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March 14, 2023; 100 (11) Research Article

Mood and Anxiety Disorders and Suicidality in Patients With Newly Diagnosed Focal Epilepsy

An Analysis of a Complex Comorbidity

Andres M. Kanner, Anita S. Saporta, Dong H. Kim, John J. Barry, Hamada Altalib, Hope Omotola, Nathalie Jette, Terence J. O'Brien, Siddhartha Nadkarni, Melodie R. Winawer, Michael Sperling, Jacqueline A. French, Bassel Abou-Khalil, Brian Alldredge, Martina Bebin, Gregory D. Cascino, Andrew J. Cole, Mark J. Cook, Kamil Detyniecki, Orrin Devinsky, Dennis Dlugos, Edward Faught, David Ficker, Madeline Fields, Barry Gidal, Michael Gelfand, Simon Glynn, Jonathan J. Halford, Sheryl Haut, Manu Hegde, Manisha G. Holmes, Reetta Kalviainen, Joon Kang, Pavel Klein, Robert C. Knowlton, Kaarkuzhali Krishnamurthy, Ruben Kuzniecky, Patrick Kwan, Daniel H. Lowenstein, Lara Marcuse, Kimford J. Meador, Scott Mintzer, Heath R. Pardoe, Kristen Park, Patricia Penovich, Rani K. Singh, Ernest Somerville, Charles A. Szabo, Jerzy P. Szaflarski, K. Liu Lin Thio, Eugen Trinka, Jorge G. Burneo, and the Human Epilepsy Project
First published December 20, 2022, DOI: https://doi.org/10.1212/WNL.0000000000201671
Andres M. Kanner
From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine.
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Anita S. Saporta
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Dong H. Kim
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John J. Barry
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Hamada Altalib
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Hope Omotola
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Nathalie Jette
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Terence J. O'Brien
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Siddhartha Nadkarni
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Melodie R. Winawer
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Michael Sperling
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Jacqueline A. French
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Bassel Abou-Khalil
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Brian Alldredge
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Martina Bebin
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Gregory D. Cascino
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Andrew J. Cole
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Mark J. Cook
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Kamil Detyniecki
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Orrin Devinsky
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Dennis Dlugos
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Edward Faught
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David Ficker
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Madeline Fields
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Barry Gidal
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Michael Gelfand
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Simon Glynn
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Jonathan J. Halford
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Sheryl Haut
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Manu Hegde
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Manisha G. Holmes
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Reetta Kalviainen
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Joon Kang
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Pavel Klein
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Robert C. Knowlton
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Kaarkuzhali Krishnamurthy
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Ruben Kuzniecky
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Patrick Kwan
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Daniel H. Lowenstein
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Lara Marcuse
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Kimford J. Meador
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Scott Mintzer
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Heath R. Pardoe
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Kristen Park
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Patricia Penovich
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Rani K. Singh
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Ernest Somerville
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Charles A. Szabo
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Jerzy P. Szaflarski
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K. Liu Lin Thio
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Eugen Trinka
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Jorge G. Burneo
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Citation
Mood and Anxiety Disorders and Suicidality in Patients With Newly Diagnosed Focal Epilepsy
An Analysis of a Complex Comorbidity
Andres M. Kanner, Anita S. Saporta, Dong H. Kim, John J. Barry, Hamada Altalib, Hope Omotola, Nathalie Jette, Terence J. O'Brien, Siddhartha Nadkarni, Melodie R. Winawer, Michael Sperling, Jacqueline A. French, Bassel Abou-Khalil, Brian Alldredge, Martina Bebin, Gregory D. Cascino, Andrew J. Cole, Mark J. Cook, Kamil Detyniecki, Orrin Devinsky, Dennis Dlugos, Edward Faught, David Ficker, Madeline Fields, Barry Gidal, Michael Gelfand, Simon Glynn, Jonathan J. Halford, Sheryl Haut, Manu Hegde, Manisha G. Holmes, Reetta Kalviainen, Joon Kang, Pavel Klein, Robert C. Knowlton, Kaarkuzhali Krishnamurthy, Ruben Kuzniecky, Patrick Kwan, Daniel H. Lowenstein, Lara Marcuse, Kimford J. Meador, Scott Mintzer, Heath R. Pardoe, Kristen Park, Patricia Penovich, Rani K. Singh, Ernest Somerville, Charles A. Szabo, Jerzy P. Szaflarski, K. Liu Lin Thio, Eugen Trinka, Jorge G. Burneo, and the Human Epilepsy Project
Neurology Mar 2023, 100 (11) e1123-e1134; DOI: 10.1212/WNL.0000000000201671

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Abstract

Background and Objectives Mood, anxiety disorders, and suicidality are more frequent in people with epilepsy than in the general population. Yet, their prevalence and the types of mood and anxiety disorders associated with suicidality at the time of the epilepsy diagnosis are not established. We sought to answer these questions in patients with newly diagnosed focal epilepsy and to assess their association with suicidal ideation and attempts.

Methods The data were derived from the Human Epilepsy Project study. A total of 347 consecutive adults aged 18–60 years with newly diagnosed focal epilepsy were enrolled within 4 months of starting treatment. The types of mood and anxiety disorders were identified with the Mini International Neuropsychiatric Interview, whereas suicidal ideation (lifetime, current, active, and passive) and suicidal attempts (lifetime and current) were established with the Columbia Suicidality Severity Rating Scale (CSSRS). Statistical analyses included the t test, χ2 statistics, and logistic regression analyses.

Results A total of 151 (43.5%) patients had a psychiatric diagnosis; 134 (38.6%) met the criteria for a mood and/or anxiety disorder, and 75 (21.6%) reported suicidal ideation with or without attempts. Mood (23.6%) and anxiety (27.4%) disorders had comparable prevalence rates, whereas both disorders occurred together in 43 patients (12.4%). Major depressive disorders (MDDs) had a slightly higher prevalence than bipolar disorders (BPDs) (9.5% vs 6.9%, respectively). Explanatory variables of suicidality included MDD, BPD, panic disorders, and agoraphobia, with BPD and panic disorders being the strongest variables, particularly for active suicidal ideation and suicidal attempts.

Discussion In patients with newly diagnosed focal epilepsy, the prevalence of mood, anxiety disorders, and suicidality is higher than in the general population and comparable to those of patients with established epilepsy. Their recognition at the time of the initial epilepsy evaluation is of the essence.

Glossary

ASM=
antiseizure medication;
BPD=
bipolar disorder;
CSSRS=
Columbia Suicidality Severity Rating Scale;
MDD=
major depressive disorder;
MDE=
major depressive episode;
MINI=
the Mini International Neuropsychiatric Interview;
SA=
suicidal attempt;
SI=
suicidal ideation;
PWE=
people with epilepsy

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Submitted and externally peer reviewed. The handling editor was Associate Editor Barbara Jobst, MD, PhD, FAAN.

  • Editorial, page 499

  • Received January 9, 2022.
  • Accepted in final form October 25, 2022.
  • © 2022 American Academy of Neurology
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