title: Utilization of care among drug resistant epilepsy patients with symptoms of anxiety and depression.
abstract: OBJECTIVE
  Epilepsy patients have a significantly higher rate of anxiety and depression than the general population, and psychiatric disease is particularly prevalent among drug resistant epilepsy patients. Symptoms of anxiety and depression might serve as a barrier to appropriate epilepsy care. The aim of this study was to determine if drug resistant epilepsy patients with symptoms of anxiety and/or depression receive different epilepsy management than controls.
  
  
  METHODS
  We identified 83 patients with drug resistant focal epilepsy seen at the Penn Epilepsy Center. Upon enrollment, all patients completed 3 self-report scales and a neuropsychiatric inventory and were grouped into those with symptoms of anxiety and/or depression and controls. Each patient's medical records were retrospectively reviewed for 1-2 years, and objective measures of outpatient and inpatient epilepsy management were assessed.
  
  
  RESULTS
  At baseline, 53% (n=43) of patients screened positive for symptoms of anxiety and/or depression. The remaining 47% (n=38) served as controls. Patients with anxiety and/or depression symptoms had more missed outpatient visits per year compared to controls (median 0.84 vs. 0.48, p=0.02). Patients with symptoms of both anxiety and depression were more likely to undergo an inpatient admission or procedure (56% vs. 24%, p=0.02).
  
  
  CONCLUSIONS
  For most measures of epilepsy management, symptoms of anxiety and/or depression do not alter epilepsy care; however, drug resistant epilepsy patients with anxiety and/or depression symptoms may be more likely to miss outpatient appointments, and those with the highest burden of psychiatric symptoms may be admitted more frequently for inpatient services compared to controls.
authors.affiliation: Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Katherine T
authors.initials: KT
authors.lastname: Hamilton
authors.affiliation: Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Anderson
authors.affiliation: Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Nabila
authors.initials: N
authors.lastname: Dahodwala
authors.affiliation: Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Kathy
authors.initials: K
authors.lastname: Lawler
authors.affiliation: GH Sergievsky Center and Department of Epidemiology, Columbia University, New York, NY, USA.
authors.forename: Dale
authors.initials: D
authors.lastname: Hesdorffer
authors.affiliation: Epilepsy Study Consortium and Department of Neurology, New York University, New York, NY, USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: French
authors.affiliation: Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: john.pollard@uphs.upenn.edu.
authors.forename: John R
authors.initials: JR
authors.lastname: Pollard
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects; D001007:Anxiety / Q000150:complications*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003863:Depression / Q000150:complications*; D004827:Epilepsy / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care
chemical_list: D000927:Anticonvulsants
keywords: Anxiety; Depression; Drug resistant; Epilepsy; Quality of care; management