BOSTON -- Some epilepsy patients, particularly those with a history of depression, are at increased risk of postictal suicidal ideation, a study has shown. The results are consistent with previous reports of elevated lifetime prevalence rates of suicide among people with epilepsy, suggesting that a thorough psychiatric evaluation for patients with epilepsy should be standard practice, reported Dr. Hillary R. Gross-Kanner and Dr. Andres M. Kanner of Rush-Presbyterian-St. Luke's Medical Center in Chicago.
Of 100 consecutive patients with drug-resistant partial epilepsy enrolled in the study, 13 experienced postictal suicidal ideation (PSI) with a median estimated duration of 24 hours, Dr. Gross-Kanner said at the annual meeting of the American Epilepsy Society.
The investigators used a 42-item questionnaire to identify the presence and clinical characteristics of postictal psychiatric and cognitive symptoms experienced by study patients during the 3 months before the survey.
The questionnaire established the prevalence, frequency of occurrence, and median estimated duration of depressive symptoms (feelings of hopelessness, and helplessness, crying bouts, self-deprecation, guilt, hypomania, psychosis, and neurovegetative symptoms) during the postictal period, defined as the 72 hours after a seizure or cluster of seizures. Only those symptoms that occurred after more than half of the seizures were included for analysis.
None of the patients enrolled in the study were taking psychotropic drugs, and all underwent a psychiatric evaluation to identify any psychiatric history of mood, anxiety, psychosis, attention-deficit disorder, and past hospitalizations. All of the patients also underwent a prolonged video-EEG monitoring study, high-resolution magnetic resonance imaging, and neuropsychological studies.
A history of depression and of psychiatric hospitalization were significantly and independently associated with PSI. The occurrence of PSI also correlated significantly with postictal feelings of hopelessness and helplessness, crying bouts, self-deprecation, and guilt. …