Bornovski Yarden, Jackson-Shaheed Ebony, Argraves Stephanie, Hitchins Adrianna, Tolchin Benjamin, Galluzzo Daniela, Cheung Kei-Hoi, Goulet Joseph, Skanderson Melissa, Brandt Cynthia A, Pugh Mary Jo, Altalib Hamada
Department of Neurology (YB, EJ-S, SA, BT, HA), Yale School of Medicine, New Haven, CT; University of Rochester Medical Center (AH); Westchester Medical Center (DG), NY; Connecticut VA Healthcare System (K-HC, JG, MS, CAB), West Haven; Department of Emergency Medicine (K-HC, JG, CAB), Yale School of Medicine, New Haven; and VA Salt Lake City Healthcare System (MJP), University of Utah.
Neurol Clin Pract. 2021 Oct;11(5):372-376. doi: 10.1212/CPJ.0000000000001070.
The increased rate of suicide associated with epilepsy has been described, but no studies have reported the rates of suicide and suicide-related behavior (SRB) associated with psychogenic nonepileptic seizures (PNESs).
This retrospective cohort study analyzed data from October 2002 to October 2017 within Veterans Health Administration services. Of 801,734 veterans, 0.09% had PNES, 1.37% had epilepsy, and 98.5% had no documented seizures. Veterans coded for completed suicide, suicide attempts, and suicidal ideation were identified from electronic health records. The primary measure was the suicide-specific standardized mortality ratio (SMR) based on the number of suicide deaths and CDC national suicide mortality database. A Poisson regression was used to calculate the relative risk (RR) of suicide across groups.
A total of 1,870 veterans (mean age [SD] 33.76 [7.81] years) completed suicide. Veterans with PNES (RR = 1.75, 95% confidence interval [CI] 0.84-4.24) and veterans with epilepsy (RR = 2.19, 95% CI 2.10-2.28) had a higher risk of suicide compared with the general veteran population. Veterans with PNES or epilepsy had a higher risk of suicide and SRB if they had comorbid alcohol abuse, illicit drug abuse, major depression, posttraumatic stress disorder, and use of psychotropic medications. Conversely, those who were married or attained higher education were at a decreased risk. The SMR for completed suicide for PNES, epilepsy, and the comparison group was 2.65 (95% CI 1.95-5.52), 2.04 (95% CI 1.60-2.55), and 0.70 (95% CI 0.67-0.74), respectively.
Veterans with seizures (both psychogenic and epileptic) are at a greater risk of death by suicide and SRB than the comparison group. These findings suggest that although the pathophysiology of PNES and epilepsy is different, the negative impact of seizures is evident in the psychosocial outcomes in both groups.
已有研究描述了癫痫相关自杀率的上升，但尚无研究报告与精神性非癫痫性发作（PNES）相关的自杀及自杀相关行为（SRB）发生率。
这项回顾性队列研究分析了2002年10月至2017年10月退伍军人健康管理局服务范围内的数据。在801,734名退伍军人中，0.09%患有PNES，1.37%患有癫痫，98.5%无癫痫发作记录。从电子健康记录中识别出编码为自杀死亡、自杀未遂和自杀意念的退伍军人。主要指标是基于自杀死亡人数和美国疾病控制与预防中心国家自杀死亡率数据库的自杀特异性标准化死亡率（SMR）。采用泊松回归计算各组间自杀的相对风险（RR）。
共有1870名退伍军人（平均年龄[标准差]33.76[7.81]岁）自杀死亡。与普通退伍军人人群相比，患有PNES的退伍军人（RR = 1.75，95%置信区间[CI]0.84 - 4.24）和患有癫痫的退伍军人（RR = 2.19，95%CI 2.10 - 2.28）自杀风险更高。患有PNES或癫痫的退伍军人若同时存在酒精滥用、非法药物滥用、重度抑郁症、创伤后应激障碍以及使用精神药物，则自杀和SRB风险更高。相反，已婚或受过高等教育者风险降低。PNES、癫痫和对照组的自杀死亡SMR分别为2.65（95%CI 1.95 - 5.52）、2.04（95%CI 1.60 - 2.55）和0.70（95%CI 0.67 - 0.74）。
有发作（包括精神性和癫痫性）的退伍军人自杀和SRB死亡风险高于对照组。这些发现表明，尽管PNES和癫痫的病理生理学不同，但发作在两组的社会心理结局方面的负面影响是明显的。
