Abstracts

Rationale: Up to 50% of children and youth with epilepsy are diagnosed with a comorbid psychiatric or cognitive disorder (1) and report that these mental health comorbidities can be more bothersome than seizure activity (2, 3). Thus, we designed a population-based retrospective cohort study to determine the distribution and determinants of psychiatric comorbid conditions in youth with epilepsy compared with lower extremity fracture controls.Methods: Data were obtained from all non-federal hospital and emergency department encounters in SC from 2000-2011. Youth ages 6-18 with an ICD-9 diagnosis of epilepsy (345.x) (cases; N=8,041) or lower extremity fracture (controls; N=15,358) were selected and classified according to the presence of ICD-9 documented comorbid psychiatric conditions, which were categorized into four clusters: 1) depression, anxiety and/or suicidal ideation/attempt, 2) substance abuse and/or alcoholism, 3) psychosis and/or schizophrenia and 4) personality disorder. Differences in group characteristics were assessed using descriptive statistics, t-test for continuous variables and chi-square tests for proportions. Proportions were further compared among the outcome groups with 95% confidence intervals (CI) constructed under the assumption of independence and normal approximation. The association of a diagnosis of a psychiatric condition with cases and controls were assessed using univariate and multivariable logistic regression. Results: Forty-five percent of youth with epilepsy were positive for a psychiatric diagnosis compared with 16% of youth with lower extremity fracture. After adjustment for neurodevelopmental conditions (e.g., intellectual disability, autism spectrum disorders, etc) and demographic factors, the association of a psychiatric diagnosis was three times higher in youth with epilepsy compared to those with lower extremity fracture. When the association of the specific clusters of psychiatric comorbidities with epilepsy were examined after adjusting for the covariables in the model, all four clusters (depression, anxiety or suicidal ideation /attempt; substance abuse; psychosis or schizophrenia; or personality disorder) were strongly associated (OR range 2.5-3.5) in youth with epilepsy. Conclusions: This study addresses the Institute of Medicine s recent recommendations for epilepsy surveillance research (4). The finding supports integrated screening for psychiatric comorbidities during routine epilepsy visits according to recommendations and clinical consensus statements for the assessment of and treatment initiation for psychiatric disorders in youth with epilepsy (5, 6). 1. Jensen F. Epilepsia. 2011;52(Suppl 1):1-6. 2. Berg A. Epilepsia. 2011;52(Suppl 1):7-12. 3. Baca C. et al. Pediatrics. 2011;128:e1532-31543. 4. Epilepsy across the spectrum: Promoting health and understanding: Institute of Medicine of the National Academies; 2012. 5. Kerr M et al. Epilepsia. 2011;52:2133-8. 6. Barry JJ et al. Epilepsy & Behavior. 2008;13 Suppl 1:S1-29.