Department of Neurology, Penn State University, PA, USA.
Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
Epilepsy Res. 2020 Jul;163:106341. doi: 10.1016/j.eplepsyres.2020.106341. Epub 2020 Apr 18.
Patients with epilepsy are at increased risk for mental health and substance abuse disorders. Given ongoing contemporary societal controversies about medicinal and recreational cannabis use, we aimed to ascertain recent nationwide prevalence, trends, and psychiatric diagnoses associated with cannabis use disorders (CUD) among epilepsy patients.
We interrogated the National Inpatient Sample database comprising a total of 398,936 adults (aged 18 years and above) with epilepsy between the years 2006 and 2014, identified using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes 780.39 and 345.X. A subset of these patients with a secondary discharge diagnosis of CUD (ICD-9-CM: 304.30, 304.31, 304.32, 305.20, 305.21, and 305.22), excluding those in remission, were selected. Logistic regression model adjusting for gender, race, age, primary payer, bed size, household income, region, teaching hospital, admission day, length of stay (LOS), Charleson Comorbidity Index (CCI) and, year category was used to ascertain the independent associations of demographic features and mental health comorbidities with CUD. Finally, we generated CUD trend estimates overall and by psychiatric diagnoses.
Of all hospitalized patients with epilepsy, 3.19 % had CUD. After adjusting for confounders, CUD was higher in males, Blacks, those aged 18-44 years, those with lower incomes, and those hospitalized during more recent years. CUD was more likely to be present in epilepsy patients with depression, bipolar disorder, and tobacco use disorder (TUD). In contrast, alcohol use disorder (AUD) was associated with lower odds of CUD. Overall, CUD prevalence more than doubled among epilepsy patients (2.18 % in 2006 to 4.41 % in 2014). Among patients with PTSD, CUD prevalence increased over fivefold, and it nearly tripled in those with tobacco use disorder.
Documented CUD has doubled among hospitalized patients with epilepsy in the United States over the last decade and is especially more prevalent in specific demographic and mental health disorder groups. Increased awareness and potential screening for CUD in high-risk epilepsy patients may be warranted, given the risk for potential complications.
癫痫患者存在心理健康和物质滥用障碍的风险增加。鉴于当前社会对药用和娱乐用大麻使用的持续争议，我们旨在确定最近全国范围内癫痫患者中与大麻使用障碍（CUD）相关的患病率、趋势和精神科诊断。
我们利用国际疾病分类，第 9 修订版，临床修正（ICD-9-CM）代码 780.39 和 345.X，对 2006 年至 2014 年间全国范围内 398936 名年龄在 18 岁及以上的癫痫成年患者（共计 398936 名）的国家住院患者样本数据库进行了调查。从这些患者中，选择了具有 CUD 二次出院诊断（ICD-9-CM：304.30、304.31、304.32、305.20、305.21 和 305.22）的患者子集，排除了处于缓解期的患者。使用调整了性别、种族、年龄、主要支付方、床位大小、家庭收入、地区、教学医院、入院日、住院时间（LOS）、Charlson 合并症指数（CCI）和年份类别的逻辑回归模型，确定人口统计学特征和精神健康合并症与 CUD 之间的独立关联。最后，我们总体和按精神科诊断生成了 CUD 趋势估计。
在所有因癫痫住院的患者中，有 3.19%患有 CUD。在调整了混杂因素后，男性、黑人、18-44 岁、收入较低和最近几年住院的患者中，CUD 的发生率更高。患有抑郁症、双相情感障碍和烟草使用障碍（TUD）的癫痫患者更有可能出现 CUD。相比之下，酒精使用障碍（AUD）与 CUD 的几率较低相关。总体而言，癫痫患者中 CUD 的患病率增加了一倍以上（2006 年为 2.18%，2014 年为 4.41%）。在患有创伤后应激障碍的患者中，CUD 的患病率增加了五倍多，而在患有烟草使用障碍的患者中，CUD 的患病率增加了两倍多。
在过去十年中，美国因癫痫住院的患者中，记录到的 CUD 增加了一倍，并且在特定的人口统计学和精神健康障碍群体中更为普遍。鉴于潜在并发症的风险，可能需要在高危癫痫患者中加强对 CUD 的认识和潜在筛查。
