# Clinical Characteristics associated with functional seizures in individuals with psychosis

## TL;DR

Functional seizures are more common in people with psychosis and are linked to higher healthcare use and worse outcomes like suicidality and catatonia.

## Contribution

This study identifies a strong association between functional seizures and psychosis, along with specific clinical and behavioral differences in affected individuals.

## Key findings

- Patients with psychosis had a 10-fold higher odds of having functional seizures compared to controls.
- Functional seizures were linked to higher rates of suicidality, catatonia, and sexual trauma history in patients with psychosis.
- Patients with comorbid functional seizures had significantly more hospital visits over 10 years after a psychosis diagnosis.

## Abstract

Functional seizures (FS) are episodes characterized by seizure-like events that are not caused by hypersynchronous neuronal activity. Prior studies have suggested an increased prevalence of psychotic disorders among patients with FS, but results have been inconsistent. We hypothesize that FS are associated with psychosis and that among patients with psychosis, the presence of FS may influence patient clinical characteristics, mortality, and medical resource utilization.

The association between FS and psychosis was assessed using electronic health records data from a total of 761,848 individuals receiving care at Vanderbilt University Medical Center between 1989 and 2023. Analyses of the association between FS and psychiatric outcomes, sexual trauma, healthcare utilization, and other clinical comorbidities were conducted in a subset of 5219 patients with psychosis.

Odds of FS were elevated among patients with psychosis compared to controls (OR = 10.09, 95 % CI = 8.40–12.13). Among patients with psychosis, those with FS exhibited higher rates of suicidality (OR = 2.18 95 % CI = 1.50–3.17), catatonia (OR = 2.15, 95 % CI = 1.33–3.45), sexual trauma history (OR = 2.93, 95 % CI = 2.00–4.29) and had a greater number of antipsychotic trials (4.63 versus 3.37, beta = 1.23, SE = 0.18, adjusted p < 0.001) than those without FS. Furthermore, patients with comorbid FS had more hospital presentations at one, three, five, and ten years after receiving a psychosis diagnosis (adjusted p < 0.001).

FS are more common among patients with psychosis and are associated with increased healthcare utilization as well as an increased prevalence of suicidality, catatonia, and certain psychiatric and medical comorbidities.