Risks of suicidality in adult patients with epilepsy

Table 1 Demographic and clinical features of the studied group of epilepsy (mean ± SD) n (%)

Demographic and clinical features	Patients (n = 200)	Patients with history of suicidality (n = 70)	Patients without history of suicidality (n = 130)
Male/female	100/100	34/36	66/64
Age (yr)	20-48 (30.47 ± 7.56)	20-48 (29.33 ± 7.60)	20-48 (31.08 ± 7.50)
Age at onset of disease (yr)	1-40 (16.24 ± 8.40)	1-39 (15.46 ± 8.66)	1-40 (16.66 ± 8.26)
Duration of illness (yr)	3-35 (13.94 ± 7.24)	3-31 (13.77 ± 6.93)	3-35 (14.04 ± 7.42)
Type of epilepsy
GTC	76 (38.0)	23 (32.9)	53 (40.8)
Complex partial/partial epilepsy with secondary generalization	124 (62.0)	47 (67.1)	77 (59.2)
Frontal	60 (48.39)	22 (46.81)	38 (49.35)
Temporal	58 (46.77)	23 (48.94)	35 (45.45)
Parietal	5 (4.03)	1 (2.13)	4 (5.19)
Occipital	1 (0.80)	1 (2.13)	0
Side of epileptic activity
Right	50 (40.32)	22 (46.81)	28 (36.36)
Left	74 (59.68)	25 (53.19)	49 (63.63)
AED(s) utilized
CBZ	114 (57.0)	31 (44.3)	83 (63.8)
VPA	48 (24.0)	21 (30.0)	27 (20.8)
Polytherapy	38 (19.0)	18 (25.7)	20 (15.4)
Dose of AED(s) (mg/d)
CBZ	400-1200 (750.54 ± 350.5)	400-1200 (700.24 ± 320.25)	400-1200 (760.25 ± 300.25)
VPA	200-1400 (850.50 ± 345.7)	200-1400 (840.30 ± 305.75)	200-1400 (730.50 ± 255.7)
Duration of treatment (yr)	2-30 (9.28 ± 4.02)	2-30 (9.28 ± 4.02)	2-30 (9.38 ± 4.39)
Serum drug level (μg/mL)
CBZ	4.30-12.80 (9.56 ± 4.5)	4.30-12.80 (9.56 ± 4.5)	4.30-12.80 (9.56 ± 4.5)
VPA	35.54-120.45 (80.50 ± 30.0)	35.54-120.4 (100.50 ± 30.0)	35.54-120.4 (85.50 ± 25.0)
Degree of control on AED(s)
Controlled	45 (22.5)	9 (12.9)	24 (26.2)
Partially controlled	47 (23.5)	14 (20.0)	3 (25.4)
Uncontrolled	108 (54.0)	47 (67.1)	63 (48.5)

GTC: Generalized tonic-clonic; AEDs: Antiepileptic drugs; CBZ: Carbamazepine; VPA: Valproate; Controlled: Seizure free for ≥ 1 year; Partially controlled: Occasional or rare in frequency; Uncontrolled: Very frequent or frequent in frequency.

Table 2 The frequencies of psychiatric symptoms in the studied group of epilepsy n (%)

Psychiatric disorders	Patients (n = 200)	Patients with history of suicidality (n = 70)	Patients without history of suicidality (n = 130)
BDI-II	108 (54)	56 (80.00)	52 (40)
Mild	17 (15.74)	5 (8.93)	12 (23.08)
Moderate	37 (34.26)	18 (32.14)	19 (36.54)
Severe	54 (50)	33 (58.93)	21 (40.38)
HAM-A	96 (48.0)	51 (72.86)	45 (34.62)
Mild	19 (19.79)	7 (13.73)	12 (26.67)
Moderate	30 (31.25)	14 (27.45)	16 (35.56)
Severe	47 (48.96)	30 (58.82)	17 (37.78)
Y-BOCS	102 (52.5)	39 (55.71)	66 (50.77)
Mild	45 (44.12)	13 (33.3)	32 (48.48)
Moderate	27 (26.47)	7 (17.95)	20 (30.30)
Severe	18 (17.65)	11 (28.21)	7 (10.61)
Extreme	15 (14.71)	8 (20.51)	7 (10.61)
EPQ-R
Psychosis	71 (35.5)	13 (18.4)	58 (44.6)
Neurosis	36 (18.0)	11 (15.7)	25 (19.2)
Extroversion	33 (16.5)	5 (7.1)	28 (21.5)
Lying	0	0	0
Aggression	70 (35)	37 (52.9)	33 (25.4)

