Original Article
Copyright ©2012 Baishideng. All rights reserved.
World J Psychiatr. Apr 22, 2012; 2(2): 33-42
Published online Apr 22, 2012. doi: 10.5498/wjp.v2.i2.33
Risks of suicidality in adult patients with epilepsy
Sherifa A Hamed, Yaser BE Elserogy, Madleen A Abdou, Mostafa M Abdellah
Sherifa A Hamed, Yaser BE Elserogy, Department of Neurology and Psychiatry, Assiut University Hospital, PO Box 71516, Assiut, Egypt
Madleen A Abdou, Department of Clinical Pathology, Assiut University Hospital, PO Box 71516, Assiut, Egypt
Mostafa M Abdellah, Department of Pharmacology, Assiut University Hospital, PO Box 71516, Assiut, Egypt
Author contributions: Hamed SA carried out the clinical evaluation, collected samples, participated in the design of the study, statistical analysis and drafting of the manuscript; Elserogy YBE carried out the psychiatric evaluation blood and participated in the design of the study and its statistical analysis; Abdou MA carried out the routine and specific laboratory investigations, participated in the design and statistical analyses of the study and drafting of the manuscript; Abdellah MM carried out the serum drug level of antiepileptic medications, participated in the laboratory analyses of routine and specific laboratory investigations and participated in the design of the study and its statistical analysis. All authors read and approved the final manuscript.
Correspondence to: Sherifa Ahmad Hamed, MBBch, MSc, MD, Consultant Neurologist, Associate Professor, Department of Neurology and Psychiatry, Assiut University Hospital, PO Box 71516, Assiut, Egypt. hamed_sherifa@yahoo.com
Telephone: +20-88-2374904 Fax: +20-88-2333327
Received: June 3, 2011
Revised: October 16, 2011
Accepted: February 25, 2012
Published online: April 22, 2012
Abstract

AIM: To determine the prevalence and risks of suicidality in a group of patients with epilepsy.

METHODS: Included were 200 adult patients and 100 matched healthy subjects. The clinical interview using The Diagnostic and Statistical Manual of Mental Disorders (4th edition), Beck Depression Inventory (2nd edition) (BDI-II), Hamilton Anxiety Rating Scale (HAM-A), Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Eysenck Personality Questionnaire-Revised Rating Scale testings were used for diagnosis and assessment of severity of psychiatric symptoms. Blood concentrations of serotonin, catecholamines and dopamine were also measured.

RESULTS: Suicidality was reported in 35% (compared to 9% for controls), of them 80%, 72.86%, 55.71% and 52.9% had depression, anxiety, obsession and aggression respectively. Patients with suicidality had higher scores of BDI-II (P = 0.0001), HAM-A (P = 0.0001), and Y-BOCS (P = 0.037) and lower scores of psychotic (P = 0.0001) and extroversion (P = 0.025) personality traits. Regardless the presence or absence of suicidality, patients with epilepsy had low serotonin (P = 0.006), noradrenaline (P = 0.019) and adrenaline (P = 0.0001) levels. With suicidality, significant correlations were identified between: (1) age and scores of BDI-II (r = 0.235, P = 0.0001) and HAM-A (r = 0.241, P = 0.046); (2) age at onset and concentrations of noradrenaline (r = -0.502, P = 0.024); (3) duration of illness and scores of BDI-II (r = 0.247, P = 0.041), Y-BOCS (r = 0.270, P = 0.025) and neurotic personality trait (r = -0.284, P = 0.018); and (4) doses of antiepileptic drugs and scores of psychotic personality traits (r = -0.495, P = 0.006 for carbamazepine; r = -0.508, P = 0.0001 for valproate).

CONCLUSION: This is the first study which systematically estimated the prevalence and risks of suicidality in a homogenous group of patients with epilepsy. This study emphasizes the importance of epilepsy itself as a risk for suicidality and not its treatment.

Keywords: Epilepsy; Anti-epileptic drugs; Psychosocial variables; Serotonin; Catecholamines; Dopamine