Psychiatric comorbidities and sleep quality in Epilepsy: A Cross-sectional study in tribal population of Mayurbhanj district of Odisha.

OBJECTIVE

Our primary objective is to determine the prevalence of various psychiatric comorbidities in patients with epilepsy (PWE) and to assess sleep quality in PWE.

METHODS

Present study was a hospital based cross sectional study conducted over 2 months (January and February of 2022) that included 242 tribal patients from outdoor patient department in Mayurbhanj district of Odisha. Consecutive sampling was conducted. The patients fulfilling the inclusion and exclusion criteria were first assessed using a semi structured proforma for the socio-demographic data. The International Classification of Epilepsies (ILAE-1981) was used to classify seizure types. We used the Mini International Neuropsychiatric Interview (MINI 7.0.2) to assess psychiatric co-morbidity in all subjects. Hamilton anxiety scale (HAM-A), Hamilton rating scale for depression (HAM-D), brief psychiatric rating scale (BRPS), and young mania rating scale (YMRS) was applied accordingly depending on the psychiatric symptoms. Pittsburg sleep quality inventory (PSQI) was used to measure the sleep quality. Adherence in this study was determined by using a simple yes/no question that if the patient was taking the prescribed medications in the recommended dose, frequency and duration as prescribed by the mental health professional. Non-adherence refers to not taking the prescribed anti-epileptic drug and/or psychotropics if any as per recommended dose and duration as prescribed by the health care provider.

RESULTS

The prevalence of major depressive disorder, generalized anxiety disorder, psychotic disorder, and panic disorder was 18.2%, 16.1%, 15.7%, 1.2%, respectively. Hypomania and mania constituted 0.8% and 1.7% of the sample respectively. Suicidality with no other psychiatric illness was seen 2.1% of the population. PSQI scores among PWE had positive correlation with age (r = 0.171, P = 0.008), BPRS scores (r = 0.177, P = 0.006), HAM-D scores (r = 0.436, P = 0.000), and HAM-A scores (r = 0.228, P = 0.000), while negative correlation with duration since last seizure (r = -0.142, P = 0.027). Median age (P = 0.028), median duration of illness (0.009), HAM-D (P = 0.034), and PSQI scores (P = 0.004) were higher among non-adherent PWE. Duration since last seizure had higher median value among adherent PWE (P = 0.000). There is significant association of compliance with side effects (P = 0.020) and number of seizures per year (P = 0.016).

CONCLUSION

Depressive and anxiety disorders are more common psychiatric co-morbidities tribal PWE. When compared to unselected epilepsy patients, tribal PWE had higher prevalence of psychotic spectrum disorders, while lower prevalence of manic and hypomanic disorders. Sleep disturbance is an important indicator for poor maintenance of epilepsy. Non-adherence is associated with poor control of seizure and longer duration of illness. Tribal PWE with depression and poor sleep also have poor adherence. Improving adherence and sleep quality may improve the seizure control. Also, treatment of psychiatric co-morbidities may help in better seizure control. Non association of adherence and unemployment suggests that finance was not a barrier for adherence to treatment in tribal population of Mayurbhanj as most of the PWE were being treated under district mental health program (DMHP).