An integrated neuropsychiatric approach to diagnosis and management of patients with epileptic seizures

Abstract

In patients who present to neurology settings with history of epileptic seizures, psychiatric disorders may be the sole manifestation of apparent neurologic symptoms, or they may coexist. Current challenges for clinicians include distinguishing between two disorders and making the correct diagnoses, interpreting test results, and (co-) managing the disorder(s). Our goal is to provide the clinician with an integrated neuropsychiatric approach for the triage, assessment (history, screening tools, examination, diagnostic tests), and treatment (neurologic and/or psychiatric) of these challenging patients. In particular, use of schemata, tables, and algorithms will offer step-by-step approaches and guidelines for the clinician. Recommendations are made for the indications for psychiatric consultation, and co-management is recommended for patients with emergencies, those who fail routine psychiatric treatments, and those with complex presentations or multiple comorbid conditions.

Psychopharmacology for Neurologists

“…Screening tools may be helpful (Hilty et al, 2005). The risk of overtreatment pales in comparison with undertreatment (eg, worsening outcomes, suicide).…”

“…The disorders often coexist; for example with epilepsy, the interictal lifetime prevalence is up to 50% for mood, 30% for anxiety, 40% for somatoform, 10% for psychotic, and 40% for personality disorders (Hilty et al, 2005). The disorders often coexist; for example with epilepsy, the interictal lifetime prevalence is up to 50% for mood, 30% for anxiety, 40% for somatoform, 10% for psychotic, and 40% for personality disorders (Hilty et al, 2005).…”