Psychiatric comorbidities of epilepsy and treatment gap among children and adolescents at Butabika National Referral Psychiatric Hospital of Uganda

Abstract

Introduction: psychiatric comorbidities of epilepsy are common. In order to improve the overall quality of life of the affected individuals it is imperative for clinicians to screen and treat these conditions early. We aimed at determining prevalence of psychiatric comorbidities of epilepsy and treatment gap among children and adolescents (6-17) at Butabika Hospital. Methods: we conducted a cross sectional study; psychiatric disorders were assessed using the Mini International Neuropsychiatric Interview for Children (MINI-kid 7.0.2 version) and clinical data abstraction was used to collect data from patient file. Quantitative data was analyzed using SPSS v25 software while qualitative data was analyzed using thematic analysis. The study followed the Consolidated criteria for Reporting Qualitative research (COREQ) and statement on guidelines for Strengthening the Reporting of Observational studies in epidemiology (STROBE). Results: a total of 157 participants were enrolled and, 38.9% (95%CI: 31.5-46.6%) had at least one psychiatric disorder whereas 12.1% had two or more psychiatric disorders. Attention Deficit Hyperactivity Disorder (11.5%), Autism Spectrum Disorder (7.0%) and Major Depressive Disorder (5.1%) were the most common psychiatric disorders. The treatment gap was 33.1% (95%CI: 26.1-40.7%). The barriers to screening were challenging psychiatric disorders, exhausting to screen; and inadequate diagnostic information. The barriers to treatment were poor compliance to treatment, poorly controlled seizures and inadequate human resources. Conclusion: psychiatric disorders are highly prevalent among children and adolescents with epilepsy but there is substantial screening and treatment gap. To close the gap, there is need to address institutional, caregiver and patient barriers to screening and treatment of the psychiatric comorbidities. Improving human resources, capacity building and provision of basic requirements for screening, could reduce the assessment and treatment gap.