Abstracts

Rationale: In 2008 the FDA identified an increased risk of suicidal behavior or thoughts in people taking antiepileptic drugs (AEDs) and recommended that all patients treated with AEDs should be monitored for suicidal thoughts or behavior and other unusual changes in behavior. In order to meet this mandate, physicians must be able to take a baseline psychiatric history prior to administering new AEDS and continue monitoring psychiatric symptoms after taking AEDs. The new recommendation impacts all physicians. While experienced practitioners are aware of the association between epilepsy and mood disorders, residents who have fewer years of clinical experience may encounter patients with greater psychiatric problems. Methods: This retrospective review analyzed the ability of Neurology residents to record a psychiatric history in outpatient epilepsy clinic. 37 consecutive charts were reviewed. All patients were already on AEDs on their first visit. Elements reviewed: mood, memory, suicidal behavior/thoughts, substance abuse, psychotic disorders and mental retardation syndrome. Results: The common elements documented in psychiatric history included either absence or presence of: substance abuse (78%), mood disorders (35%), memory disorders (16%), psychotic disorders (13%), mental retardation (11%), suicidal behavior/thoughts(8%). Most patients (97%) disclosed presence or absence of psychiatric history on intake forms with 47% disclosing positive history of psychiatric illness. Over time, 10% (2 of 19) of patients without prior psychiatric history developed de novo psychiatric pathology (behavior/mood changes). When psychiatric history was present, it was typically recorded, but "pertinent negatives" were not recorded. Conclusions: Residents are adept at taking a drug and alcohol history. Consequently, substance abuse was the most problem documented. Given the socio-economic status of these patients and the prevalence of depression in epilepsy, mood disorders are under-reported. The importance of taking the history of suicidal behavior or thoughts on patients on AEDs has been newly emphasized by the FDA, but was not emphasized to residents before. Psychiatric history taking is not part of the learner's initial epilepsy education. Lack of formal structures for screening psychiatric pathology limits identification of the symptoms of psychiatric disorders in epilepsy patients. Residency training should be modified to provide all learners with clinical skills essential for current standards in epilepsy care.