Clinical Characteristics associated with functional seizures in individuals with psychosis

Functional seizures (FS) are episodes characterized by seizure-like events that are not caused by hypersynchronous neuronal activity. Prior studies have suggested an increased prevalence of psychotic disorders among patients with FS, but results have been inconsistent. We hypothesize that FS are associated with psychosis and that among patients with psychosis, the presence of FS may influence patient clinical characteristics, mortality, and medical resource utilization.

The association between FS and psychosis was assessed using electronic health records data from a total of 761,848 individuals receiving care at Vanderbilt University Medical Center between 1989 and 2023. Analyses of the association between FS and psychiatric outcomes, sexual trauma, healthcare utilization, and other clinical comorbidities were conducted in a subset of 5219 patients with psychosis.

Odds of FS were elevated among patients with psychosis compared to controls (OR = 10.09, 95 % CI = 8.40-12.13). Among patients with psychosis, those with FS exhibited higher rates of suicidality (OR = 2.18 95 % CI = 1.50-3.17), catatonia (OR = 2.15, 95 % CI = 1.33-3.45), sexual trauma history (OR = 2.93, 95 % CI = 2.00-4.29) and had a greater number of antipsychotic trials (4.63 versus 3.37, beta = 1.23, SE = 0.18, adjusted p < 0.001) than those without FS. Furthermore, patients with comorbid FS had more hospital presentations at one, three, five, and ten years after receiving a psychosis diagnosis (adjusted p < 0.001).

FS are more common among patients with psychosis and are associated with increased healthcare utilization as well as an increased prevalence of suicidality, catatonia, and certain psychiatric and medical comorbidities.