Abstracts

Rationale: The increase in prescription drug use and misuse in recent years poses a significant public health challenge. In a comprehensive epilepsy center our clinical impression suggests that multiple medication use may be an unidentified risk factor in the psychogenic non-epileptic (NEE) patient population. This study reviews the frequency of pain, benzodiazepine, psychotropic and AED medication use in psychogenic NEE patients admitted to the hospital. Methods: The sample consisted of all adult patients diagnosed with psychogenic NEEs or both psychogenic NEEs and epileptic seizures during a 2013 hospital admission. A retrospective record review identified prescribed medications upon admission. Additional data collected included: demographics, recent emergency department frequency, type of admission (scheduled vs. emergency), number of psychiatric diagnoses, non-prescription medication use, and marijuana and alcohol use. Data were analyzed using analyses of variance and the chi-square statistic. Results: There were 91 patients ages 17 to 76 who fit study criteria. Seventy seven (85%) had NEEs and 13(15%) had both NEEs and epilepsy. There were slightly more scheduled admissions (53 %) compared to those admitted through the emergency department (46%). Reported prescription medication use at the time of admission included 40% on pain medications, 43% on benzodiazepines, 66 % on psychotropics, and 68% on AEDs. Ten percent reported marijuana use and 29% alcohol use. In addition, acetaminophen and/or ibuprofen usage was reported in 43% of the sample. Psychiatric diagnoses were identified in 71%. Females were more likely to have a psychogenic NEE diagnosis and men were more likely to be mixed (p=.018). Individuals on a greater number of pain medications were more likely to make visits to the hospital emergency department (p=.042). There was a trend for greater psychotropic medication use in mixed diagnosis patients when compared to NEEs (p=.069). Conclusions: Patients admitted to the hospital with NEEs are frequently taking multiple medications at the time of admission including pain medications, benzodiazepines, psychotropics and AEDs. Prescription medication use should be considered a new risk factor for NEEs. Possible explanations include drug seeking behavior, chronic pain and misdiagnosed epilepsy. These findings reinforce the medical and mental health complexity of this challenging and changing patient population. An integrative and collaborative approach, one that connects behavioral and physical health, may best guide the assessment and treatment of the epilpesy center patients.