Psychiatric symptoms in epilepsy patients and quality of life and relationship of comorbidities with sigmatization

OBJECTIVE: Research around the frequency of psychiatric diseases and psychosocial consequences caused by seizures and stigmatization in epilepsy patients is important, in terms of multidimensional evaluation of the condition, increasing quality of life and controlling the frequency of seizures. This prospective study aims to evaluate comorbid psychiatric diseases and stigmatization in patients with epilepsy, by ınvestıgatıng their relatıonshıp with clinical and sociodemographic data, and to determine their effects on patients' quality of life and perceived stigma. METHODS: Three hundreds patients were evaluated, aged between 18-65 years old, diagnosed with epilepsy, literate, and without intellectual disability. They were followed up in the Department of Clinical Neurophysiology of Istanbul Istanbul Faculty of Medicine, Istanbul Unıversıty, and seen in the Epilepsy outpatient clinic between November 2020 and October 2021. Age, gender, level of education, marital status, age of epilepsy onset, duration of disease, MR imaging findings, electroencephalography findings, neuropsychological test results, family history of epilepsy, history of epilepsy surgery, seizure frequency, and number of antiepileptic treatments used were all investigated. Patients were divided into subgroups according to the 2017 epilepsy syndrome and seizure classification of the International League Against Epilepsy (ILAE). SCL90-R Symptom Check List, Quality of Life in Epilepsy Scale (QOLIE-10), and Perceived Stigma Scale were applied to all epilepsy patients included in the study. Patients having a SCL90-R general symptom index (GSI) score more than 1 were considered to be at high risk for psychiatric disorder and were assessed using the Mini International Neuropsychiatric Interview (MINI) by experienced psychiatrists at the Istanbul Faculty of Medıcıne Department of Psychiatry. The frequency of psychiatric comorbidities, the relationship of comorbid psychiatric disorders with quality of life, and stigmatization in epilepsy patients were evaluated. Statistics Package of Social Science 21.0 programme was used for statistical analyses. RESULTS: 195 (65%) of the patients had focal epileptic syndrome, 93 (31%) had generalized epilepsy, and 9 (3.3%) had both focal and generalized epilepsy. In two (0.7 percent) of the patients, the epilepsy syndrome could not be identified. 92 patients (30.8%) had idiopathic/genetic epilepsy, 112 (37.3%) had structural epilepsy, 6 (2%) had genetic epilepsy, and 77 (25.6%) had epilepsy of unknown origin. The patients' mean seizure frequency was 1.48 per month. Psychiatric comorbidities were found in 24% (n=64) of epilepsy patients, with mood 4 (18.7%, n=50) and anxiety disorder being the most common (10.4%, n=28 ). The frequency of seizures (p=0,004), the number of antiepileptics (p=0,015), history of epilepsy surgery and psychiatric disorder (p<0,001), and high perceived Stigma (p<0,001) and QOLIE-10 (p<0,001) scores were all correlated to psychiatric comorbidities. CONCLUSION: According to the results of the study, it was determined that the most important predictors of psychiatric comorbidities in epilepsy patients were a history of psychiatric disease, poor quality of life and high perceived stigma scores. Thıs suggests that screening patients for comorbid psychiatric conditions in epilepsy outpatient clinics is critical, as is establishing strong collaboration with the psychiatry clinic, in order to reduce psychosocial ıssues and economic burden of stigmatisation and improve quality of life. Key Words: Psychiatric Comorbidity, Quality of Life, Perceived Stigma