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Greenwood HT, French J, Ferrer M, Jandhyala N, Thio LL, Dlugos DJ, Park KL, Kanner AM. Prevalence of Suicidality in Adolescents With Newly Diagnosed Focal Epilepsy at Diagnosis and Over the Following 36 Months. Neurology 2024; 103:e209397. [PMID: 38833656 DOI: 10.1212/wnl.0000000000209397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Individuals with epilepsy have increased risk of suicidal ideation (SI) and behaviors when compared with the general population. This relationship has remained largely unexplored in adolescents. We investigated the prevalence of suicidality in adolescents with newly diagnosed focal epilepsy within 4 months of treatment initiation and over the following 36 months. METHODS This was a post hoc analysis of the enrollment and follow-up data from the Human Epilepsy Project, an international, multi-institutional study that enrolled participants between 2012 and 2017. Participants enrolled were 11-17 years of age within 4 months of treatment initiation for focal epilepsy. We used data from the Columbia Suicide Severity Rating Scale (C-SSRS), administered at enrollment and over the 36-month follow-up period, along with data from medical records. RESULTS A total of 66 adolescent participants were enrolled and completed the C-SSRS. At enrollment, 14 (21%) had any lifetime SI and 5 (8%) had any lifetime suicidal behaviors (SBs). Over the following 36 months, 6 adolescents reported new onset SI and 5 adolescents reported new onset SB. Thus, the lifetime prevalence of SI within this population increased from 21% to 30% (14-20 adolescents), and the lifetime prevalence of SB increased from 8% to 15% (5-10). DISCUSSION The prevalence of suicidality in adolescents with newly diagnosed focal epilepsy reported in our study is consistent with previous findings of significant suicidality observed in epilepsy. We identify adolescents as an at-risk population at the time of epilepsy diagnosis and in the following years.
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Affiliation(s)
- Hadley T Greenwood
- From the Department of Neurology (H.T.G., J.F., M.F., N.J.), and Department of Pediatrics (M.F.), NYU Grossman School of Medicine, New York; Department of Neurology (L.L.T.), Washington University in St. Louis School of Medicine, MO; Department of Pediatrics and Neurology (D.J.D.), Children's Hospital of Philadelphia, PA; Department of Pediatrics and Neurology (K.L.P.), University of Colorado School of Medicine, Aurora; and Department of Neurology (A.M.K.), Miller School of Medicine, University of Miami, FL
| | - Jacqueline French
- From the Department of Neurology (H.T.G., J.F., M.F., N.J.), and Department of Pediatrics (M.F.), NYU Grossman School of Medicine, New York; Department of Neurology (L.L.T.), Washington University in St. Louis School of Medicine, MO; Department of Pediatrics and Neurology (D.J.D.), Children's Hospital of Philadelphia, PA; Department of Pediatrics and Neurology (K.L.P.), University of Colorado School of Medicine, Aurora; and Department of Neurology (A.M.K.), Miller School of Medicine, University of Miami, FL
| | - Monica Ferrer
- From the Department of Neurology (H.T.G., J.F., M.F., N.J.), and Department of Pediatrics (M.F.), NYU Grossman School of Medicine, New York; Department of Neurology (L.L.T.), Washington University in St. Louis School of Medicine, MO; Department of Pediatrics and Neurology (D.J.D.), Children's Hospital of Philadelphia, PA; Department of Pediatrics and Neurology (K.L.P.), University of Colorado School of Medicine, Aurora; and Department of Neurology (A.M.K.), Miller School of Medicine, University of Miami, FL
| | - Nora Jandhyala
- From the Department of Neurology (H.T.G., J.F., M.F., N.J.), and Department of Pediatrics (M.F.), NYU Grossman School of Medicine, New York; Department of Neurology (L.L.T.), Washington University in St. Louis School of Medicine, MO; Department of Pediatrics and Neurology (D.J.D.), Children's Hospital of Philadelphia, PA; Department of Pediatrics and Neurology (K.L.P.), University of Colorado School of Medicine, Aurora; and Department of Neurology (A.M.K.), Miller School of Medicine, University of Miami, FL
