Abstracts

Rationale: Depression is the most common psychiatric co-morbidity in patients with epilepsy (PWE) with a lifetime prevalence of approximately 30%. PWE are also more likely to report anxiety disorders with a 1-year prevalence of 25%. Despite these findings, mood and anxiety disorders are frequently unrecognized and under-treated. Previous studies have shown that 30- 50% of PWE are symptomatic for more than one year before any treatment is suggested, irrespective of the severity of the symptoms. The purpose of this study was to establish whether the lack of recognition of these psychiatric comorbidities are due to the Neurologists' knowledge of these conditions and their impact, their failure to screen for them, and /or their discomfort with the use of psychotropic drugs. Methods: We conducted a survey among the neurologists attending a Neurology Update conference in February 2014 sponsored by the Department of Neurology of the University Of Miami, Miller School of Medicine. The survey was distributed during the epilepsy presentation of this conference and was answered anonymously. The topic of psychiatric co-morbidities in PWE was not discussed during the presentation. A total of 10 questions were asked. Questions gathered general information about the Neurologist's type of practice, experience, percentage of epileptic patients in their practice, recognition of mood and anxiety disorders and their impact on the quality of life of PWE, frequency with which they screen for these conditions, methods used, and therapeutic interventions if symptoms were detected. Results: A total of 171 neurologists attended the conference of which 64 (37.5%) answered the survey. The majority of responding Neurologists were in private practice (70%) with more than 15 years of experience (64%). Epileptic patients were less than 30% of the total number patients seen in their practice for 75% of physicians. The overwhelming majority (96.8%) recognized that depression and/or anxiety disorders were frequent in PWE (96.8%), and that they have a negative impact of the quality of life of PWE (100%). Yet, only 69% reported screening for symptoms of depression and/or anxiety disorders in these patients. The most commonly reported method for screening was interview during the patient's visit (62%), while only 12% used screening instruments. Furthermore, while 80% felt comfortable prescribing antidepressant medications, only 54% would initiate treatment upon diagnoses and only 48% reported asking about suicidal ideation after screening for depression/and or anxiety symptoms. Conclusions: The results of this survey reflect a contradictory approach by General Neurologists to the screening and treatment of depression and anxiety disorders in PWE. They recognize the negative impact of these comorbidities, but fail to take the time to screen for them. They also fail to initiate pharmacologic treatment, despite feeling comfortable with the use of antidepressant drugs. Isn't it time that Neurologists recognize this contradiction and face their causes (e.g., economic reasons and /or intellectual laziness)?