Abstracts

Rationale: In December 2008, the Food and Drug Administration instructed the manufacturers of all AEDs to include a warning that all of these drugs were associated with an increased risk of suicidal ideation and behavior. Accordingly physicians prescribing these drugs were directed to identify patients with an increased suicidal risk before starting a new AED and to monitor for this risk during the treatment with the drug. This includes patients with a major depressive episode (MDE), generalized anxiety disorder (GAD), patients with current suicidal ideation and current and/or prior history of suicidal attempts. The purpose of this study was to test the diagnostic yield of two self-rating screening instruments, one to identify current MDE, the Neurologic Depressive Disorder Inventory in Epilepsy (NDDI-E), one to identify current GAD, the Generalized Anxiety Disorder-7 (GAD-7) and a six item questionnaire, rhe sucicdality module of the Mini International Neuropsychiatric Inventory (S-MINI) developed to screen for history of suicide attempts and current suicidal ideation of icreasing severity. The S-MINI yielded a severity risk (mild, moderate, severe). The second aim was to identify whether scores of the NDDI-E and GAD suggestive of MDE, GAD or GAD+MDE were associated with a greater severity suicidal risk. Methods: Completion of the three isnstruments took place while patients were waiting to see their neurologist in the waiting room and took less than 5 minutes to complete in all patients. A total of 236 consecutive outpatient adults followed at the Rush Epilepsy Center, aged 18 to 70 years old completed the NDDI-E, GAD-7 and the S-MINI during one of their scxheduled outpatient visits. For each patient we calculated the total score of the NDDI-E (a score > 15 is suggestive of MDE) of GAD-7 (a score of >10 is suggestive of GAD) and the level of severity of suicidality (mild, moderate, severe). We used the Kruskal Wallis Test to determine if the presence MDE, GAD or GAD+MDE were associated with a more severe suicidal risk. Results: Among the 236 patients, 41 (17%) had a NDDI-E score suggestive of MDE, 13 (5.4%) had a GAD-7 score suggestive of GAD and 8 had scores suggestive of both GAD+MDE. 17 (7%) patients reported a prior suicidal attempt and 37 (15.6%) endorced any suicidal symptom. Among these 37 patients, the suicidality risk met S-MINI criterion of mild in 27 (11.5%), moderate in 7 (3%) and severe in 3 (1.3%). The presence of MDE (χ2 = 16.4, df = 3, p = 0.001), GAD (χ2 = 19.8, df = 3, p<0.0001) and GAD+MDE (χ2 = 14.0, df = 3, p = 0.003) were significantly associated with the level of severity of suicidal risk. Conclusions: Suicidal symptoms appear to occur in about 15% of outpatients with epilepsy from tertiary level epilepsy centers. Most of the suicidal symptoms are mild in severity and immediate intervention was necessary in 1% of these patients. The use of the NDDI-E, GAD-7 and S-MINI appear to yield practical clinical data in screening for suicidal risk when starting and maintaining patients on AEDs.