| | - Liu Lin Thio
- From the Department of Neurology (H.T.G., J.F., M.F., N.J.), and Department of Pediatrics (M.F.), NYU Grossman School of Medicine, New York; Department of Neurology (L.L.T.), Washington University in St. Louis School of Medicine, MO; Department of Pediatrics and Neurology (D.J.D.), Children's Hospital of Philadelphia, PA; Department of Pediatrics and Neurology (K.L.P.), University of Colorado School of Medicine, Aurora; and Department of Neurology (A.M.K.), Miller School of Medicine, University of Miami, FL
| | - Dennis J Dlugos
- From the Department of Neurology (H.T.G., J.F., M.F., N.J.), and Department of Pediatrics (M.F.), NYU Grossman School of Medicine, New York; Department of Neurology (L.L.T.), Washington University in St. Louis School of Medicine, MO; Department of Pediatrics and Neurology (D.J.D.), Children's Hospital of Philadelphia, PA; Department of Pediatrics and Neurology (K.L.P.), University of Colorado School of Medicine, Aurora; and Department of Neurology (A.M.K.), Miller School of Medicine, University of Miami, FL
| | - Kristen L Park
- From the Department of Neurology (H.T.G., J.F., M.F., N.J.), and Department of Pediatrics (M.F.), NYU Grossman School of Medicine, New York; Department of Neurology (L.L.T.), Washington University in St. Louis School of Medicine, MO; Department of Pediatrics and Neurology (D.J.D.), Children's Hospital of Philadelphia, PA; Department of Pediatrics and Neurology (K.L.P.), University of Colorado School of Medicine, Aurora; and Department of Neurology (A.M.K.), Miller School of Medicine, University of Miami, FL
| | - Andres M Kanner
- From the Department of Neurology (H.T.G., J.F., M.F., N.J.), and Department of Pediatrics (M.F.), NYU Grossman School of Medicine, New York; Department of Neurology (L.L.T.), Washington University in St. Louis School of Medicine, MO; Department of Pediatrics and Neurology (D.J.D.), Children's Hospital of Philadelphia, PA; Department of Pediatrics and Neurology (K.L.P.), University of Colorado School of Medicine, Aurora; and Department of Neurology (A.M.K.), Miller School of Medicine, University of Miami, FL
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Zhang Y, Wang H, Liu L. Risk factors of suicide-related events in patients with epilepsy: A systematic review and meta-analysis. Seizure 2024; 120:72-82. [PMID: 38908144 DOI: 10.1016/j.seizure.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 06/24/2024] Open
Abstract
PURPOSE This systematic review and meta-analysis examined the risk factors for suicide-related events (SRE) in patients with epilepsy (PWE). METHODS The PubMed, Embase, Cochrane Online Library, and ClinicalTrials.gov databases were searched for relevant articles published from 1946 to August 30, 2022. The quality of the extracted articles was assessed using the Newcastle-Ottawa scale. Subsequently, a meta-analysis of PWE was performed to calculate the random-effects pooled odds ratios (ORs) for studies investigating the association between suicide and its associated risk factors. All statistical analyses were performed using R version 4.1.0. RESULTS A total of 2,803 studies were screened, of which 23 articles comprising 6,723 PWE were included in our meta-analysis. Female sex (odds ratio [OR]=1.24, 95 % confidence interval [CI]: 1.08-1.43), low quality of life (QOL) scores (standardized mean difference [SMD]= -0.89, CI: -1.17 - -0.61), poor social support (OR=3.44, CI: 1.83-6.46), unemployment (OR=1.82, CI: 1.40-2.38), unmarried status (OR=1.48, CI: 1.12-1.97), low income (OR=1.37, CI: 1.07-1.76), low education (OR=1.33, CI: 1.04-1.68), use of antidepressant drugs (OR=7.77, CI: 3.17-19.03), uncontrolled seizures (OR=2.28, CI: 1.63-3.18), use of multiple antiepileptic drugs (OR=1.70, CI: 1.33-2.18), early age at onset of epilepsy (SMD= -0.15, CI: -0.30 - -0.0002), depression (OR=6.85, CI: 4.88-9.62), and anxiety (OR=3.76, CI: 2.92-4.84) were identified as significant risk factors of SRE. SIGNIFICANCE There are many risk factors for SRE in PWE, as outlined above. Interventions targeting these risk factors may help reduce the risk of SRE in PWE.
