Abstracts

Rationale: Mood disorders (MD), anxiety disorders (AD), attention deficit hyperactivity disorder (ADHD) and suicidal thoughts or behaviors (STB) are comorbid with epilepsy (Jones,2003); MD, AD, ADHD and suicide attempt are associated with an increased risk for epilepsy (Hesdorffer,2004;2012). The psychiatric comorbidities of epilepsy including MD, AD and ADHD are known to be primary risk factors for STB. We used standardized instruments designed to make a DSM-IV TR diagnosis in a community-based sample of childhood-onset epilepsy followed into adulthood. In this sample we examined factors associated with suicidal ideation (SI), including psychiatric disorders and impulsivity, separately in cases and their sibling controls.Methods: Study subjects were recruited at the diagnosis of epilepsy, throughout the state of Connecticut (Berg,1999). Fifteen years after study entry, once adults, they were invited to participate. Sibling controls were selected from a subsample of cases. Uncomplicated epilepsy was defined as FSIQ>80, normal neurological exam, normal imaging, no known etiology. All subjects completed the Diagnostic Interview Schedule (DIS-IV), the Barrett Impulsiveness Scale (BIS) and the suicidality module of the DIS for children. Logistic regression models adjusted for age at assessment and sex, examined 1. lifetime (LT) MD, LTAD, ADHD, impulsivity, and 2. number of psychiatric diagnoses and impulsivity.Results: Of 236 cases included in this analysis, 194 (82.2%) had uncomplicated epilepsy and 50% were male. The mean age at interview was 22.9 yrs (SD=3.3) among cases. Overall 38 (16.1%) cases had LTSI. This proportion was similar in complicated (11.9%) and uncomplicated (17%) groups. In model 1 LTMD was associated with SI (Table 1); results were unchanged for uncomplicated and complicated epilepsy. The association was not as strong considering only manic disorders. In model 2 having one psychiatric disorder increased the risk of SI more than 6-fold; the risk was 30-fold higher if 2 or more disorders were present. Findings were similar in complicated and uncomplicated cases. Among subjects with MD 24 cases (49%) also had AD, 4 (8.2%) also had ADHD and in 2 (4.1%) all three disorders were present. In the uncomplicated group the pattern was similar. Among the 126 controls included 35.7% were male and 17 (13.5%) had LTSI. The mean age at assessment was 23.6 (SD=4.4). The two logistic regression models showed results similar to cases (Table 1).Conclusions: As expected in the literature there was a strong association between MD and SI in cases and controls. This could reflect a possible familial aggregation of SI or the absence of a difference in SI risk in epilepsy compared to the general population. Impulsivity was not associated with SI in cases or controls, despite the occurrence of ADHD. Interestingly having multiple psychiatric disorders increased the risk of SI, even when the single disorder was not itself associated with SI. Clinicians treating epilepsy should screen for MD and SI, in accordance with recommendations (http://www.uspreventiveservicestaskforce.org/).