Abstracts

Rationale: Patients with epilepsy (PWE) have an increased risk of suicide compared to the general population with rates reported in the literature between 1-67% with an average of 11%. (Jones. Epilepsy & Behavior 4 (2003) S31–S38). Patients with psychogenic non-epileptic spells (PNES) have significant risk of suicide as well (Ettinger. Epilepsia, 40(9):1292-1298, 1999). In a pediatric population sample, patients with PNES had higher risk of suicidal ideation than patients with epileptic seizures (Sullwold. Epilepsia 46(8);81, 2005). Recent suicidal ideation (in the past 30 days) is an important risk factor for suicide in the general population, but there is little data available regarding the prevalence of recent ideation for PWE or patients with PNES. Additionally, there is currently no consensus regarding optimal screening tools or practices.  The aim of this investigation is to describe the prevalence of recent suicidal ideation and behavior in adult patients admitted to a tertiary epilepsy monitoring unit (EMU) and to assess differences between PWE and patients with PNES. Methods: The study is a retrospective observational analysis of data collected from patients admitted to the EMU at Parkland Memorial Hospital from 04/01/2015 to 06/01/2016. The study was approved by the IRB at UT Southwestern and Parkland Memorial Hospital. The Columbia Suicide Screening Rate Score (C-SSRS) Screen Version-Recent was administered by nursing staff during the admission process for each patient. The screening version of the C-SSRS is composed of an algorithmic set of questions to assess suicidal ideation and behavior in the previous thirty days. A suicide screen was considered positive if the patient answered yes to any of the questions administered. Over the 14-month period, 487 unique patients were evaluated in the EMU. Patients who could not complete the C-SSRS, those with a non-diagnostic EMU stay (absence of spell during admission), and those with a defined non-psychological non-epileptic etiology were excluded. Patient were categorized into three groups [Epilepsy (ES), psychogenic non-epileptic spells (PNES) and both epilepsy and PNES (MIX)], based on video EEG results.  Results: Of the 316 patients included in the study, 179 (57%) were classified as having epilepsy (ES), 116 (37%) were PNES, and 21 (7%) were MIX. The demographics and baseline characteristics are shown in table 1. Participants in the ES group were more likely to be younger males, with less psychiatric co-morbidities and less use of psychotropic medications. Additionally, ES participants were more likely to be employed. Overall, 25 patients (8%) in the study sample screened positive for suicide risk using the C-SSRS; of note, this rate was higher than other patient populations (burn 4.1%, trauma 4.6%, p=0.01) in the same hospital (unpublished data, personal communication, K.R).  The percent was highest in the MIX group (14%), followed by PNES (10%) and ES (6%) although this did not reach statistical significance (See Table 2). Males in the MIX group had significantly higher rate of positive suicide screens (33%, p=0.03), but note that only 6 subjects were in this group.  Conclusions: In the study sample, there was no statistical significant difference in the risk of recent suicidality using the C-SSRS Recent version among the three groups. However, males in the MIX group seem to have the highest risk, which could be an interest of future studies with larger sample size. The rates of positive responses to suicide screenings may be higher than other treatment seeking populations in healthcare settings -- a preliminary finding that warrants further study as well. We recommend that patients in the EMU be screened for suicide risk, and the screener version of C-SSRS appears feasible.  Funding: none