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Abstract Details

Psychosis and Seizures in the Veteran Population
Epilepsy/Clinical Neurophysiology (EEG)
P2 - Poster Session 2 (8:00 AM-9:00 AM)
12-007
Describe the relationship of epileptic and non-epileptic seizure with psychosis in the Veteran population

The prevalence of psychotic disorders within the general population is estimated to be around 1-4%, but is higher (6%) among people with epilepsy. Psychotic symptoms such as hallucinations, paranoia, and delusions may manifest as ictal or post-ictal phenomena. Post-ictal irritability and aggression may be misdiagnosed as psychosis. Psychiatric comorbidities of psychogenic non-epileptic seizures (PNES) can result in accurate or inaccurate diagnoses of psychosis.

Electronic health records of post-9/11 Veterans were extracted (N= 801,883) to identify Veterans in VA care with a diagnosis of epilepsy (n = 10,994), PNES (n = 751) and general sample without seizures (n = 790,068). We examined the International Classification of Disease 9 and 10 (ICD) diagnoses of schizophrenia, psychosis NOS, and post-traumatic stress disorder (PTSD) within these groups. 
We found that 28% of epilepsy patients were coded for psychosis not otherwise specified (NOS) and 2% were coded with schizophrenia. Within the PNES sample, 31% were coded for psychosis NOS and 1% with schizophrenia, while in the sample without seizures, 5% were coded for psychosis NOS and 0.5% with schizophrenia. PTSD was 72% in the epilepsy sample, 83% within the PNES population, and 37% in the general sample. Of the general sample coded for psychosis, 9% had PTSD. Coding for psychosis were primarily mental health (55-58%), physiatry (13-15%), and neurology (1-2%). 

The increased proportion of psychosis NOS within epileptic and PNES patients may represent a coding error within the EHR or may have important clinical implications.  We will determine if the large proportion of psychosis NOS diagnoses is an EHR coding error or a result of peri-ictal phenomena, post-ictal agitation, or co-morbid psychosis. If results were due to coding error, this error disproportionately affects patients with epilepsy and PNES.

Authors/Disclosures
Yarden Bornovski, MD (Westchester Medical Center)
PRESENTER 		Dr. Bornovski has nothing to disclose.
No disclosure on file
Ebony Jackson-Shaheed No disclosure on file
Benjamin D. Tolchin, MD, MS, FÂ鶹´«Ã½Ó³»­ (Yale University School of Medicine) The institution of Dr. Tolchin has received research support from C.G. Swebilius Trust.
No disclosure on file
No disclosure on file
No disclosure on file
Hamada H. Altalib, DO (VA Connecticut Healthcare System) The institution of Dr. Altalib has received research support from UCB. The institution of Dr. Altalib has received research support from DEPARTMENT OF DEFENSE - CONGRESSIONALLY DIRECTED MEDICAL RESEARCH PROGRAMS.