BDI-II: Beck Depression Inventory (2nd edition); HAM-A: Hamilton Anxiety; Y-BOCS: Yale-Brown Obsessive Compulsive Scale; EPQ-R: Eysenck Personality Questionnaire-Revised Rating Scale.

Table 3 Frequencies of psychiatric abnormalities in the studied group of epilepsy in relation to gender n (%)

Psychiatric disorders	Males (n = 100)		Females (n = 100)
	Males with suicide (n = 34)	Males without suicide (n = 66)	Females with suicide (n = 36)	Females without suicide (n = 64)
BDI-II	34 (100)	18 (27.27)	26 (72.22)	34 (53.13)
Mild	3 (8.82)	7 (38.89)	2 (7.69)	5 (14.71)
Moderate	10 (23.26)	5 (27.78)	8 (30.77)	14 (41.18)
Severe	17 (52.94)	6 (33.33)	16 (61.54)	15 (44.12)
HAM-A	27 (79.41)	15 (22.72)	24 (66.67)	30 (46.88)
Mild	4 (14.81)	3 (20)	3 (12.5)	9 (30)
Moderate	9 (33.33)	8 (53.33)	5 (20.83)	8 (26.67)
Severe	14 (51.85)	4 (26.67)	16 (66.67)	13 (43.33)
Y-BOCS	22 (64.71)	27 (40.91)	17 (47.22)	39 (60.94)
Mild	9 (40.91)	13 (48.15)	4 (23.53)	19 (48.72)
Moderate	4 (18.18)	7 (25.93)	3 (17.65)	13 (33.33)
Severe	4 (18.18)	4 (14.81)	7 (41.18)	3 (7.69)
Extreme	5 (22.73)	3 (11.11)	3 (17.65)	4 (10.26)
EPQ-R
Psychosis	5 (14.7)	29 (43.9)	8 (22.4)	29 (45.3)
Neurosis	4 (11.8)	18 (27.3)	7 (19.4)	7 (19.4)
Extroversion	4 (11.8)	22 (33.3)	1 (2.8)	6 (9.4)
Lying	0	0	0	0
Aggression	20 (58.8)	21 (31.8)	17 (47.2)	12 (18.8)

BDI-II: Beck Depression Inventory (2nd edition); HAM-A: Hamilton Anxiety; Y-BOCS: Yale-Brown Obsessive Compulsive Scale; EPQ-R: Eysenck Personality Questionnaire-Revised Rating Scale.

Table 4 Significance between patients and control subjects in scores of BDI-II, HAM-A, Y-BOCs and EPQ-R in relation to epilepsy itself- and its treatment-related variables regardless to the presence or absence of suicidality

