Psychiatric comorbidities in epilepsy: identification and treatment

The relationship between epilepsy and psychiatric disorders, as well as their reciprocal influence, has been confirmed in several studies. The diagnosis of these psychiatric comorbidities becomes particularly complex, for clinical manifestations vary and patients may not fulfil the criteria of traditional diagnostic classifications.

Mood disorders are the more frequent conditions associated with epilepsy, followed by anxiety, attention-deficit, psychotic and personality disorders. Patients with focal epilepsies, and mainly those with temporal and frontal lobe epilepsy, have a greater incidence of depression, anxiety or psychosis, compared with the general population. For a long time, patients and physicians tended to focus solely on the control of epileptic seizures, while disregarding the presence of comorbid psychiatric symptoms and disorders. Recognition of their negative impact in the life of patients with epilepsy in recent years has highlighted the need for their early identification with a careful psychiatric history or, at the least, to screen for the presence of psychiatric symptoms with objective scales. Furthermore, the identification of psychiatric symptoms plays an important role in the choice of antiepileptic drugs as some are known to have positive or negative psychotropic effects.

An early diagnosis of comorbid psychiatric disorders and a multidisciplinary approach in the evaluation and management of these patients result in the selection of an optimal comprehensive treatment.