First-episode psychosis and mood disorder onset in individuals with epilepsy

Psychiatric disorders represent a major burden for patients with epilepsy (PwE). This study examined how demographic, epilepsy-related, and clinical risk factors contribute to the onset of mood and psychotic disorders in epilepsy.

In this retrospective cohort, we intersected a hospital structured database with results from direct text mining in all available documentation from each patient to include PwE without prior psychiatric history. Logistic regression evaluated age, sex, epilepsy type, treatment resistance, histories of status epilepticus and febrile seizures, neurological and neurodevelopmental comorbidities as risk factors of psychotic and mood disorders. A five-fold cross-validated logistic regressor tested their predictive performance. Pairwise comparisons examined psychiatric outcomes across monotherapy treatments.

We screened 4269 individuals ; 1709 were excluded for lack of an established epilepsy diagnosis or anti-epileptic medication ; 696 already had a psychiatric history at the time of first antiseizure medication. In 1864 PwE without prior psychiatric history, psychiatric disorders occurred in 25% of cases (15.8% mood, 2.9% psychosis, 3.4% mood and psychosis). Risks for mood disorders included female sex, focal epilepsy, drug resistance, a history of febrile seizures, neurological comorbidities, and neurodevelopmental disorders. Risk factors for psychotic disorders included drug resistance, a history of febrile seizures and neurodevelopmental disorders. Supervised analyses significantly predicted outcomes for mood disorders (AUC = 0.70, p < 0.001) and psychosis (AUC = 0.61, p < 0.001). Pairwise treatment comparisons found no significant differences.

Identification of these risk factors to psychosis and mood disorder onset provides clinicians with red flags that will facilitate timely psychiatric referral and intervention, as well as integrated care between neurologists and psychiatrists.