[Emotional and affective disorders, anxiety and personality disorders in epilepsies]

The wide spectrum of comorbid mental disorders in epilepsy includes anxiety, affective as well as personality disorders and psychosis. While the prevalence of mental disorders in the general epilepsy population is reported to be 6%, for focal epilepsies, especially temporal lobe epilepsy, this rate is considerably higher and the numbers given in the literature range from 20 to 70%, of which anxiety and depression have the highest share.According to the diathesis-stress model pre-existing vulnerability factors, neurobiological factors, iatrogenic effects and psychosocial stress factors are individually of different significance in the development of mental disorders in epilepsy. Learned reactions in answer to psychosocial stress as well as structural and functional disturbances in the neuronal limbic networks for the regulation of affective, emotional and social behaviour are fundamental driving factors. Furthermore, therapeutic measures may add to the development of mental health problems. Several antiepileptic drugs (AE) have proven their value in the psychiatric treatment of mental disorders; however, AE may also cause psychiatric side effects.Similarly, although established as a successful treatment option in focal epilepsies, surgery is also reported to have an influence on mental health. Newly diagnosed mental problems are rarely reported after surgery; more often positive changes are observed across the entire spectrum of mental disorders associated with epilepsy.