Heidi M Munger Clary1, Rachel D Croxton2, Beverly M Snively3, Gretchen A Brenes4, James Lovato5, Fatemeh Sadeghifar6, James Kimball7, Cormac O'Donovan8, Kelly Conner9, Esther Kim10, Jonathan Allan11, Pamela Duncan12. 1. Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: hmungerc@wakehealth.edu. 2. Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: croxrd13@alumni.wfu.edu. 3. Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: bmellen@wakehealth.edu. 4. Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: gbrenes@wakehealth.edu. 5. Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: jlovato@wakehealth.edu. 6. Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: fsadeghi@wakehealth.edu. 7. Department of Psychiatry, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: jkimball@wakehealth.edu. 8. Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: odonovan@wakehealth.edu. 9. Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: kconner@wakehealth.edu. 10. Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: EKKim@mednet.ucla.edu. 11. Department of Psychiatry, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: drallan@happierliving.com. 12. Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: pduncan@wakehealth.edu.
Abstract
OBJECTIVE: Anxiety and depression symptoms in epilepsy are common, impactful and under-recognized and undertreated. While prior survey data suggests equipoise among epileptologists for managing anxiety and/or depression via prescribing in the epilepsy clinic versus psychiatry referral, patient preferences are unknown and should potentially influence practice habits among epileptologists. Thus, the primary objective of this study was to determine patient preference for anxiety and/or depression prescribing by neurologists versus psychiatry referral among an adult epilepsy clinic sample of symptomatic patients. METHODS: Management preferences for anxiety and/or depression were surveyed in an adult tertiary care epilepsy clinic. Individuals who screened positive for anxiety and/or depression symptoms on validated instruments during a routine care-embedded learning health system study were recruited. Demographics, social variables, psychiatric treatment history, and treatment priorities and preferences were surveyed. Preference was defined as a slightly greater than 2:1 ratio in favor neurology prescribing or psychiatry referral. The study was powered to assess this primary objective using a two-sample binomial test. Multinomial logistic regression examined an a priori multivariable model of treatment preference (secondary objective). RESULTS: The study sample included N = 63 symptomatic adults, with 64% women and mean age 42.2 years. Most reported past or current treatment for anxiety and/or depression, and treatment for these symptoms was a high or moderate priority among 65.1% of the sample. Neurologist prescribing was preferred in 83.0% (nearly 5:1) over psychiatry referral among those who chose neurology or psychiatry (as opposed to neither of the two; p < 0.001, 95% CI 0.702-0.919). Overall, 69.8% of the total study sample preferred neurology prescribing. Multivariable modeling indicated preference for neither management option (compared with neurologist prescribing) was associated with low overall treatment prioritization and having never received neurologist medication management. None of the factors examined in the a priori multivariable model were associated with selecting psychiatry referral (compared to neurologist prescribing). CONCLUSION: In this sample, most patients indicated a preference for neurologists to prescribe for anxiety or depression symptoms in the epilepsy clinic. Care models involving neurologist prescribing for anxiety and depression symptoms merit further investigation and potential adoption in clinical practice.
OBJECTIVE: Anxiety and depression symptoms in epilepsy are common, impactful and under-recognized and undertreated. While prior survey data suggests equipoise among epileptologists for managing anxiety and/or depression via prescribing in the epilepsy clinic versus psychiatry referral, patient preferences are unknown and should potentially influence practice habits among epileptologists. Thus, the primary objective of this study was to determine patient preference for anxiety and/or depression prescribing by neurologists versus psychiatry referral among an adult epilepsy clinic sample of symptomatic patients. METHODS: Management preferences for anxiety and/or depression were surveyed in an adult tertiary care epilepsy clinic. Individuals who screened positive for anxiety and/or depression symptoms on validated instruments during a routine care-embedded learning health system study were recruited. Demographics, social variables, psychiatric treatment history, and treatment priorities and preferences were surveyed. Preference was defined as a slightly greater than 2:1 ratio in favor neurology prescribing or psychiatry referral. The study was powered to assess this primary objective using a two-sample binomial test. Multinomial logistic regression examined an a priori multivariable model of treatment preference (secondary objective). RESULTS: The study sample included N = 63 symptomatic adults, with 64% women and mean age 42.2 years. Most reported past or current treatment for anxiety and/or depression, and treatment for these symptoms was a high or moderate priority among 65.1% of the sample. Neurologist prescribing was preferred in 83.0% (nearly 5:1) over psychiatry referral among those who chose neurology or psychiatry (as opposed to neither of the two; p < 0.001, 95% CI 0.702-0.919). Overall, 69.8% of the total study sample preferred neurology prescribing. Multivariable modeling indicated preference for neither management option (compared with neurologist prescribing) was associated with low overall treatment prioritization and having never received neurologist medication management. None of the factors examined in the a priori multivariable model were associated with selecting psychiatry referral (compared to neurologist prescribing). CONCLUSION: In this sample, most patients indicated a preference for neurologists to prescribe for anxiety or depression symptoms in the epilepsy clinic. Care models involving neurologist prescribing for anxiety and depression symptoms merit further investigation and potential adoption in clinical practice.
Authors: Madhukar H Trivedi; A John Rush; Stephen R Wisniewski; Andrew A Nierenberg; Diane Warden; Louise Ritz; Grayson Norquist; Robert H Howland; Barry Lebowitz; Patrick J McGrath; Kathy Shores-Wilson; Melanie M Biggs; G K Balasubramani; Maurizio Fava Journal: Am J Psychiatry Date: 2006-01 Impact factor: 18.112
Authors: Heidi M Munger Clary; Rachel D Croxton; Jonathan Allan; James Lovato; Gretchen Brenes; Beverly M Snively; Mingyu Wan; James Kimball; Matthew H Wong; Cormac A O'Donovan; Kelly Conner; Victor Jones; Pamela Duncan Journal: Epilepsy Behav Date: 2020-01-27 Impact factor: 2.937
Authors: Aylin Y Reid; Amy Metcalfe; Scott B Patten; Samuel Wiebe; Sophie Macrodimitris; Nathalie Jetté Journal: Epilepsia Date: 2012-01-05 Impact factor: 5.864
Authors: Anup D Patel; Christine Baca; Gary Franklin; Susan T Herman; Inna Hughes; Lisa Meunier; Lidia M V R Moura; Heidi Munger Clary; Brandy Parker-McFadden; Mary Jo Pugh; Rebecca J Schultz; Marianna V Spanaki; Amy Bennett; S Andrew Josephson Journal: Neurology Date: 2018-10-03 Impact factor: 9.910
Authors: Heidi M Munger Clary; Beverly M Snively; Umit Topaloglu; Pamela Duncan; James Kimball; Halley Alexander; Gretchen A Brenes Journal: JAMIA Open Date: 2022-10-12