Rationale

Patients with seizure disorders have relatively high rates of comorbid psychological and sleep disorders. Because these can profoundly affect quality of life, early recognition and treatment are of potential benefit. As a quality improvement project, we evaluated the performance and utility of a set of mental health and sleep quality screening questionnaires in patients admitted to a VA seizure monitoring unit (SMU).

Methods

Questionnaires, including the Beck Depression Inventory-II (BDI-II), the post-traumatic stress disorder (PTSD) checklist (PCL), the Quality of Life in Epilepsy Inventory-31 (QOLIE-31), and the Pittsburgh Sleep Quality Index (PSQI), were administered to 100 patients admitted to the Portland VAMC SMU. Scored results were entered into the electronic medical record (EMR) within 72 h of hospital admission. We assessed how many patients exceeded questionnaire cutoff scores, and whether these patients had prior mental health or sleep diagnoses or evaluations within the six months preceding admission. Following hospital discharge, providers completed a survey regarding the utility of the questionnaire results. We also reviewed EMR documented mental health and sleep visits during the six months following the SMU admission.

Results

Forty-seven patients (47.5%) exceeded the cutoff score for the BDI-II, including 15 without an admission diagnosis of depression, and 14 who had not seen a mental health provider in the previous six months. Similarly, 33 patients (33.3%) exceeded the cutoff score for the PCL, including nine without a diagnosis of PTSD. Scores on the BDI-II and PCL were highly correlated with the QOLIE-31 total score (r = 0.7). Seventy patients (70.7%) exceeded the cutoff score for poor sleep quality, and 37 did not have a sleep disorder diagnosis. Providers indicated that the questionnaire results were moderately or very helpful in most cases and influenced discharge recommendations to patients and referring providers in more than 50% of cases. Discharge recommendations for mental health or sleep follow-up were associated with EMR documented consultations within the six months following SMU admission.

Conclusions

The results suggest that a standard set of screening questionnaires can identify SMU patients at risk for mental health and sleep disorders, including patients not currently diagnosed or recently evaluated. Questionnaire results were perceived as helpful by providers and influenced discharge recommendations. Given that these disorders are treatable and have a major influence on health-related quality of life, the effort to collect and document this information is well justified.

中文翻译：

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精神健康和睡眠筛查问卷对入住癫痫监测单位的患者的效用

基本原理

癫痫症患者的心理和睡眠障碍共病率相对较高。由于这些会严重影响生活质量，因此早期识别和治疗具有潜在益处。作为一个质量改进项目，我们评估了一组心理健康和睡眠质量筛查问卷在入住 VA 癫痫监测单元 (SMU) 的患者中的性能和效用。

方法

问卷，包括贝克抑郁量表-II (BDI-II)、创伤后应激障碍 (PTSD) 检查表 (PCL)、癫痫生活质量量表-31 (QOLIE-31) 和匹兹堡睡眠质量指数(PSQI)，对入住波特兰 VAMC SMU 的 100 名患者进行了管理。评分结果在入院后 72 小时内输入电子病历 (EMR)。我们评估了有多少患者超过了问卷截止分数，以及这些患者在入院前六个月内是否有过心理健康或睡眠诊断或评估。出院后，提供者完成了一项关于问卷结果效用的调查。我们还审查了 SMU 入院后六个月内 EMR 记录的心理健康和睡眠访问。

结果

47 名患者 (47.5%) 超过了 BDI-II 的截止分数，其中 15 名没有入院诊断为抑郁症，14 名在过去六个月内没有看过心理健康提供者。同样，33 名患者 (33.3%) 超过了 PCL 的截止评分，其中 9 名患者没有被诊断为 PTSD。BDI-II 和 PCL 的分数与 QOLIE-31 总分高度相关（r = 0.7）。70 名患者 (70.7%) 超过了睡眠质量差的临界值，37 名患者没有睡眠障碍诊断。提供者表示，问卷结果在大多数情况下具有中等或非常有帮助，并且在超过 50% 的情况下影响了对患者和转诊提供者的出院建议。心理健康或睡眠随访的出院建议与 SMU 入院后六个月内 EMR 记录的咨询相关。

结论

结果表明，一套标准的筛查问卷可以识别有心理健康和睡眠障碍风险的 SMU 患者，包括目前未诊断或最近未评估的患者。问卷调查结果被提供者认为有帮助，并影响了出院建议。鉴于这些疾病是可以治疗的，并且对健康相关的生活质量有重大影响，收集和记录这些信息的努力是有充分理由的。