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.
Highlights
Epilepsy is a common but serious neurological disease affecting an estimated 50 million people worldwide [1], with active epilepsy prevalence ranging from 0.2%–4.1% [2]
Various psychiatric disorders were demonstrated after newly diagnosed epilepsy and closely related to general seizure and use of medical services for epilepsy
The follow-up results show the psychiatric disorders with the highest incidence in patients newly diagnosed with epilepsy were neurotic disorders (44.7 per 1000 person-years), dementia, depression, alcohol and drug dependence, mental retardation, non-organic sleep disorders, alcohol and drug psychosis, schizophrenia, bipolar disorders, physiological
Summary
Epilepsy is a common but serious neurological disease affecting an estimated 50 million people worldwide [1], with active epilepsy prevalence ranging from 0.2%–4.1% [2]. A study found 4.8% of patients with idiopathic generalized epilepsy (IGE) had attempted suicide, a much higher rate than that of the general population [7,8,9]. These suicidal patients were diagnosed with one or more psychiatric disorders [7]. The most common psychiatric comorbidities found among patients with epilepsy are depression, neuroses (nonpsychotic anxiety disorders) and psychoses. These lead to a poorer prognosis for epileptic patients than for epileptic patients without psychiatric comorbidities [12,13]. 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
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