Psychiatric Comorbidities in Epilepsy More Common in Patients Than Healthy Adults

Psychiatric comorbidities in epilepsy are significantly more prevalent among individuals with vs those without the condition, according to study findings published in JAMA Neurology.

A team of researchers conducted a systematic review and meta-analysis of epidemiological studies to estimate the prevalence of common psychiatric disorders in persons with epilepsy. Articles were included in the analysis if they reported original data, investigated 1 of 15 predetermined psychiatric disorders, used a validated symptom measure or other validated data collection measures, included controls, and reported the prevalence of a single psychiatric disorder. Studies were excluded if they contained non–peer-reviewed data or involved studies of less than 30 people.

Odds ratios (ORs) were calculated using the Mantel-Haenszel method; the Higgins I² test and Cochran Q statistic were employed for statistical analysis.

A total of 27 studies met eligibility criteria; the meta-analysis included 565,443 persons with and 13,434,08 persons without epilepsy. Pooled analysis of the 15 studies that reported a significantly higher prevalence of anxiety disorders in individuals with vs those without epilepsy (8.4% vs 5.7%; OR, 2.11; 95% CI, 1.73-2.58; P <.001). Analysis of individual anxiety disorders showed a significantly higher prevalence in generalized anxiety disorder and specific phobia, but not for social phobia or agoraphobia.

Pooled analysis of the 16 studies involving depression showed a significantly higher prevalence in persons with vs those without epilepsy (13.7% vs 9.3%; OR, 2.45; 95% CI, 1.94-2.09; P <.001). Pooled analysis of 4 studies of bipolar disorder showed a significantly higher prevalence for persons with vs those without epilepsy (1.2% vs 1.1%; OR, 3.12; 95% CI, 2.23-4.46; P <.001). Significant moderators to the overall effect included age 19 years older, diagnosis method for psychiatric comorbidity, diagnosis criteria for psychiatric comorbidity, and diagnosis method for epilepsy.

A significantly greater prevalence was also observed in persons with vs those without epilepsy for suicidal ideation (20.0% vs 11.7%; OR, 2.25; 95% CI, 1.75-2.88; P <.001), but not for suicide attempt (3.2% vs 0.6%; OR, 3.17; 95% CI, 0.49-20.46; P =.23).

The following conditions were more prevalent in persons with vs those without epilepsy:

• any psychotic disorder (14.8% vs 6.3%; OR, 3.98; 95% CI, 2.57-6.15; P <.001),
• schizophrenia (3.3% vs 0.9%; OR, 3.72; 95% CI, 2.44-5.67; P <.001),
• obsessive-compulsive disorder (OCD; 0.4% vs 0.1%; OR, 2.71; 95% CI, 1.76-4.15; P <.001),
• eating disorder (1.2% vs 0.7%; OR, 1.87; 95% CI, 1.73-2.01; P <.001), and
• post-traumatic stress disorder (PTSD; 5.6% vs 3.7%; OR, 1.76; 95% CI, 1.14-2.73; P =.01).

In addition, a significantly greater prevalence was observed in persons with vs those without epilepsy in the following disorders:

• alcohol misuse (6.8% vs 2.6%; OR, 3.64; 95% CI, 2.27-5.83; P <.001),
• alcohol dependence (3.3% vs 1.1%; OR, 4.94; 95% CI, 3.50-6.96; P <.001),
• substance use disorder (6.4% vs 5.2%; OR, 2.75; 95% CI, 1.61-4.72; P <.001),
• autism spectrum disorder (10.9% vs 1.0%; OR, 10.67; 95% CI, 6.35-17.91; P <.001), and
• attention-deficit/hyperactivity disorder (13.0% vs 3.4%; OR, 3.93; 95% CI, 3.80-4.08; P <.001)

No publication bias was observed in any of the meta-analyses. Study limitations included heterogeneity and the use of self-rating psychiatric instruments. “These findings show the high burden of psychiatric comorbidities in [persons with epilepsy]. The findings suggest that the training curriculum for epilepsy care should incorporate validated psychiatric screening tools,” the researchers concluded.

One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.