Veterans With Drug-Resistant Epilepsy Show High Prevalence of Psychiatric Burden

Prevalence of psychiatric comorbidity, emergency care usage, and inpatient psychiatric admissions were shown to be substantial among veterans with drug-resistant epilepsy (DRE), with women especially affected. Results were published in Epilepsy & Behavior.

Psychiatric conditions are prevalent in patients with epilepsy, in part due to shared risk factors, physiological mechanisms, and bidirectional influences, in which those with drug-resistant disease are at particular risk.

Researchers noted that prior studies examining veterans with epilepsy suggest this population may present with unique psychiatric and clinical features, with implications for quality of life and service utilization. However, there remains a paucity of literature assessing risk of psychiatric dysfunction in veterans with DRE.

To expand the clinical understanding of veterans with DRE, they conducted a comprehensive retrospective analysis of a Veterans Health Administration (VHA)–wide sample, describing psychiatric conditions, medications, and health care utilization. Four aims were explored for the analysis:

• Quantify the prevalence of various psychiatric disorders
• Examine trends in psychiatric medication use
• Assess the hospital and emergency department (ED) utilization trends for psychiatric conditions
• Compare these variables between the present DRE sample and established epilepsy literature

“Psychiatric and hospitalization data were collected on 52,579 veterans enrolled in VHA health care between [2014-2020] from the VHA Corporate Data Warehouse administrative data. Data examined include psychiatric diagnosis, psychotropic medication use, and utilization of hospital services,” explained the study authors.

For the analysis, psychiatric comorbid conditions were evaluated based on diagnoses, present in at least 2 outpatient encounters or 1 inpatient encounter, during the study period, including for depressive disorder, anxiety disorder, bipolar disorder, unspecified mood disorder, schizophrenia, and suicidality.

Moreover, the following classes of medication were included if the drugs were prescribed for at least 30 days: selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, monoamine oxidase inhibitors, atypical antipsychotics, and other antidepressants.

Among the study cohort, 88.6% were male and 11.4% were female; on average, the female sample was younger and more racially diverse than the male sample. At least 1 psychiatric diagnosis was present in 70.2% of patients, with the mean (SD) number of psychiatric diagnoses in the overall sample being 1.7 (1.5), and 49.8% reporting 2 or more diagnoses.

Female patients were shown to be more likely than males to have at least 1 psychiatric diagnosis (86.1% vs 68.1%; P < . 001), as well as exhibit a higher number of comorbid psychiatric conditions (2.4 vs. 1.6; P < .001), with an average of 0.75 more psychiatric diagnoses (95% CI, 0.71-0.80).

Of the psychiatric comorbidities reported, depression (51.7%) was the most common diagnostic category, followed by posttraumatic stress disorder (PTSD; 38.8%) and anxiety (38.0%). A total of 73.3% of the sample was prescribed at least 1 psychiatric medication, with SSRIs being the most commonly prescribed psychiatric medication for the overall sample (49.5%) and across sexes.

Furthermore, the mean number of ED visits during the study period was 5.7 (9.9) for the overall sample. These visits were indicated to be highest in those with suicidality (14.9 visits), followed by bipolar disorder (10.3) and schizophrenia (12.1). Psychiatric-related hospitalizations were highest among veterans with DRE with comorbid schizophrenia (2.5) and bipolar disorder (2.3).

Similar to that shown for psychiatric diagnoses, females reported more psychiatric medications (3.4 vs. 2.3; P < .001) and ED utilization than males (6.9 vs. 5.5; P < .001).

“A substantial psychiatric burden exists among veterans with DRE,” concluded the study authors. “Considering the relationship of psychiatric comorbidities in epilepsy with psychosocial functioning and quality of life, our findings highlight the need for screening and provision of services for those with DRE.”

Reference

Sullivan-Baca E, Rehman R, Towne AR, Haneef Z. Psychiatric comorbidity of drug-resistant epilepsy in veterans. Epilepsy Behav. Published online December 26, 2022. doi:10.1016/j.yebeh.2022.109059