Abstracts

Community samples of epilepsy patients experience higher rates of depression (9-25%) and anxiety (10-25%) disorders than the general population (depression 2-9%; anxiety 2.5-6.5%). In treatment resistant epilepsy, estimates are even higher (e.g., depression 25-55%). Despite these issues, many epilepsy programs do not adequately assess for or address mental health problems. This paper describes program development and referral practices during the first year of a clinical psychology service devoted to epilepsy patients., Participants: 132 consecutive SMU admissions over 10 months were explored for clinical psychology and psychiatry referrals. 1657 consecutive outpatient visits over 6 months were explored for clinical psychology referrals. All referrals were from epileptologists (n = 7). Procedure: The Clinical Psychology Service was developed separately from Neuropsychology in two phases: Phase I: Seizure Monitoring Unit (SMU); Phase II: Outpatient. Phase I SMU: Neurologists and nurses completed a referral package: referral form, patient history, and patient-completed background information questionnaire. Nurses contacted the psychologist when the referral was completed. Referrals were reviewed by the psychologist for appropriateness. Phase II Outpatient: Referral package (same as SMU) was forwarded to the psychologist for one of three possible services: assessment only; assessment and brief (up to 6 sessions) therapy; and therapy only. Clinical psychology referral information was tracked in an excel database. Overall SMU admission rates were obtained from the master SMU admission list. Number of outpatient visits for each epileptologist was provided by the Clinical Neurosciences program manager., SMU: 52.5% (n = 72) received a clinical psychology assessment; 18.5% (n = 24) received a psychiatry assessment. Overlap in referrals to clinical psychology and psychiatry occurred in the first month. Psychology referrals increased in months 3-5. Referrals reduced in later months. OUTPATIENT: 2.4% (n = 40) of clinic visits to epileptologists were referred for outpatient services. Referral rates ranged from 0-4.7% per neurologist. Rates varied according to years of experience (i.e., junior neurologists referred more often) and number of visits (i.e., junior neurologists with more visits referred more often)., Clinical psychology services are well-integrated into the SMU but referrals to the outpatient service remain low, particularly when compared to the established rates of mental health problems in epilepsy patients. The low referral rates may reflect the [ldquo]newness[rdquo] of the resource. It may also reflect poor mental health assessment practices at clinic visits. Despite the low outpatient referral rate, the clinical psychology service maintains a 3-4 month waiting list, suggesting that more outpatient resources (e.g., groups) are required prior to increasing the number of referrals to the program.,