Epilepsy Sparks

Epilepsy & Mental Illness - A True Story from a Mental Health Nurse

My name is Greg Robin and I am a PaediatricMental Health Registered Nurse¹at Sharp Mesa Vista Hospital² in San Diego³, California⁴, U.S.A.

San Diego, Greg Robin

Favorite food: Eggplant Parmesan⁵

Favorite song: Wish You Were Here⁶ by Incubus⁷

I have had the privilege of treating patients with mental health disorders as a registered Nurse over the last 5 years. In my current role, I work at an inpatient psychiatric hospital with units varying from geriatric to adult, to intensive care, to chemical dependency, through to my primary unit of children and adolescents.

Although I do not personally have epilepsy or any other neurological disorder, I treat psychiatric patients who do.

Overview

There is a proven high comorbidity⁸ between those diagnosed with epilepsy and mental illnesses. A recent study done by the NCBI estimated that 39.9% of people with epilepsy had a mental health issue, with the most common illness being depression which affected 13%⁹.

With such a high coexistence between epilepsy and mental illness, it is imperative that further research and patient education continues and improves; to manage patient safety and provide the best treatment methods.

When people with epilepsy also have mental health disorders such as clinical depression¹⁰, psychosis¹¹ or schizophrenia¹², they are far more susceptible to an increased number of seizures as a result of not taking their anti-epileptic drugs (AEDs) or self-injury. Reasons can include:

· Cognitive impairments¹³ – people can be unaware that they have a seizure disorder and forget to take their prescribed AEDs

· Auditory and visual hallucinations¹⁴ – these cause people to hear or see things that don’t exist, but which can make them fearful and scared of taking their AEDs

· Paranoid delusions¹⁵ – these are irrational beliefs which can make people believe that their AEDs contain poison, hence they refuse to take them

· Self-inflicted head trauma – this can occur during a psychotic episode or in an instance of self-harm, and directly trigger a seizure

When people have a depressive disorder such as clinical depression¹⁰ or bipolar disorder¹⁶, they tend to have at-risk behaviors which often occur during:

· The Manic phase¹⁷ – when people can forget to take their AEDs and;

· The Depressive phase¹⁷ – when people can intentionally abstain from taking their AEDs due to severe thoughts of hopelessness, depression and even suicide

Studies show a high comorbidity between epilepsy and schizophrenia. In fact, according to a study at Harvard individuals with schizophrenia are about six times more likely to develop epilepsy compared to individuals without the diagnosis, and individuals with epilepsy were found to be about eight times more likely to develop schizophrenia¹⁸.

Overactive brain, TheDigitalArtist

A Patient with Epilepsy & Schizoaffective Disorder

One personal experience of a patient with a comorbidity of these disorders that I feel inclined to share occurred just yesterday.

Admission

I was filling in as a Nurse on a locked, adult psychiatric unit and was instructed by the Charge Nurse¹⁹ to get a Nurse-to-Nurse report for a patient (we will call her Sally) that had been admitted to the unit a few hours prior. Sally was a 57-year-old female with diagnoses' of epilepsy and schizoaffective disorder²⁰, and who used a wheelchair and wore a helmet.

Sally had been brought to the hospital by staff at an outpatient therapy facility after an incident where she punched a wall and reported that she’d had command auditory hallucinations to hurt herself.

While giving me the report, the Shift Nurse (we’ll call him Bob) told me that Sally had been prescribed Fluphenazine²¹: a drug class of a typical (first-generation) antipsychotic²² which balances neurotransmitters²³ in the brain to reduce episodes of hallucinations, delusions, disorganized speech, and other psychotic behaviors associated with schizophrenia.

Sally was on the long-acting injectable version of Fluphenazine (Fluphenazine Decanoate) which is administered every 14-28 days and is prescribed for patients who struggle to self-administer medications on a daily basis.

Patient Advocate

As a patient’s Nurse, it is my responsibility to be their advocate. When calling the Psychiatrist, I informed him that Sally was receiving the Fluphenazine Decanoate every 14 days and that her next scheduled dose for the injection was to be in just two days, and that she was taking Anti-Epileptic Drugs for her epilepsy. As soon as I informed Sally’s Physician²⁵, he gave me the order to continue Sally’s medications, stating that she had been taking them for years.

Sally's Epilepsy

Sally had epilepsy and uncontrolled tonic-clonic seizures²⁶ so as well as us providing her with her Anti-Epileptic Drugs, we also got her bed rails to be padded, for her bed to be set in the lowest position, and we provided her with a bed alarm.

I passed on all of the information about Sally's epilepsy and schizoaffective disorder to the next shift so that they could provide her with the care that she needed and deserved.

Conclusion

To maintain safety and provide the highest standard of care possible for those with a mental health disorder and a comorbidity of epilepsy, it’s extremely important for healthcare professionals to educate themselves about epilepsy and objectively report all pertinent patient history to the healthcare team in a timely manner.

Greg Robin

Paediatric Mental Health Registered Nurse

Sharp Mesa Vista Hospital, San Diego