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Affiliation(s)
- Yu Zhang
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu 610041, Sichuan, PR China; Department of Neurology, Chengdu Shangjin Nanfu Hospital, Shang Jin Road 253 Chengdu 610000, Sichuan, PR China
| | - Haijiao Wang
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu 610041, Sichuan, PR China; Department of Neurology, Third Xiangya Hospital, Central South University, No.138 Tong Zipo Road, Yuelu District, Changsha City, PR China
| | - Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu 610041, Sichuan, PR China.
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Johnstone T, Isabel Barros Guinle M, Grant GA, Porter BE. Expanding eligibility for intracranial electroencephalography using Dexmedetomidine Hydrochloride in children with behavioral dyscontrol. Epilepsy Behav 2024; 150:109541. [PMID: 38035536 DOI: 10.1016/j.yebeh.2023.109541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/27/2023] [Accepted: 11/12/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Invasive intracranial electroencephalography (IEEG) is advantageous for identifying epileptogenic foci in pediatric patients with medically intractable epilepsy. Patients with behavioral challenges due to autism, intellectual disabilities, and hyperactivity have greater difficulty tolerating prolonged IEEG recording and risk injuring themselves or others. There is a need for therapies that increase the safety of IEEG but do not interfere with IEEG recording or prolong hospitalization. Dexmedetomidine Hydrochloride's (DH) use has been reported to improve safety in patients with behavioral challenges during routine surface EEG recording but has not been characterized during IEEG. Here we evaluated DH administration in pediatric patients undergoing IEEG to assess its safety and impact on the IEEG recordings. METHODS A retrospective review identified all pediatric patients undergoing IEEG between January 2016 and September 2022. Patient demographics, DH administration, DH dose, hospital duration, and IEEG seizure data were analyzed. The number of seizures recorded for each patient was divided by the days each patient was monitored with IEEG. The total number of seizures, as well as seizures per day, were compared between DH and non-DH patients via summary statistics, multivariable linear regression, and univariate analysis. Other data were compared across groups with univariate statistics. RESULTS Eighty-four pediatric patients met the inclusion criteria. Eighteen (21.4 %) received DH treatment during their IEEG recording. There were no statistical differences between the DH and non-DH groups' demographic data, length of hospital stays, or seizure burden. Non-DH patients had a median age of 12.0 years (interquartile range: 7.25-15.00), while DH-receiving patients had a median age of 8.0 years old (interquartile range: 3.00-13.50) (p = 0.07). The non-DH cohort was 57.6 % male, and the DH cohort was 50.0 % male (p = 0.76). The median length of IEEG recordings was 5.0 days (interquartile range: 4.00-6.25) for DH patients versus 6.0 days (interquartile range: 4.00-8.00) for non-DH patients (p = 0.25). Median total seizures recorded in the non-DH group was 8.0 (interquartile range: 5.00-13.25) versus 15.0 in the DH group (interquartile range: 5.00-22.25) (p = 0.33). Median total seizures per day of IEEG monitoring were comparable across groups: 1.50 (interquartile range: 0.65-3.17) for non-DH patients compared to 2.83 (interquartile range: 0.89-4.35) (p = 0.25) for those who received DH. Lastly, non-DH patients were hospitalized for a median of 8.0 days (interquartile range: 6.00-11.25), while DH patients had a median length of stay of 7.00 days (interquartile range: 5.00-8.25) (p = 0.27). No adverse events were reported because of DH administration. CONCLUSIONS Administration of DH was not associated with adverse events. Additionally, the frequency of seizures captured on the IEEG, as well as the duration of hospitalization, were not significantly different between patients receiving and not receiving DH during IEEG. Incorporating DH into the management of patients with behavioral dyscontrol and intractable epilepsy may expand the use of IEEG to patients who previously could not tolerate it, improve safety, and preserve epileptic activity during the recording period.
