CHICAGO (EGMN) – 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 2010 Epilepsy and Depressive Disorders Conference (EDDC).

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), 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 authors disclosed no conflicts of interest. The conference was jointly sponsored by the EDDC and the office of continuing education of Elsevier, which owns this news organization.

Copyright (c) 2010 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

芝加哥(EGMN)——美国明尼苏达州圣保罗市的明尼苏达癫痫研究组(Minnesota Epilepsy Group)的Robert C. Doss和Patricia E. Penovich医生在2010年癫痫与抑郁症大会(Epilepsy and Depressive Disorders Conference，EDDC)的壁报展示中提到，既往有精神病史、抑郁症的患者或正在使用精神科药物的患者出现自杀行为的倾向明显增加。

 

既往研究显示，约30%癫痫患者存在严重的抑郁症，而美国癫痫基金会(Epilepsy Foundation)的研究显示其中约50%患者的抑郁障碍没有得到治疗。癫痫患者的自杀率平均为12%，而一般人群中为1%(Epilepsy Behav. 2003;4:[Suppl. 3]S31-8)。研究者认为，由于此类问题的发生率较高，并且2008年美国FDA曾对自杀和抗癫痫药物间的关联发出过警告，所以急需对此问题开展进一步的研究。为此，他们共招募了58例癫痫患者，受试者均接受了长期视频脑电监护、神经心理测验、人格评定(使用人格评定量表)、社会工作评定，对于有指证的患者还进行了心理和(或)精神病学的咨询。

 

研究结果显示，10例(平均36岁)自杀倾向指数(Suicide Potential Index, SPI)升高，48例(平均38岁)未升高。SPI中包括了能完整描述自杀关键危险因素量表的20种特征。SPI阳性与SPI阴性患者相比，抑郁症(80% 对19%)、既往精神病史(90%对27%)、正在使用精神科药物(50%对13%)等百分率明显更高。而SPI阳性与SPI阴性两组患者在其他变量方面没有明显区别(包括年龄、性别、教育程度、癫痫持续时间、颞叶癫痫、复杂的部分性癫痫发作、其他神经系统疾病史、治疗癫痫的手术、抗癫痫药物的种类、癫痫发作的频率、焦虑障碍、认知障碍持续状态等)。该研究显示，癫痫患者的自杀倾向反映了在这一人群中精神疾病共病的发生率更高，而不是任何神经系统或人口统计学方面的因素。

 

既往报道，与一般人群相比，颞叶癫痫及曾接受过癫痫治疗手术的患者，自杀和企图自杀的终身发生率明显偏高，但此研究中这两个因素的影响均不突出。SPI阳性组患者中30%为颞叶癫痫，阴性组中55%为颞叶癫痫，而SPI阳性组及阴性组接受癫痫治疗手术的比率分别为20%和10%。同样，两组患者使用抗癫痫药物种类也相近，分别为2.0种和1.8种。

 

基于此研究结果，研究者认为，癫痫患者常规诊疗应包括筛查现症或既往精神疾病的症状，对有明确精神病史的癫痫患者要给予特别关注。

 

研究者声明该研究没有利益冲突。大会由EDDC及Elsevier继续教育办公室联合发起。

 

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