Neuropsychiatric Aspects of Epilepsy

Psychiatric symptoms occur in many people with epilepsy. These symptoms can be classified according to their temporal relationship to seizures: peri-ictal (preictal/ictal/postictal) or interictal. Interictal depression and anxiety are common, especially in people with refractory epilepsy. Treatment includes pharmacotherapy, psychological and psychosocial interventions. Psychotic disorders are less common but can be severe. Postictal psychosis is more likely to occur following a cluster of focal impaired consciousness seizures, focal to bilateral tonic–clonic seizures or status epilepticus. Short courses of benzodiazepines or antipsychotic medications are effective treatments. Interictal psychosis is a chronic disorder resembling primary schizophrenia, and long-term treatment with antipsychotic medications is necessary. Epilepsy treatments, namely, some antiseizure medications and epilepsy surgery, can cause mood or anxiety symptoms and, rarely, psychosis. Comorbid psychiatric conditions are important to recognise and treat as they can have an adverse effect on functional status and quality of life.