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Affiliation(s)
- Thomas Johnstone
- Stanford University, School of Medicine, 120 Campus Drive, Stanford, CA, 94305, USA
| | | | - Gerald A Grant
- Department of Neurosurgery, Duke University School of Medicine, 1554A Duke South, Box 3271, Durham, NC, 27710, USA
| | - Brenda E Porter
- Division of Child Neurology, Lucile Packard Children's Hospital, 300 Pasteur Road, Stanford University, Stanford, CA, 94305, USA.
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Hague C, Waber D, Rotenberg A, Vega C. Prevalence of suicidality in children and adolescents with depressive disorders with and without epilepsy. Epilepsy Behav 2023; 148:109467. [PMID: 37844439 DOI: 10.1016/j.yebeh.2023.109467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/25/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE Children with epilepsy (CWE) are at risk for a range of adverse emotional, behavioral, and social outcomes. Approximately one-third of CWE experience depressive disorders, and up to 20% of children and adolescents with epilepsy may experience suicidality, suggesting that epilepsy increases the risk for suicidality among children and adolescents with depressive disorders. Consequently, the goal of the present study is to compare rates of suicidality in children and adolescents diagnosed with depressive disorders with or without co-morbid epilepsy. PARTICIPANTS AND METHODS A retrospective chart review was conducted for 100 pediatric patients with a history of both seizures and depressive disorders and 100 patients with a history of depressive disorders only. Cases were coded for depression diagnosis, suicidality, suicidal ideation, suicide attempts, psychiatric hospitalizations, and self-injury. The distributions of these variables for the two groups were compared. RESULTS The age and sex distributions of the two groups were comparable. Patients with co-morbid depressive disorders and epilepsy found a high rate of suicidal ideation (69%) but did not differ from those with depressive disorders without epilepsy on any of the suicidality variables (all p > 0.20), with the exception of self-injury, which was higher in those without epilepsy. CONCLUSIONS CWE and co-morbid depression are at significant risk for suicidality, including ideation, attempts, and hospitalizations, but at rates that are comparable to those with depressive disorders without seizures. However, patients with co-morbid epilepsy are less likely to engage in other self-injurious behaviors. These findings support the need for careful monitoring of the psychiatric status of children and adolescents with epilepsy.
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Affiliation(s)
- Cole Hague
- Massachusetts General Hospital, 275 Cambridge St, Boston, MA, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, USA
| | - Deborah Waber
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, USA
| | - Alexander Rotenberg
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, USA; Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, USA
| | - Clemente Vega
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, USA.
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Zinchuk M, Kustov G, Pashnin E, Rider F, Sviatskaya E, Popova S, Voinova N, Yakovlev A, Guekht A. Self-injurious thoughts and behaviors in Russian patients with epilepsy: A prospective observational study. Seizure 2023; 107:28-34. [PMID: 36940646 DOI: 10.1016/j.seizure.2023.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVE A two-stage study aimed to estimate the prevalence of different types of self-injurious behaviors (suicidal ideation (SI), suicide attempts (SA), and nonsuicidal self-injury (NSSI)) in Russian patients with epilepsy (PWE), to identify factors associated with such behaviors, and to assess their impact on 3-year mortality. METHODS We enrolled 459 consecutive adult PWE from two level 2 outpatient epilepsy centers in Moscow. The study consisted of two phases - first, we assessed all demographic and clinical characteristics and patients' history of SI, SA, and NSSI. In the second phase, three years after the initial screening, we analyzed patients' medical records to assess how self-injurious thoughts and behaviors were related to actual mortality. RESULTS In our sample, the total lifetime and 12-month prevalence of SI was 20% and 5.7%, of SA was 8.3% and 0.7%, and of NSSI was 15.3% and 2.8%, respectively. We found no differences between deceased and alive PWE regarding lifetime and 12-month prevalence of SI, SA, and NSSI. Higher seizure frequency, lifetime NSSI and lifetime diagnosis of mental disorder were associated with SI, whereas traumatic brain injury (TBI), substance abuse, and NSSI were associated with SA in PWE. SIGNIFICANCE Our study adds to the existing data on the prevalence of different types of suicidal behaviors in PWE and advances research on NSSI in this population. However, more research is needed on the long-term consequences of different types of self-injurious behaviors.
