Psychiatric Comorbidity in Epilepsy

Abstract

A relationship between psychiatric disorders and epilepsy has been recognized for several centuries. This psychiatric comorbidity manifests as psychoses, mood disorders, anxiety disorders, and personality disorders. Psychiatric disorders are classified in three categories with regard to their relationship to seizures: inter-ictal-the state during which the patient is not having seizures: ictal-psychiatric symptoms during the seizure; and post-ictal-psychiatric symptoms that are followed by a seizure. The most common inter-ictal psychiatric disorders in epilepsy patients are depression and interictal anxiety. Ictal psychiatric symptoms, such as ictal psychosis and ictal depression, are rare. Ictal fear and anxiety, on the other hand, are common. Post-ictal psychosis has been well described, while post-ictal depression and anxiety have not been well characterized. Although psychiatric disorders in epilepsy have been known for centuries, they are often underrecognized and undertreated. This psychiatric comorbidity contributes to the stigma associated with epilepsy.