Psych. and psychiatric aspects of brain disorders I: Suicidality in patients with neurological disorders - Antiepileptic drugs and suicidality
3 important questions on Psych. and psychiatric aspects of brain disorders I: Suicidality in patients with neurological disorders - Antiepileptic drugs and suicidality
Evidence on AEDs and suicide
- contradictory results between different studies. some report increased suicide, others no difference
- limitations:
- failure to account for past suicide attempts,
- other corrections that don't work - risk of suicide differs over time (17% in year one, 30% after 10 years), and in absence of adjustment of prior suicidal behaviour, impossible to determine if AEDs are associated with suicidal behaviour
The issue of suicide in epilepsy
- risk for suicide is 3 times higher in patients with epilepsy and a comorbid disorder, and 2 times in people with only epilepsy
- 90% of people committing suicide successfully has at least one psychiatric disorder
- post-ictal suicidal ideation is normal in patients with treatment resistent partial epilepsy
- Bidirectional correlation
- people with a history of suicidal behaviour had a 5 times higher risk of developing epilepsy
[There are multifactorial, biological, constitutional, and social variables implicated with epilepsy. screening for epilepsy is relevant]
Psychiatric Adverse Events ofAEDs in Patients with Epilepsy
- AED effects are related to direct and indirect mechanisms.
First generation links
- barbiturates -> depression
- carbamazepine -> mood stabilizing and antimanic
second generation
- tiagabine and topiramate -> treatment emergent depressive symptoms
- levetiracetam -> dysphoria and mood disorder
treatment-emergent depressive symptoms
- are sometimes associated with sudden complete control of seizures
- Development of psychiatric adverse effects is higher in those with history of psychiatric problems
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