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Affiliation(s)
- Mikhail Zinchuk
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation.
| | - Georgii Kustov
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Evgenii Pashnin
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Flora Rider
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | | | - Sofya Popova
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Nadezhda Voinova
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Alexander Yakovlev
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation; Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russian Federation
| | - Alla Guekht
- Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation; Pirogov Russian National Research Medical University, Moscow, Russian Federation
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Courtwright SE, Jones J, Barton A, Peterson K, Eigen K, Feuerstein J, Pawa A, Pawa A, Northridge J, Pall H. Including Voices of Adolescents With Chronic Conditions in the Redesign of Children's Mental Health Systems: Implications for Resource Allocation. J Pediatr Health Care 2023. [PMID: 36863886 DOI: 10.1016/j.pedhc.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Adolescents with chronic conditions have disparate mental health outcomes. This study aimed to explore the perspectives of adolescents with chronic conditions on mental health system redesign to improve outcomes. METHOD Within an interpretive phenomenological approach, semistructured interviews with 17 adolescents aged 10-20 years with chronic conditions were conducted. Purposive sampling and recruitment occurred at three ambulatory sites. Data were analyzed using inductive and deductive thematic analysis until information saturation was achieved. RESULTS Four themes were identified: (1) Brushed off: I need to be heard, (2) I need someone I can really talk to and trust, (3) They need to reach out to us. Check in on us, and (4) the school nurse is for physical illness only. DISCUSSION Mental health system redesign should be considered for adolescents with chronic conditions. The findings can inform future research to test innovative health care delivery models to reduce mental health disparities in this vulnerable population.
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Affiliation(s)
- Suzanne E Courtwright
- Suzanne E. Courtwright, Postdoctoral Research Fellow, College of Nursing, University of Colorado, Aurora, CO; Center for Healthcare Delivery Research and Innovations, Columbia University School of Nursing, New York, NY.
| | - Jacqueline Jones
- Jacqueline Jones, Professor of Nursing, Assistant Dean and PhD Program Director, College of Nursing, University of Colorado, Aurora, CO
| | - Amy Barton
- Amy Barton, Professor, Senior Associate Dean for Faculty and Students, Daniel and Janet Mordecai Endowed Chair in Rural Health Nursing, College of Nursing, University of Colorado, Aurora, CO
| | - Kerry Peterson
- Kerry Peterson, Associate Professor, Specialty Director of the PMHNP program, University of Colorado, Aurora, CO
| | - Karen Eigen
- Karen Eigen, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Pediatric Emergency Medicine Physician, Department of Emergency Medicine, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ
| | - Jessica Feuerstein
- Jessica Feuerstein, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Pediatrician, Departments of Emergency Medicine and Adolescent Medicine, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ, and Pediatrician; Department of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Anil Pawa
- Anil Pawa, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Chair of Pediatrics, and Professor, Section Chief, Primary Care Pediatrics, Department of Pediatrics, K. Hovnanian Children's Hospital, Jersey Shore University Medical Center, Neptune, NJ
| | - Akhil Pawa
- Akhil Pawa, Research Assistant, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Research Assistant, Department of Emergency Medicine, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ
| | - Jessica Northridge
- Jessica Northridge, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Section Chief, Adolescent Medicine, Department of Emergency Medicine, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ
| | - Harpreet Pall
- Harpreet Pall, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Chair of Pediatrics, and Professor, Department of Pediatrics, K. Hovnanian Children's Hospital, Jersey Shore University Medical Center, Neptune, NJ
