Abstracts

Rationale: While suicidal ideation (SI) and suicidal behavior (SB) have been typically associated with depressive disorders in patients with epilepsy (PWE), these phenomena have been observed in the absence of a mood disorder. Occasionally, SI has been identified in patients with epilepsy without "overt" psychiatric illness, but the frequency of this phenomenon is not known. The purpose of this study is to assess recent SI and SB in treatment-resistant focal seizures without depression and without any identifiable psychiatric disorders. Methods: A mulitcenter, cross-sectional study at 6 epilepsy centers. Inclusion criteria were: 18-70 years; EEG-confirmed focal epilepsy for >2 years; >1 simple partial (with motor component), complex partial/secondarily generalized seizure per month for the past 6 months; currently taking 1-3 AEDs; and failed >2 AEDS, including current therapy. SI and SB were assessed with the Columbia Suicide Severity Rating Scale. The MINI International Neuropsychiatric Interview assessed current Axis I psychiatric disorders. High risk SI included intent / plan. SB included suicide attempt (SA), interrupted or aborted attempt, preparatory acts/behavior, and non-suicidal self-injurious behavior. Analyses examined current psychiatric disorders and SI/SB in the absence of recent depression and any psychiatric disorder, according to our findings on the MINI. Results: Among the 204 participants, those with current depression [n = 31 (15.2%)] were more likely to have current SI (51.6% vs 12.7%; p<0.0001), but were not more likely to have current SA (9.7% vs 4.1%; p=0.2). Among the 173 (84.8%) without recent depression, 25 (14.5%) displayed SI and/or SB: 18 (10.4%) had recent SI only, 3 (1.7%) had recent SB only and 4 (2.3%) had both recent SI and SB. Among the 22 subjects with SI, 5 (22.7%) had high risk SI. Among the 7 with SB, 3 (42.9%) attempted suicide, 2 (28.6%) engaged in non-suicidal self-injurious behavior, 1 (14.3%) aborted the SA, and 2 (28.6%) prepared for a SA. Among the 22 subjects with SI without current depression, anxiety was present in 7 (31.8%), eating disorders in 1 (4.6%), and substance abuse with a psychiatric disorder in 3 (13.6%). One of these patients had anxiety and eating disorders. Among the 7 subjects with SB without current depression, anxiety was present in 1(14.3%), and eating disorders in 1 (14.3%). Among the 132 who denied any symptoms of current psychiatric disorder, 11 (8.3%) had SI only, 2 (1.5%) had SB only and 4 (3.0%) had both SI and SB. Conclusions: In patients with treatment-resistant focal epilepsy, the occurrence of SI and SB can be associated not only with depression, but also with anxiety and eating disorders without concurrent depression. In addition, SI and /or SB can be identified in close to 13% of patients with no "apparent" psychiatric disorder. Thus, screening for depression is not sufficient to identify all patients at risk for suicidality.