Hospitalization for Epilepsy Linked to Subsequent Psychosis Hospitalization

Initial hospitalization for epilepsy may be independently associated with a subsequent readmission for psychosis, according to study results published in Epilepsia.

The study included data from the Nationwide Readmissions Database, a nationally representative healthcare cost database in the United States, in 2013. The researchers used International Classification of Diseases, 9th Revision, Clinical Modification codes to identify medical conditions. Researchers calculated readmission rates for psychotic episodes within 90 days of discharge of index hospitalizations and used Cox regression analysis to test for associations between admission type and readmission for psychotic episodes up to 1 year after index admission.

The researchers identified 58,278 index admissions for epilepsy compared with 215,821 for stroke and 973,078 for other common medical causes (pneumonia, urinary tract infection, congestive heart failure, and chronic obstructive pulmonary disease).

Up to 90 days from index admissions, the researchers found that there were 683 readmissions for psychotic episodes per 100,000 index admissions in the epilepsy group, 92 per 100,000 index admissions in the stroke group, and 58 to 206 per 100,000 index admissions in the medical group. The first 30 days following index admission had the highest relative rate of readmission (311 per 100,000).

The fully-adjusted hazard ratio for readmission in the epilepsy group was 3.63 compared with the stroke group (95% CI, 3.08‐4.28; P <2×10⁻¹⁶) and 1.95 compared with the medical group (95% CI, 1.76‐2.15; P <2×10⁻¹⁶).

The researchers found that documented psychosis history at the time of index admission, younger age, and lower income quartile were strongly associated with psychosis readmission.

“This increased intermediate‐term risk of readmission for psychosis following an epilepsy admission exemplifies the significantly higher burden of illness borne by persons with epilepsy beyond the risk of seizures alone and suggests hospital admissions are a particularly vulnerable time for these patients,” the researchers wrote.

Reference

Rossi KC, Kim AM, Jette N, et al. Increased risk of hospital admission for ICD-9-CM psychotic episodes following admission for epilepsy [published online July 4, 2018]. Epilepsia. doi:10.1111/epi.14508