Abstracts

Rationale: Mood disorders, particularly depression, are extremely common in patients with epilepsy. They can have a profound effect on patients’ health related quality of life (QOL) and can have significant effects on hospital length of stay, overall health care costs, and loss of time from work. Studies have shown that physicians inconsistently address these factors. However, most studies have focused on primary care settings, and have shown that physicians infrequently initiated discussions regarding depression, unless there was suggestion of severe impairment. Fewer studies have addressed the prevalence of depression in chronic neurologic illnesses. The goal of the current study is to examine the rates of informal screening for depression, anxiety, and health related QOL in an epilepsy monitoring unit (EMU), with the goal of determining strategies to establish routine testing and identification of these common comorbid conditions in this patient population. Methods: Records from patients admitted to a University-based EMU over a 6-month period from March 2007 to August 2007 were retrospectively reviewed to determine if they had been given readily available screening measures for depression, anxiety, and QOL by reviewing our clinical patient database. The measures included the Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), and Quality of Life in Epilepsy Scale (QOLIE-31). This number of patients was compared with the overall number of patients admitted to the EMU during the same time period to determine the consistency of our screening procedures. Patients were categorized by diagnosis (epileptic seizures, nonepileptic seizures (NES), both, or undetermined diagnosis). Results: A total of 4 (4.9%) patients, including those with epileptic seizures (n=2) and NES (n=2), were given screening tools, out of a total of 82 patients admitted during this 6-month period. Overall, there were 29 patients with NES, 26 patients with epileptic seizures, 4 patients with a combination of epileptic and NES, 5 patients with NES and unconfirmed epileptic seizures, and 18 patients for whom the diagnosis could not be confirmed. Conclusions: Despite the high prevalence of mood disorders amongst patients with epilepsy and the availability of screening measures for mood and anxiety disorders and quality of life, patients in our EMU were only informally administered screening measures on 4.9% of admissions. In addition, in patients where only non-epileptic events were documented, screening measures were only given on 6.9% of admissions, despite the presumption that there is often associated psychiatric comorbidity with such patients. However, for all patients who returned for follow up in the Maryland Epilepsy Center, screening was offered and may have been administered in the outpatient setting. The results of this preliminary study will be used for quality improvement with a goal of administering regular screening for mood and anxiety disorders and quality of life to all patients who are admitted for inpatient monitoring, regardless of their admission diagnosis.