Epilepsy in acute psychiatric inpatient settings: Prevalence, treatment gaps, and mortality.

Background: The underrepresentation of acute psychiatric settings in epilepsy research presents a barrier to delivering equitable healthcare for people with comorbid epilepsy and severe mental illness. We aimed to report the prevalence of epilepsy among people receiving acute psychiatric inpatient care and examine the sociodemographic and clinical characteristics influencing their treatment outcomes.

Methods: We analysed electronic patient records to estimate the lifetime prevalence of epilepsy in a retrospective cohort of 9,237 people admitted to psychiatric inpatient wards in South London between 2015 and 2019. Hospital and national databases were used to examine the characteristics of those with epilepsy, including sociodemographic variables, antiseizure medication prescriptions, and engagement with specialist neurology services. Kaplan-Meier and Cox regression analyses identified predictors of all-cause mortality in individuals with epilepsy and a comparator cohort without epilepsy.

Results: The lifetime prevalence of epilepsy in this population was 3 % (95 % CI: 2.65 to 3.36). Among individuals with epilepsy, 64.1 % were prescribed two or more antiseizure medications, while only 32.6 % received specialist neurology input in the year before and after their latest admission. Additionally, 72.8 % lived in areas with high levels of socioeconomic deprivation. Adjusting for clinical and demographic covariates, the presence of epilepsy was associated with a 43 % increased risk of mortality in this population (HR = 1.43, 95 % CI: 1.08-1.90, p = 0.01).

Conclusions: Epilepsy has an elevated prevalence and is a predictor of increased mortality among people receiving acute psychiatric inpatient care. Improving outcomes in this population will require interdisciplinary collaboration and patient advocacy.