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Wang H, Zhang Y, Tan G, Chen D, Fu Y, Liu L. Suicidality and epilepsy: A systematic review and meta-analysis. Front Psychiatry 2023; 14:1097516. [PMID: 37065883 PMCID: PMC10090680 DOI: 10.3389/fpsyt.2023.1097516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/16/2023] [Indexed: 04/18/2023] Open
Abstract
Background We aimed to evaluate the association between epilepsy and suicidality, including suicidal ideation, attempts and completed suicide. Methods We systematically searched PubMed, Embase, Cochrane Online Library, and Clinicaltrials.gov from 1946 to June 21, 2021 and assessed the quality of the studies using the Newcastle-Ottawa Scale. We calculated the pooled OR and the crude rate for suicidal ideation, suicide attempts and completed suicide in patients with epilepsy (PWE). Results We screened 2,786 studies and included 88 articles with 1,178,401 PWE and 6,900,657 participants as controls. Search terms included epilepsy and suicide. The pooled rates of suicidal ideation, suicide attempts and completed suicide in PWE were 19.73% (95% CI: 17.00-22.62%), 5.96% (95% CI: 4.82-7.20%), and 0.24% (95% CI: 0.11-0.42%), respectively. Compared to the control group, PWE were at a significantly higher risk of total suicidality (pooled OR, 2.60; 95%: 2.13-3.18), including suicidal ideation (pooled OR, 2.70; 95% CI, 2.21-3.30), suicide attempts (pooled OR, 2.74; 95% CI, 2.08-3.61) and completed suicide (pooled OR, 2.36; 95% CI, 1.45-3.83). Subgroup analyses showed significant differences in the subgroups of the measurement of suicidality. Conclusion The rate of suicidal ideation, suicide attempts and completed suicide in PWE were about 19.73, 5.96, and 0.24%. And there was an increased risk of suicidality in PWE especially temporal lobe epilepsy and drug-resistant epilepsy. Clinicians need to be aware of this risk in PWE with early identification and prevention at the time of diagnosis.Protocol Registration: PROSPERO CRD42021278220.
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Affiliation(s)
- Haijiao Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha City, China
| | - Yu Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Department of Neurology, Chengdu Shangjin Nanfu Hospital, Chengdu, China
| | - Ge Tan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Deng Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yaoqi Fu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Ling Liu,
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Lopez-Castroman J, Jaussent I, Pastre M, Baeza-Velasco C, Kahn JP, Leboyer M, Diaz E, Courtet P. Severity features of suicide attempters with epilepsy. J Psychiatr Res 2022; 154:44-49. [PMID: 35926425 DOI: 10.1016/j.jpsychires.2022.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/22/2022] [Accepted: 07/18/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND After the Food and Drug Administration alert about antiepileptic medication and suicide, incident epilepsy has been associated with first or recurrent suicide attempts independently of psychiatric comorbidities and antiepileptic treatment. Following this thread, the aim of this study was to analyze if epilepsy was associated with a higher severity of lifetime suicide attempts (SAs). METHODS Analyses were carried out on 1677 adults hospitalized between 1999 and 2012 after a SA in a specialized ward for affective episodes. Five severity features were studied: frequent SAs (>2), early onset of first SA (≤26 years), history of violent SA, high suicide intent and high lethality of the SA. Adjusted logistic regression models were used to estimate the association between the lifetime diagnosis of epilepsy and the severity features. RESULTS Among suicide attempters, ninety-three patients reported a lifetime diagnosis of epilepsy (5.5%). Epileptic patients diagnosed after the first SA were more likely to be frequent suicide attempters than non-epileptic ones. They showed also higher SA planification scores. LIMITATIONS Diagnosis accuracy is limited by the use of self-reports for epilepsy. The lack of precise information about the disease course and treatment have not allowed for further statistical analysis. With regard to psychiatric comorbidities, personality disorders could not be taken into account. CONCLUSIONS Suicide attempters with epilepsy present an increased severity in some aspects of their suicidal behavior regardless of demographic and clinical variables. Our results give support to the existence of a bidirectional association between epilepsy and suicidal behavior.
