Suicidal Behavior Increased With Opioids, Psychotropic Medication Misuse in Epilepsy

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A diagnosis of epilepsy confers a mortality risk 2- to 3-times that of the general population.
A diagnosis of epilepsy confers a mortality risk 2- to 3-times that of the general population.

A study in JAMA Neurology demonstrates that patients with epilepsy have higher rates of suicidal ideation, thoughts, and actions compared with individuals without epilepsy, making careful monitoring of psychological state and stability an important aspect of epilepsy care.

The English Clinical Practice Research Datalink (CPRD) and Welsh Secure Anonymised Information Linkage (SAIL) Databank were used to collect hospitalization and mortality data on patients with and without epilepsy. In the CPRD database, investigators collected data on 44,678 people with epilepsy and 891,429 individuals without epilepsy; the SAIL database provided 14,051 people with epilepsy and 279,365 patients without epilepsy.

Patients with epilepsy were matched with those without epilepsy by age, sex, and general practice. The investigators compared both groups by rates of unnatural mortality, as defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes V01 through Y98 in the Office for National Statistics mortality records.

Overall, patients with epilepsy were more likely to die by suicide (hazard ratio [HR], 2.15; 95% CI, 1.51-3.07), unintentional injury or poisoning (HR, 2.97; 95% CI, 2.54-3.48), or any unnatural cause (HR, 2.77; 95% CI, 2.43-3.16) compared with non-epilepsy controls. In the pooled analysis, unintentional medication poisoning (HR, 4.99; 95% CI, 3.22-7.74) and intentional self-poisoning with medication (HR, 3.55; 95% CI, 1.01-12.53) represented two of the largest mortality risks among patients with epilepsy. The most common medications used for self-poisoning were opioids (56.5% [95% CI, 43.3%-69.0%]) and psychotropic medications (32.3% [95% CI, 20.9%-45.3%)] vs antiepileptic drugs (9.7% [95% CI, 3.6%-19.9%]).

The potential for residual confounding as well as misclassification of suicide attempts or behavior represent possible limitations of this analysis.

For clinical practice, physicians “should provide advice on unintentional injury and poisoning and suicide prevention and consider the toxicity of concomitant medication when prescribing drugs for people with epilepsy.”

Reference

Gorton HC, Webb RT, Carr MJ, DelPozo-Banos M, John A, Ashcroft DM. Risk of unnatural mortality in people with epilepsy [published online April 9, 2018]. JAMA Neurol. doi: 10.1001/jamaneurol.2018.0333

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