Abstracts

Rationale: Psychosocial and behavioral problems are often neglected in the process of delivering care to persons with epilepsy (PWE). This stems from both under-recognition of these underlying problems as well as limited resources and programs with which to intervene. Unfortunately, the consequences are sometimes more disabling than the seizures themselves. Depression is the most commonly studied co-morbidity and is prevalent in an estimated 25-55% of PWE. Memory dysfunction is also prominent and can also be significantly disabling. A recently published Institute of Medicine report summarized the public health implications of co-morbidities in PWE such as depression and memory dysfunction. The aim of this study was to implement a screening tool to improve the recognition of psychosocial comorbidities such as depression and cognitive symptoms in an epilepsy clinic. Methods: The study was conducted at Dartmouth-Hitchcock Epilepsy Center (DHEC). A screening tool was developed based on an existing tool created by Giliam et al, which quantifies symptoms of depression (NDDI-E, scored 6-24, with scores >15 suggestive of major depression) and a quality of life Likert scale (scale of 1-10, with 10 equaling best quality of life) along with a review of systems which includes memory and concentration. The screening tool was distributed to all patients seen by DHEC's 6 epilepsy providers over an 18 month period. Medical records were reviewed for all patients age 18-49 completing questionnaires. Patients with severe intellectual disability and purely non-epileptic seizures were excluded. Records were reviewed to determine which providers used the data obtained by the screening tool for clinical decision making (designated as "adaptors") and whether the screening tool impacted referrals to mental health providers or new prescriptions for antidepressants. Results: Of 140 patients who met inclusion criteria, the average NDDI-E score was 11 and average OOL 6.8; 26% qualified for major depression based on the NDDI-E. The prevalence of memory symptoms was 55%, and this correlated significantly with QOL and NDDI-E scores. Three providers reported routinely used the questionnaire in decision making and were considered "adapters". Major depression was addressed with mental health referral or medication change in 45% of cases by adapters and 36% by non-adapters (p=0.6). Adapters made medication changes in 36.6% (p=0.01) and prescribed new antidepressants for 3.9% of cases (p=0.02) compared to non-adapters who made medication changes in only 10% and did not prescribe any new antidepressants. Compliance with new antidepressant at 3 months was 57%. Only one patient with memory symptoms was referred for cognitive rehabilitation. Conclusions: Psychosocial comorbidities such as depression and cognitive dysfunction impact quality of life for PWE and contribute significantly to socioeconomic burden, yet are often not addressed routinely during clinic visits. Implementation of a screening tool can improve the recognition of these comorbidities and improve the rate at which these symptoms are addressed.