Epilepsy and Psychiatric Comorbidities: New Approaches and Perspectives

Abstract

Psychiatry and neurology are specialties learned separately, but often the semiology and the pathophysiology of the different cases are linked. Patients often need an integrative approach in order to have an appropriate answer to their problems. In this chapter we will discuss the psychiatric comorbidities of epilepsy, such as depression, psychosis, stress, and anxiety disorders. Depression is the most common psychiatric comorbidity of epilepsy, significantly affecting the quality of life of patients. Anxiety disorders occupy a second place, often generating severe problems. They are usually underestimated at the clinical level, despite the abundant scientific evidence that supports the search and treatment of them in this group of patients. The problem of psychotic disorders in epilepsy is often controversial. There are few studies on this subject, and the psychopathological mechanisms behind them remain largely unknown. The problem of diagnoses and management of psychogenic nonepileptic seizures will also be briefly reviewed. They usually represent 20% of the patients referred to specialized centers of epilepsy, after having spent between 5 and 10 years through the health system. They are a frequent entity but often confused and mistreated, generating unnecessary expenses and waste of time. Finally, we will summarize how the management of stress and emotions in general has a direct impact on the quality of life of these patients.