Redefining the practical roles of psychiatrists in epilepsy care: A framework for collaboration in Japan

Psychiatric symptoms are prevalent among people with epilepsy (PWE), yet psychiatric care remains underdeveloped in epilepsy services worldwide. Many psychiatrists lack sufficient familiarity with epilepsy, contributing to gaps in care. Japan, however, has a distinctive history where psychiatrists played a central role in epilepsy treatment, especially in managing epilepsy-related psychosis. This legacy, though fading, offers valuable insights. This review proposes a renewed framework to reestablish the psychiatrist's role in epilepsy care, informed by Japan's historical context and current global trends. The framework consists of five domains: (1) the historical relationship between psychiatry and epilepsy; (2) diagnosis and treatment of psychiatric symptoms in PWE; (3) psychosocial interventions; (4) interdisciplinary collaboration; and (5) future directions in training, research, policy, and clinical integration. While psychiatry's role in epilepsy has diminished in many countries, Japan may still retain structural and cultural foundations for reintegration. By redefining psychiatric involvement, we aim to inspire general psychiatrists and trainees to engage with epilepsy care. Reaffirming the psychiatric perspective is essential for delivering comprehensive, patient-centered care to PWE.