Psychiatry and epilepsy: A century of evolving understanding

Psychiatric illness is very commonly associated with epilepsy, both in adults as well as in children and adolescents; however, the etiology of psychiatric conditions in persons with epilepsy is still controversial. Although the understanding of psychiatric comorbidity has vastly improved over the past century, in many cases, it is difficult to resolve whether psychiatric illness is coincidental or associated with the underlying seizure disorder. Despite numerous reports confirming an overrepresentation of psychiatric illness associated with epilepsy, many patients do not receive mental health treatment. Unfortunately, in some cases, the psychiatric comorbidity may be more impairing to quality of life than the seizure themselves.The consistently high level of psychiatric comorbidity suggests that epilepsy is a complicated illness that may have neuropsychiatric symptoms well beyond discrete seizures.Epileptologists and advocacy groups have raised awareness of the need for an interdisciplinary approach to management of epilepsy. The existing literature tends to focus upon one of three potential explanations for psychiatric comorbidity: symptoms related to psychosocial stress of chronic disease, symptoms related to medication side effects, and symptoms directly related to epilepsy pathophysiology. Although the evidence base is limited regarding treatment for the most common comorbidities of depression, anxiety, attention and cognitive disorders, recent studies have been encouraging in terms of outlining practical treatment approaches in the context of specific epilepsy factors.This chapter addresses historical and theoretical characteristics of psychiatric illness associated with epilepsy as well as strategies for managing the most common psychiatric comorbidities.