Streamlined Psychosocial Comorbidity Screening Methods Needed for Epilepsy
Clinicians may face too many choices regarding the methods for screening patients with epilepsy for comorbidities.
Compared with the general population, individuals with epilepsy are at a higher risk of developing cognitive and behavioral comorbidities that can begin in childhood or adulthood, according to the 2016 Interprofessional Care Symposium session Interprofessional Assessment & Intervention of the Psychosocial Comorbidities of Epilepsy at the American Epilepsy Society conference.
“Psychosocial comorbidity” refers to how psychological and social environment affects physical and mental capabilities and function. Speaker Jana Jones, PhD, said that compared with the general population, children with epilepsy are more likely to develop attention-deficit/hyperactivity disorder, behavioral disorders, depression, anxiety, developmental delay, and intellectual disability.
Study results have also shown that patients with epilepsy have a higher risk of schizophrenia, suicidal behaviors, and psychiatric disorders.
Treating a patient with epilepsy requires an extensive interdisciplinary team that can identify and treat behavioral and psychiatric comorbidities. According to the session, patients may need a neurologist, social worker, nurse, pharmacist, neuropsychologist, psychologist, mental health provider, and a representative from the Epilepsy Foundation in their healthcare team to achieve the best possible health outcome.
Some healthcare providers use the National Institutes of Health Toolbox to assess cognitive, emotional, sensory, and motor functions in patients with epilepsy. This resource has been extensively studied and is psychometrically sound. It is accessed through an application on an iPad, and big data can be extracted if many clinicians implement the tool, according to the session.
However, it may be difficult to gather data in a clinical setting, and the initial cost of the iPads may be too costly for some providers, which may prevent them from screening their patients this way, Dr Jones said.
In another presentation during the symposium, presenter Mary Lou Smith, PhD, discussed preliminary findings from a survey administered to those treating patients with epilepsy. Approximately 79% of respondents reported that they screen patients for comorbidities under all circumstances, and few reported that they screen patients if their disease is unmanageable, they are on several antiepileptic drugs, or patients have requested the screening.
Most physicians reported that they ask questions to determine a patient’s comorbidities. In the survey, 53.9% of respondents said they do not have enough time to administer the screening questions, and 36.5% said their clinical staff does not have time to do so. Another 35.9% reported that the screening questionnaires are too long, which highlights the need for newer and more concise tests, according to the session.
In addition, physicians do not know which questionnaires to use or which questions to ask, and some reported that they are uncomfortable starting treatments for patients’ symptoms.
Dr Smith said that, to date, the Psychosocial Comorbidities Committee has made progress toward alleviating the issues physicians face by creating some direct questions and different sets of questions for screening adults and children. The committee also provides physicians with an algorithm to determine next steps.
The goal is to help physicians feel more comfortable administering screening tests and feel confident they are providing beneficial next steps for their patients.
To improve the diagnosis of comorbidities in patients with epilepsy, the American Epilepsy Society and the American Academy of Neurology are being encouraged to create and validate screening tests for early identification in patients with epilepsy who are considered to be at risk. These screening tests would help create a standard protocol for patients and allow patients with persistent seizures to receive treatment from an epileptologist, Dr Jones said during her presentation.
Although the screening process has improved, to improve patient outcomes, further work is needed to create a streamlined screening process to determine if adults and children with epilepsy have certain psychosocial como