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

My name is Greg Robin and I am a PaediatricMental Health Registered Nurse1 at 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
Greg Robin
References:
1.
Nurse Journal: https://nursejournal.org/psychiatric-nursing/what-do-psychiatric-and-mental-health-nurses-do/
2.
Sharp Mesa Vista Hospital: https://www.sharp.com/hospitals/mesa-vista/
3.
The City of San Diego: https://www.sandiego.gov/
4.
State of California: https://www.ca.gov/
5.
Martha Stewart: https://www.marthastewart.com/313564/baked-eggplant-parmesan
6.
YouTube, IncubusTV: https://www.youtube.com/watch?v=8295rOMvtQI
7.
Incubus: https://www.incubushq.com/
8.
Very Well Mind: https://www.verywellmind.com/what-is-comorbidity-3024480
9.
National Centre for Biotechnology Information
(NCBI): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685646/
10. Mental
Health America: https://www.mentalhealthamerica.net/conditions/depression
11. Mental
Health America: https://www.mentalhealthamerica.net/conditions/psychosis
12. Mental
Health America: https://www.mentalhealthamerica.net/conditions/schizophrenia
13. CDC
(Centres for Disease Control & Prevention): https://www.cdc.gov/aging/pdf/cognitive_impairment/cogimp_poilicy_final.pdf
14. Healthline:
https://www.healthline.com/health/hallucinations#types
15. Mental
Health America: https://www.mentalhealthamerica.net/conditions/paranoia-and-delusional-disorders
16. National
Institute of Mental Health: https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
18.
Health Harvard: https://www.health.harvard.edu/newsletter_article/schizophrenia-and-epilepsy
19.
Study.com: https://study.com/articles/Charge_Nurse_Duties_and_Responsibilities.html
20. Mayo
Clinic:https://www.mayoclinic.org/diseases-conditions/schizoaffective-disorder/symptoms-causes/syc-20354504
21. NCBI:
https://www.ncbi.nlm.nih.gov/books/NBK459194/
22. Mind:
https://www.mind.org.uk/information-support/drugs-and-treatments/antipsychotics/
23. The
University of Queensland: https://qbi.uq.edu.au/brain/brain-physiology/what-are-neurotransmitters
24. Your
Health In Mind: https://www.yourhealthinmind.org/psychiatry-explained/whats-a-psychiatrist
25. Royal
College of Physicians: https://www.rcplondon.ac.uk/education-practice/advice/what-physician
26.
Epilepsy Action: https://www.epilepsy.org.uk/info/seizures/tonic-clonic