Determining treatment levels of comorbid psychiatric conditions in people with epilepsy attending selected Local Clinics in Lusaka, Zambia

Abstract

Background- Psychiatric co-morbidities, particularly mood and anxiety disorders, occur more frequently in patients with epilepsy compared to the general population and tend to worsen morbidity and mortality in this group of patients via suicide among other causes. Treatment of these disorders is key to reducing mortality. This study determined the levels of treatment of psychiatric co-morbid conditions in people living with epilepsy attending local clinics in Lusaka province of Zambia and some factors likely to affect chances of being on treatment. Methodology- This was a cross-sectional study conducted from 5 (five) Health institutions within Lusaka District. Enrolment of participants was from March to September, 2015. The study included participants with epilepsy for over 3 months aged 18years and above. The sample size to estimate the prevalence of psychiatric co-morbidity in epilepsy patients was calculated according to the simple proportion formula developed by Cochran in 1963. The Brief psychiatric rating scale (BPRS) and a self-designed questionnaire for extracting demographics and medical history were administered to patients meeting the inclusion criteria to determine how many needed treatment compared to those that actually were on treatment. Results- Of the 397(56.7% Male, 43.3% Female) participants enrolled in the study, the majority 308(80%) had only lived with epilepsy for less than 10 years and the mean age of the study participants was 31.29[SD 9.7] years with a rapid drop beyond 34 years of age. Only 14(3.5%) were found to have psychiatric disorders already diagnosed by the local staff and yet the screening with BPRS showed that 158(39.8%) had anxiety symptoms, 156(39.6%) had depressive symptoms and 57(14.4%) had psychotic symptoms. 13(92.8%) of those pre-diagnosed to have psychiatric comorbidity were on treatment. The results revealed that there was a significant association between male gender and psychiatry diagnosis (p=0.017). Conclusion- The detection and treatment rate of psychiatric comorbid conditions stands at 3.5% of the epilepsy population and with comorbidity prevalence at about 39%, it means that less than 10% of those eligible receive treatment. This low treatment rate may contribute to the poor treatment outcomes (mortality included) beyond 5 years of diagnosis. There was a rapid drop in numbers of participants beyond 35years of age and this would have been due to poor life expectancy in epilepsy. There is need to improve comorbidity screening and treatment as it impacts treatment outcomes.