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ARTICLEInterictal dysphoric disorder: a frequent psychiatric comorbidity among patients with epilepsy who were followed in two tertiary centers ABSTRACTPsychiatric disorders are frequent among patients with epilepsy. Data in the literature have shown a heterogeneous clinical presentation of psychiatric disorders in patients with epilepsy. Interictal dysphoric disorder could be a specific psychiatric comorbidity associated with epilepsy, primarily in patients treated in tertiary centers. Objective: The present study aimed to determine the prevalence of interictal dysphoric disorder among patients with epilepsy who were followed in two tertiary epilepsy services in Brazil. Method: Sixty-five patients with epilepsy completed the Portuguese version of the Interictal Dysphoric Disorder Inventory. Results: Thirty-three (50.7%) patients fulfilled the diagnostic criteria for interictal dysphoric disorder, although all participants answered positively to having at least one key symptom. Conclusion: The high rate of patients with epilepsy who fulfilled the diagnosis of interictal dysphoric disorder confirms an association between epilepsy and psychiatric disorders. However, there is clearly a need to improve diagnostic tools to allow better differentiation between interictal dysphoric disorder and other psychiatric disorders.Keywords: epilepsy, interictal dysphoric disorder, psychiatric disorders. RESUMOTranstornos psiquiátricos são frequentes entre pacientes com epilepsia. Estudos evidenciam apresentações clínicas heterogêneas neste grupo. O transtorno disfórico interictal pode um transtorno específico destes pacientes, particularmente naqueles acompanhados em centros terciários. Objetivo: Determinar a prevalência de transtorno disfórico interictal entre pacientes com epilepsia atendidos em dois serviços terciários de epilepsia do Brasil. Método: Sessenta e cinco pacientes foram convidados a responder a versão brasileira do Interictal Dysphoric Disorder Inventory adaptado e validado para o Português. Resultados: Trinta e três pacientes (50,7%) preencheram critérios para transtorno disfórico interictal, embora todos os entrevistados tenham afirmado que são acometidos por ao menos um dos sintomas-chave. Conclusão: A alta prevalência de transtorno disfórico interictal em pacientes com epilepsia pode ser um indício da associação entre epilepsia e transtornos psiquiátricos. No entanto, é necessário melhorar a acurácia dos instrumentos de diagnóstico para poder diferenciar casos de transtorno disfórico interictal de outros transtornos psiquiátricos.Palavras-chave: epilepsia, transtorno disfórico interictal, transtornos psiquiátricos.

The IJPH series "Young Researcher Editorial" is a training project of the Swiss School of Public Health.Epilepsy is a common neurological disease that affects the quality of life of approximately 6.3 million people in Latin America and the Caribbean (LAC) [1]. It is characterized by an enduring tendency to experience epileptic seizures and the neurobiological, cognitive, and psychosocial consequences of these seizures. Epilepsy affects people of all ages, with a similar prevalence among men and women living in LAC (410 vs. 413 per 100,000 population, respectively).In 2019, a total of 1,375,066.9 disability-adjusted life years (DALYs) in LAC countries were attributed to epilepsy, with men being more affected. Three potential reasons may explain higher DALYs in men with epilepsy (MWE): 1) steroid hormones-adrenal corticosteroids and androgenic steroids-may increase seizure sensibility; however their molecular mechanisms are unclear 2) more epilepsy cases associated with exposure to potential injury triggers such as alcohol consumption, occupational or traffic accidents, and 3) higher incidence of Sudden Unexpected Death in Epilepsy (SUDEP) in males, particularly in the context of alcohol use [1].Depression and anxiety are important comorbidities associated with epilepsy [2]. These mental health issues can significantly impact the overall wellbeing of people with epilepsy and affect both genders. Mental disease occurrence is exacerbated by social factors such as stigma and discrimination, especially for MWE. In addition, their diagnosis and treatment are often neglected.In general, health promotion interventions and policies that aim to promote gender equity tend to focus on improving the health of children and women, while men's health issues are stigmatized and tend to be ignored [3]. This tendency is also observed in epileptology, the study and treatment of epilepsy. Despite MWE experiencing gender-specific issues cited above, data on MWE tends to ignore the influence of psychosocial factors, focusing instead on the occurrence of sexual dysfunction (SD) [4]. In fact, MWE report sexual problems more often than healthy men. The higher occurrence of SD among MWE may be due to epilepsy, the use of anti-seizure drugs, and mental health issues. However, MWE quality of life scores are influenced more by depression and anxiety occurrence than clinical issues such as seizure control or SD [4].A better understanding of the inter-relation between mental health, wellbeing, and social factors for MWE health is necessary, but data about this question are scarce. The influence of sociocultural aspects on the behavior of chronically ill men has been evaluated in other clinical contexts, such as prostate cancer or psychiatric disorders. Evidence suggests that hegemonic social constructions of masculinity-including heterosexuality, assertiveness, self-control, physical strength, and emotional restraint-define an ideal man [5]. Chronically ill men who cannot attain the ideal of masculinity may experience subordination and marginali...