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Affiliation(s)
- Jorge Lopez-Castroman
- Department of Psychiatry, CHU Nimes, Nimes, France; IGF, Université de Montpellier, CNRS-INSERM, Montpellier, France.
| | | | | | - Carolina Baeza-Velasco
- IGF, Université de Montpellier, CNRS-INSERM, Montpellier, France; Department of Emergency Psychiatry and Post-acute Care, CHU Montpellier, Montpellier, France; Université de Paris, Laboratoire de Psychopathologie et Processus de Santé, F-92100, Boulogne Billancourt, France
| | - Jean-Pierre Kahn
- Université de Lorraine, Nancy, France, Clinique Soins-Etudes de Vitry le François, Fondation Santé des Etudiants de France (FSEF), Paris, France
| | - Marion Leboyer
- INSERM U955, Neuro-Psychiatrie Translationnelle, Université Paris-Est, Créteil, France; AP-HP, DMU IMPACT, Département Médical Universitaire de Psychiatrie, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | | | - Philippe Courtet
- IGF, Université de Montpellier, CNRS-INSERM, Montpellier, France; Department of Emergency Psychiatry and Post-acute Care, CHU Montpellier, Montpellier, France
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Abstract
PURPOSE OF REVIEW Epilepsy has a bidirectional association with suicidality, and epilepsy patients are at much higher risk for suicide than the general population. This article reviews the recent literature on suicide risk factors, assessments, and management as they pertain specifically to suicidality in people with epilepsy, a population that requires unique considerations. RECENT FINDINGS Risk factors for suicidality include younger age (independent of comorbid psychiatric disorders), poor social support, psychiatric comorbidity (depression, anxiety, obsessive-compulsive symptoms, and alcohol use), and epilepsy-related factors (more frequent seizures, temporal lobe epilepsy, and drug-resistant epilepsy). Most clinicians agree with the need for addressing suicidality; however, there is inconsistency in the approach to caring for these patients. An example neurology clinic-based approach is outlined. Although PWE are at risk for suicide and risk factors have been characterized, care gaps remain. Screening strategies may help close these gaps.
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Affiliation(s)
- Luciana Giambarberi
- Department of Psychiatry, Wake Forest University School of Medicine, Winston-Salem, NC, USA. .,Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Heidi M Munger Clary
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Abstract
Self-Injurious and Suicidal Behavior in Young Adults, Teens, and Children With Epilepsy: A Population-Based Study Wirrell EC, Bieber EW, Vanderwiel A, et al. Epilepsia. 2020;61(9):1919-1930. doi:10.1111/epi.16618 Objective: Whereas studies in adult epilepsy patients have shown higher rates of suicidal ideation and attempt, such studies in children are limited. Using the Rochester Epidemiology Project database, we compared the risk of self-injurious behavior and suicidal ideation in a population-based cohort of childhood epilepsy to controls. Methods: We studied 339 cases with epilepsy and 678 age- and sex-matched controls followed to a median age of 24.7 and 23.4 years and identified 98 patients with self-injurious behavior or suicidal ideation (43 with epilepsy and 55 controls). All behaviors were categorized using the Columbia Suicide Severity Rating Scale. Results: Those with epilepsy had a significantly higher rate of any self-injurious behavior and suicidal ideation (hazard ratio [HR] = 1.56, 95% CI = 1.04-2.35) and tended to have an increased risk of suicidal ideation and attempt (HR = 1.48, 95% CI = 0.93-2.37). The prevalence of preceding mood and substance abuse disorders was similarly high in both cases and controls with self-injurious behavior or suicidal ideation; however, preceding attention-deficit/hyperactivity disorder was more than twice as common in the epilepsy cases. Among cases with epilepsy, we did not identify any specific epilepsy-related variable that was significantly correlated with risk of self-injurious behavior or suicidal ideation. Significance: Children, teens, and young adults with a history of childhood epilepsy are at greater risk of self-injurious behavior, highlighting the need for careful screening of mental health concerns as part of routine epilepsy care.
