Causative factors for the high epileptic suicide rate are reported from the Departments of Neurology, University Hospitals of Cleveland and the Johns Hopkins University, Baltimore, MD. Of 711 patients hospitalized for a suicide attempt by drug overdose, 22 patients had idiopathic epilepsy. Attempted suicide was coincident with increased seizure activity only in one epileptic patient. When matched by age, sex, and race with 44 nonepileptic controls, the patients with epilepsy had more borderline personality disorders with multiple impulsive suicide attempts, more psychotic disturbances, including hallucinations, fewer adjustment disorders, and a comparable frequency of depression. Suicide attempts in epileptics were primarily associated with interictal psychopathologic factors, such as borderline personality disorder and psychosis, rather than with specific psychosocial stressors, seizure variables, or anticonvulsant medications. 
COMMENT. Epilepsy is associated with increased suicidal behavior and the risk of completed suicide among patients with epilepsy is four or five times greater than among nonepileptic patients. Patients with complex partial seizures have a particularly high risk. Of the 22 patients reported in this study with suicide attempts, five were under 20 years of age and the median age was 28 years. The ready access of anticonvulsant drugs facilitates impulsive suicide attempts in patients with epilepsy.