Abstracts

To examine possible interactions in patients taking both antiepileptic and psychiatric medications, thereby identifying their impact on non-compliance with these drugs., A retrospective study was conducted to identify subjects with epilepsy seen in the past year at the epilepsy clinic of Temple University Hospital. 803 subjects were identified, and 500 were eligible for this study based on a clear diagnosis of epilepsy, use of at least one antiepileptic drug at the last clinic visit, and availability of mental health information in the charts. A psychiatric diagnosis was not required to be in this study. 110 subjects were then randomly selected in proportions that matched the race and gender demographical ratios of the overall epilepsy patient pool at the clinic., Of 110 subjects, 41% were African-American (AA) (27 F, 18 M), 36% Caucasian (25 F, 15 M), 18% Hispanic (10 F, 10 M), and 5% Asian (3 M, 2 F). 58% of patients were female with an age range of 19 to 77 years. Males ranged from 18 to 71 years .
The incidence of concurrent psychiatric and epilepsy diagnoses was 63% (n=69). Of these, 35% (24 of 69) were non-compliant with psychiatric medication. Among this group, men had the highest rate of non-compliance (80% of Hispanics, 36% of Caucasians, 33% of AAs were non-compliant). Women had lower rates of non-compliance with psychiatric medication (33% of Caucasians, 32% of AAs, and 13% of Hispanics were non-compliant).
Among compliant subjects (45 of 69), 40% (n=18) were on antiepileptic and psychiatric medications that were known to have at least one potential interaction with each other. Of these 18 subjects, the groups with the highest prevalence rate of potential medication interactions were AA males (n=5), Hispanic females (n=4), AA females (n=5), Caucasian males (n=3), Caucasian females (n=1), and Hispanic males (n=0).
The most common psychiatric diagnosis in patients with epilepsy was depression (52% of all psychiatric diagnoses)., In our study, there was a high rate of psychiatric comorbidity in people with epilepsy. Among compliant subjects, there was a high rate of potential interaction between antiepileptic and psychiatric medications. Among the 110 subjects however, there were no recognized clinical events attributed to drug interactions. AA males and Hispanic females were the groups with highest rate for potential interactions, yet were more likely to be compliant with psychiatric medications than other groups. This suggests that drug interactions are not only the reason for medication non-compliance.
Clinicians need to be aware of cultural, gender, and social differences among epileptic persons taking psychiatric medications. Other factors such as insurance coverage, mental health services access, neurology clinic access, communication between Psychiatrists and Neurologists, and efficacy of psychiatric and neurologic medicines will impact compliance.,