Epilepsy itself- and its treatment-related variables	BDI-II	HAM-A	Y-BOCS	EPQ-R
				Psychosis	Neurosis	Extroversion	Lying
Type of epilepsy
Generalized
P1	0.0001	0.296	0.003	0.015	0.0001	0.435	0.0001
Focal
P1	0.0001	0.214	0.008	0.001	0.0001	0.436	0.0001
P2	0.511	0.958	0.682	0.729	0.521	0.867	0.786
Focal epilepsies
Frontal
P1	0.0001	0.182	0.001	0.005	0.0001	0.346	0.0001
Temporal
P1	0.005	0.259	0.555	0.011	0.0001	0.448	0.0001
P3	0.514	0.607	0.037	0.818	0.656	0.893	0.353
Side of epileptic activity
Right
P1	0.0001	0.327	0.068	0.030	0.0001	0.131	0.002
Left
P1	0.001	0.138	0.015	0.003	0.0001	0.821	0.0001
P4	0.919	0.697	0.805	0.800	0.397	0.189	0.064
CBZ
P1	0.0001	0.852	0.007	0.0001	0.0001	0.407	0.0001
P5	0.857	0.186	0.900	0.071	0.897	0.682	0.242
P6	0.005	0.004	0.213	0.034	0.160	0.443	0.155
VPA
P1	0.007	0.074	0.108	0.207	0.0001	0.762	0.0001
P6	0.024	0.112	0.279	0.750	0.299	0.341	0.039
Polytherapy
P1	0.0001	0.003	0.003	0.380	0.0001	0.199	0.013
Controlled
P1	0.714	0.001	0.144	0.0001	0.878	0.034	0.0001
P7	0.070	0.020	0.499	0.001	0.001	0.025	0.238
P8	0.0001	0.0001	0.087	0.0001	0.0001	0.0001	0.951
Partially uncontrolled
P1	0.078	0.917	0.611	0.033	0.0001	0.992	0.0001
P8	0.0001	0.0001	0.010	0.183	0.034	0.017	0.176
Uncontrolled
P1	0.0001	0.0001	0.0001	0.373	0.0001	0.007	0.0001

CBZ: Carbamazepine; VPA: Valproate; BDI-II: Beck Depression Inventory (2nd edition); HAM-A: Hamilton Anxiety; Y-BOCS: Yale-Brown Obsessive Compulsive Scale; EPQ-R: Eysenck Personality Questionnaire-Revised Rating Scale; P1: Patients vs controls; P2: Generalized vs focal; P3: vs frontal; P4: Right vs left; P5: CBZ vs VPA; P6: vs polytherapy; P7: vs partially controlled; P8: vs uncontrolled.

Table 5 Significance between patients and control subjects in the concentrations of serotonin, catecholamines and dopamine in relation to epilepsy itself- and its treatment-related variables regardless to the presence or absence of suicidality

Epilepsy-related variables	Serotonin	Noradrenaline	Adrenaline	Dopamine
Type of epilepsy
Generalized
P1	0.002	0.016	0.0001	0.051
Focal
P1	0.017	0.007	0.0001	0.558
P2	0.176	0.305	0.662	0.096
Focal epilepsies
Frontal
P1	0.074	0.032	0.0001	0.469
Temporal
P1	0.003	0.014	0.0001	0.400
P3	0.375	0.575	0.818	0.810
Side of epileptic activity
Right
P1	0.031	0.061	0.0001	0.754
Left
P1	0.017	0.007	0.0001	0.387
P4	0.781	0.392	0.966	0.626
CBZ
P1	0.068	0.001	0.0001	0.064
P5	0.239	0.546	0.682	0.739
P6	0.051	0.374	0.682	0.528
VPA
P1	0.009	0.007	0.0001	0.324
P6	0.170	0.628	0.698	0.867
Polytherapy
P1	0.007	0.243	0.0001	0.806
Controlled
P1	0.136	0.115	0.0001	0.208
P7	0.189	0.116	0.090	0.056
P8	0.185	0.174	0.528	0.683
Partially uncontrolled
P1	0.019	0.003	0.0001	0.542
P8	0.903	0.524	0.158	0.034
Uncontrolled
P1	0.012	0.001	0.0001	0.004

CBZ: Carbamazepine; VPA: Valproate; P1: Patients vs controls; P2: Generalized vs focal; P3: vs frontal; P4: Right vs left; P5: CBZ vs VPA; P6: vs polytherapy; P7: vs partially controlled; P8: vs uncontrolled.

