Abstracts

As part of our usual care of adults with epilepsy, we evaluate patients for the presence of depressive symptoms. We sought to determine the initial outcome of assessing, counseling and attempting to refer persons with epilepsy who likely have depression., Consecutive adult patients at the Comprehensive Epilepsy Center were evaluated for depressive symptoms using the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR[sub]16[/sub]), the scale has 9 items with 4 degrees of response and a maximum score of 27. The results of the scale are divided into 5 levels of possible depression: none, mild, moderate, severe and very severe. The results of the scale were immediately discussed with the patient by a licensed clinical social worker and the decision to refer for further psychiatric intervention was based on the scale score and the brief ensuing interview., One hundred thirteen consecutive patients (72 women) were seen over two weeks. Twenty-seven patients were not evaluated: 9 refused, 7 were seen after hours and therefore missed, 6 had cognitive impairment, 4 had language barriers, and 1 had a seizure. Of 113 patients, 17 (15%) were already under the care of a mental health professional, and additional 29 patients (26%) were referred for further treatment for possible depression. Of these 29 patients, 17 (56%) refused to accept information about mental health referral. All patients with at least moderate depression were offered referral or had therapists. The most frequently stated reasons for declining referral were patients felt that they did not need treatment for depression, or thought that their current mood problems were related to an acute, temporary situation. Patients who scored in the severe and very severe range who refused therapy stated that it had not been helpful in the past., Epilepsy patients seem reluctant to acknowledge the possibility of being depressed. The reasons for this are unclear but are likely complex and may include the stigma of depression, reluctance to accept the burden of additional diagnoses and the possibilty of further medication treatment, as well as limitations of the detection process in our clinical setting.,