospective Cohort Study

Abstract

BackgroundPsychiatric manifestations after occurrence of epilepsy have often been noted. However, the association between newly diagnosed epilepsy and psychiatric disorders afterward is not completely understood. We conducted two longitudinal cohorts for patients with and without epilepsy to investigate the risk factors and hazard ratios of developing psychiatric disorders after patients were newly diagnosed with epilepsy.MethodsWe identified 938 patients with a new diagnosis of epilepsy and 518,748 participants without epilepsy from the National Health Insurance Research Database in 2000–2002 and tracked them until 2008. We compared the incidence of developing psychiatric disorders between the two cohorts, evaluated risk factors and measured the associated hazard ratios (HRs) and 95% confidence intervals (CIs) of developing psychiatric disorders.FindingsThe incidences of psychiatric disorders for people with and without epilepsy were 94.1 and 22.6 per 1000 person-years, respectively. After adjusting the covariates, the epilepsy cohort showed the highest risks in mental retardation (HR 31.5, 95% CI 18.9 to 52.4), bipolar disorder (HR 23.5, 95% CI 11.4 to 48.3) and alcohol or drug psychosis (HR 18.8, 95% CI 11.1 to 31.8) among psychiatric complications developed after newly diagnosed epilepsy. The risk increased with epileptic general seizure and frequency of outpatient visits for epilepsy, as well as with emergency room visits and hospitalizations for epilepsy, and with older age. Chronologically, the highest risk occurred in the first year after epilepsy diagnosis (HR 11.4, 95% CI 9.88 to 13.2).ConclusionVarious psychiatric disorders were demonstrated after newly diagnosed epilepsy and closely related to general seizure and use of medical services for epilepsy. This shows a need for integrated psychiatric care for patients newly diagnosed with epilepsy, especially in the first year.

Psychiatric morbidity in children with epilepsy

“…11 Another study found that psychiatric disorders affect 41% patients with epilepsy. 3 The difference can be explained by the differences in study setting and sample size distribution. In our study attention deficit hyperactivity disorder (ADHD) was found in 5.8% of the respondents.…”

“…7 Other studies revealed that the common psychiatric co-morbidities found among patients with epilepsy were depression, neuroses (non-psychotic anxiety disorders) and psychoses. 3 It has been observed that 25%-40% of individuals with certain neurological conditions such as epilepsy will develop a marked depressive disturbance and psychotic symptoms at some point during the course of illness. 3 In our study, other co-morbidities included substance abuse, schizophrenia and social phobia.…”

“…1 It is the most common neurological disorder worldwide affecting an estimated 50 million people and 80% of affected children are estimated to live in low-income countries. [2][3][4] Children with epilepsy have a high burden of psychiatric and neuro-developmental co-morbidities, and they experience poor long-term psychosocial outcomes even after remission of their epilepsy in adulthood. 1,5 Epilepsy affects physical, mental and behavioral functions and is associated with higher risk of premature death due to traumatic brain injury, status epilepticus, suicide, pneumonia and sudden death, and it accounts for 1.4% of all years of life lost.…”

“…1,5 Epilepsy affects physical, mental and behavioral functions and is associated with higher risk of premature death due to traumatic brain injury, status epilepticus, suicide, pneumonia and sudden death, and it accounts for 1.4% of all years of life lost. 3 There is now a general agreement that the incidence of neurobehavioral disorders is higher in patients with epilepsy than in the general population. 6 Co-morbidities in epilepsy can be debilitating, but they are often overlooked.…”

Lithium improved behavioral and epileptic symptoms in an adolescent with ring chromosome 20 and bipolar disorder not otherwise specified

“…Considering the bipolar disorder NOS presentation of our patient and data in the literature on links between epilepsy and bipolar disorder,24, 25, 26 we suggest there may be a link between resistant epileptic disease and bipolar disorder NOS in R(20). Therefore, we extrapolate that bipolar disorder features could be triggered or exacerbated by status epilepticus.…”