Prevalence and factors associated with psychosis among adult patients with epilepsy at Butabika National Referral Mental Hospital

Abstract

BACKGROUND Many studies have shown that the prevalence of psychiatric disorders among people with Epilepsy (PWE) appears higher than that in the general population. Psychosis is highest in patients with epilepsy at about 9.3%. There are vast Epidemiological studies in western countries addressing Psychiatric comorbidities among PWE. However there is scarcity of data on the on the burden of psychosis among PWE in Uganda. OBJECTIVE To determine the prevalence and factors associated with psychosis among adult patients with Epilepsy attending care at Butabika National Referral Mental Hospital, Uganda.

METHODS A cross-sectional study was conducted at Butabika National Referral Mental Hospitals, Uganda (BNRMH) over 1-month period. PWE aged 18 years or older who had been prescribed Anti-epileptic drugs (AEDs) for at least two months were enrolled. A standardized semi-structured questionnaire was administered to collect data on demographic and clinical characteristics, and other Epilepsy related characteristics. Participants were evaluated for psychosis using the Mini-International Neuropsychiatric Interview (M.I.N.I), module for Psychotic disorders. The associations between potential variables and the presence of psychosis in PWE was analysed using Fisher's exact tests, t-test, and multivariable logistic regression. STATA version 15.0 was used for data analysis. P-values <0.05 were considered statistically significant.

RESULTS Psychosis was significantly associated with the following variables at multivariate analysis: age (AOR=1.05, 95%CI=1.01-1.09), stigma (AOR=1.08, 95%CI=1.03-1.14), Christianity (AOR=0.22, 95%CI=0.06-0.81) and substance use (AOR=1.90, 95%CI=1.17-53.30).

CONCLUSIONS The findings of this study suggest that psychosis is a significant problem among adult out patients with epilepsy in Uganda. The study also found that age, stigma, and substance use were risk factors for the development of psychosis in Epileptic patients. Affiliation to Christianity was protective against psychosis. These findings have important implications for the diagnosis and treatment of psychosis in patients with epilepsy. It is recommended to screen all patients with Epilepsy for psychosis with early diagnosis and initiation of patient care to improve patient outcomes.