Table 6 Comparative statistics between patients with and without suicidality and control subjects in relation to psychosocial variables

	BDI-II	HAM-A	Y-BOCS	EPQ-R
				Psychosis	Neurosis	Extroversion	Lying
Patients with history of suicidality (n = 70)
Range	3.0-53.0	3.0-44.0	0.0-38.0	3.00-20.00	4.0-21.00	3.0-18.0	3.0-18.0
Mean	27.19	21.30	14.25	8.94	11.56	9.83	11.14
25th Percentiles	18.00	12.75	4.00	6.00	8.00	6.00	8.75
50th Percentiles	26.50	22.00	13.50	9.00	10.50	9.00	11.00
75th Percentiles	37.25	28.25	24.25	11.00	13.25	15.00	13.25
Patients without history of suicidality (n = 130)
Range	1.0-50.0	1.0-44.0	0.0-40.0	3.0-15.0	4.00-21.00	2.0-18.0	2.0-19.0
Mean	15.88	11.95	10.72	11.65	13.42	11.38	11.00
25th Percentiles	7.00	5.00	2.00	4.00	9.00	17.00	9.00
50th Percentiles	11.00	8.00	9.50	6.00	13.00	13.00	11.00
75th Percentiles	23.25	18.00	16.00	9.00	18.00	16.00	13.00
Control subjects (n = 100)
Range	1.0-51.0	2.0-48.0	0.0-35.0	2.0-13.0	3.0-22.0	2.0-19.0	3.0-18.0
Mean	11.80	13.20	7.54	6.50	18.08	11.27	8.47
25th Percentiles	7.00	6.00	2.25	4.00	14.00	6.25	7.00
50th Percentiles	10.00	10.50	6.00	7.00	18.00	12.00	9.00
75th Percentiles	14.00	15.00	12.00	9.00	19.75	16.75	10.00
Significance
P1	0.0001	0.0001	0.0001	0.0001	0.0001	0.050	0.0001
P2	0.031	0.235	0.042	0.0001	0.0001	0.108	0.0001
P3	0.0001	0.0001	0.037	0.750	0.003	0.025	0.911

BDI-II: Beck Depression Inventory (2nd edition); HAM-A: Hamilton Anxiety; Y-BOCS: Yale-Brown Obsessive Compulsive Scale; EPQ-R: Eysenck Personality Questionnaire-Revised Rating Scale; P1: Patients with suicide vs control subjects; P2: Patients without suicide vs control subjects; P3: Patients with suicide vs patients without suicide.

Table 7 Comparative statistics between patients with and without history of suicide and control subjects in relation to concentrations of serotonin, catecholamines and dopamine

	Serotonin (ng/mL)	Noradrenaline (ng/mL)	Adrenaline (ng/mL)	Dopamine (ng/mL)
Patients with history of suicidality (n = 70)
Range	0.00-96.3	1.1-161.5	0.10-80.2	0.10-165 222
Mean	36.25	40.27	8.60	9133.12
25th Percentiles	10.70	4.13	4.10	14.03
50th Percentiles	21.40	20.90	5.10	51.85
75th Percentiles	64.20	61.25	60.35	837.98
Patients without history of suicidality (n = 130)
Range	0.0-96.30	2.0-213.4	0.10-521.40	0.10-2145.00
Mean	42.67	57.53	27.71	301.44
25th Percentiles	21.60	4.70	0.10	5.50
50th Percentiles	42.80	30.65	0.10	34.00
75th Percentiles	64.20	104.35	4.08	161.50
Control subjects (n = 100)
Range	42.8-107.0	1.50-493.20	0.1-1914.00	0.10-5146.0
Mean	71.69	125.35	314.72	235.53
25th Percentiles	50.83	28.30	9.85	20.50
50th Percentiles	69.55	128.00	55.00	56.60
75th Percentiles	96.30	181.50	417.45	6253.80
Significance
P1	0.031	0.005	0.0001	0.282
P2	0.006	0.019	0.0001	0.077
P3	0.303	0.399	0.719	0.842

P1: Patients with suicide vs control subjects; P2: Patients without suicide vs control subjects; P3: Patients with suicide vs patients without suicide.