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Abstract
PURPOSE OF REVIEW Psychiatric comorbidities are close to 5-times higher in children and youth with epilepsy (CYE) compared to general population. With epilepsy being one of the most common neurological disorders in children, we provide a timely review of psychiatric issues in CYE. RECENT FINDINGS A meta-analysis found a pooled prevalence of anxiety in 18.9% and depression in 13.5% of CYE. Attention deficit hyperactivity disorder (ADHD) is 2.5 to 5.5 times higher in CYE compared to healthy counterparts. Recent evidence highlights that behavioral adverse effects may lead to discontinuation of anti-epileptic drugs (AEDs) in more than 10% of CYE. Up to 70% CYE shows elevation in baseline psychological symptoms after AED initiation. Identifying psychiatric symptoms can be easily accomplished by the routine use of psychiatric screening instruments in CYE clinics, which is associated with improved health-related quality of life (HRQOL). Psychoeducation is a key component for any visit with CYE. There is some evidence of the effectiveness of behavioral psychological interventions for CYE. There are no therapeutic trials of psychotropics in CYE, but treatment recommendations based on the experience in adults with epilepsy and general population are applicable. Early diagnosis and management of psychiatric comorbidities leads to improvement in HRQOL of CYE. This requires routine screening and a multidisciplinary teamwork.
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Affiliation(s)
- Anjali Dagar
- Department of Psychiatry and Epilepsy, Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue, P57, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Tatiana Falcone
- Department of Psychiatry and Epilepsy, Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue, P57, Cleveland Clinic, Cleveland, OH, 44195, USA.
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12
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Rathi N, Saldanha D, Chaudhury S, Mujawar S. Self-injurious behavior in epilepsy. Ind Psychiatry J 2020; 29:352-354. [PMID: 34158727 PMCID: PMC8188930 DOI: 10.4103/ipj.ipj_94_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 12/27/2020] [Accepted: 02/18/2021] [Indexed: 11/10/2022] Open
Abstract
Self-injurious behavior (SIB) can be described as an act involving self-inflicted destruction of tissue, right away or over a period of time. Patients with epilepsy have to deal with an often chronic and unpredictable disorder leading to adversity in many psychosocial variables such as employment, stigma, and overall quality of life. The above factors contribute toward SIB in these patients. Behavioral problems occurring in people with epilepsy can range from aggressiveness, mood fluctuations to SIB. We report a 23-year-old male, married, educated up to 10th standard, referred from neurology department for psychiatric evaluation. The patient had gone to neurologist with the chief complaints of generalized tonic-clonic convulsions and was hospitalized for breakthrough seizure. There was a history of indulging in episodes of self-SIB since the past 8 months. He responded satisfactorily to adjustment of antiepileptic medication along with fluoxetine and low-dose risperidone. Early identification of such behavior in epilepsy patients should be done so that a holistic management is undertaken leading to better functioning and improved quality of life.
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Affiliation(s)
- Neelam Rathi
- Department of Psychiatry, 166 Military Hospital, Jammu, Jammu and Kashmir, India
| | - Daniel Saldanha
- Department of Psychiatry, Dr. D Y Patil Medical College, Dr D Y Patil University, Pimpri, Pune, Maharashtra, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Dr. D Y Patil Medical College, Dr D Y Patil University, Pimpri, Pune, Maharashtra, India
| | - Swaleha Mujawar
- Department of Psychiatry, Dr. D Y Patil Medical College, Dr D Y Patil University, Pimpri, Pune, Maharashtra, India
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