Abstracts

Rationale: 1. Determine psychiatric morbidity 2. Characterize antidepressant treatment for future outcomes assessment. Methods: 1. Study period: February 12, 2007 to May 23, 2009 2. All candidates presented at weekly patient management conference (PMC) and underwent routine psychiatric screening. 3. Complete psychiatric evaluation after screening. a. Patient-rated instruments: EuroQOL, PHQ-9, GAD-7, MDQ, and CSI. b. Clinician ratings: GAF, CGI-S, and DSM IV-TR (Axis I-V) diagnosis. 4. Data entered prospectively into Knowledge Program© data base and Epic (EMR). 5. Antidepressant recommended/initiated/modified as indicated. Results: 1. 361 epilepsy surgery candidates presented in PMC and 202 (46.3%) - including 90 males and 112 females with mean age 40.2 (range 18-72) - evaluated psychiatrically. 2. DSM IV-TR diagnoses: 179 (88.6%) had at least one Axis I diagnosis, 106 (52.3%) had two Axis I diagnoses, and 26 (13%) had three Axis I diagnoses. Mood disorders (n=74, 41%) including major depressive disorders (37), atypical depressive disorder (interictal dysphoric disorder) (21), organic mood disorder (14), and dysthymia (2); adjustment disorders (n=57, 32%), psychotic disorders and personality change due to epilepsy (n=17, 9.5%), cognitive disorders (n=14, 7.8%), anxiety disorders (n=14, 7.8%). 3. Complete PHQ-9, GAF and CGI-S data sets available in 158 patients (Table 1). Fifty-seven (36%) had at least a moderate degree of PHQ-9 self-rated depression with only 4.4% in the severe range. Twenty-eight (17.7%) endorsed some degree of suicidal ideation, and 10 (6.3%) endorsed suicidal thoughts at least 50% of the time over the prior two week period. Only 4 (2.5%) endorsed daily suicidal thoughts. 4. Forty patients completed the GAD-7. Ten (25%) scored 10 or greater suggesting clinically significant anxiety. 5. Fifty seven of (28%) on antidepressants prior to assessment (Table 2). Forty-seven (82%) advised to continue or modify treatment with one advised to discontinue. Among 145 untreated patients, 30 (21%) were advised to start. Of the 77 advised to initiate, modify or maintain antidepressant medication, 66 (86%) accepted recommendation. Conclusions: 1. The results of this study coincide with previous data on prevalence of depression in epilepsy. 2. Despite high rate of psychiatric co-morbidity this population exhibited a moderate degree of depression with a low percentage severely depressed. Patient hope and expectation for seizure-freedom balances the adversity of psychiatric co-morbidity. 3. Mood disorders predominated with the dominant depressive subtypes as major depressive disorder and atypical depressive disorder (also referred to as interictal dysphoric disorder). Adjustment nearly as common as mood disorders. Clinically significant anxiety disorders may have been more prevalent than diagnosed given that 25% of 40 sampled rated themselves as having high anxiety.