Managing Psychiatric Illness in Patients with Epilepsy: Appropriate Treatment of Mental Health Problems Can Improve the Global Prognosis for the Patient Who Has a Seizure Disorder

By Puvvada, Sowmya C.; Kommisetti, Satyanarayana et al. | Current Psychiatry, May 2014 | Go to article overview

Managing Psychiatric Illness in Patients with Epilepsy: Appropriate Treatment of Mental Health Problems Can Improve the Global Prognosis for the Patient Who Has a Seizure Disorder


Puvvada, Sowmya C., Kommisetti, Satyanarayana, Reddy, Abhishek, Current Psychiatry


Patients who have epilepsy have a higher incidence of psychiatric illness than the general population--at a prevalence of 60%) Establishing a temporal association and making a psychiatric diagnosis can be vexing, but awareness of potential comorbidities does improve the clinical outcome' (Box, page 32). As this article discusses, psychiatric presentations and ictal disorders can share common pathology and exacerbate one another. (3) Their coexistence often results in frequent hospitalization, higher treatment cost, and drug-resistant seizures. (4) Risk factors for psychopathology in people who have epilepsy include psychosocial stressors, genetic factors, early age of onset of seizures, and each ictal event. (5) Among ictal disorders, temporal-lobe epilepsy confers the highest rate of comorbidity. (3)

Mood disorders

Mood disorders are the most common psychiatric disorder comorbid with epilepsy (irrespective of age, socioeconomic status, and ethnicity), affecting 43% of patients who have a seizure disorder. (5) These disorders present as an ictal aura in 1% of cases; the presence of a comorbid mood disorder implies a more severe form of epilepsy. (2) Most mood disorders are underdiagnosed in epilepsy, however, because of the mistaken assumption that depression is a normal reaction to having a seizure disorder.

Interictal depression is the most commonly reported complaint, although dysphoria also can present peri-ictally. (6) The severity of depression and the seizure disorder often are directly proportional to each other.' Decreased levels of serotonin and norepinephrine, or abnormalities in their transport or postsynaptic binding, have been reported in epilepsy and in affective illness. (6) MRI studies have documented that patients who have a depressive disorder have more gray-matter loss compared with healthy controls. (7) Depression diminishes the quality of seizure remission after medical and surgical interventions for epilepsy. (8)

Taking a multidisciplinary approach to treating a mood disorder in a patient who has epilepsy might improve ictal and mood outcomes.9Anhedonia is the most common presenting symptom, but some patients do not meet DSM-5 criteria. Depression exhibits atypically, with fatigue, irritability poor frustration tolerance, anxiety, and mood lability. (6) Self-report screening scales, such as the Neurological Disorders Depression Inventory for Epilepsy, are helpful for making a diagnosis. (10)

Treatment. Prompt antidepressant treatment is indicated. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors are the most common agents in this setting. (11) Consider possible cytochrome P450 interactions between antiepileptic drugs (AEDs) and antidepressants; sertraline, citalopram, and escitalopram have the lowest incidence of adverse effects. Because tricyclic antidepressants have proconvulsant properties, they are not commonly prescribed in these pa tientsn (Table 1). (13)

Electroconvulsive therapy and vagus nerve stimulation (14) are effective interventions in treatment-resistant depression. The efficacy of transcranial magnetic stimulation remains to be clarified.

AEDs can produce psychiatric effects, even in nonconvulsive epilepsies. Twenty-eight percent of cases of depression that are comorbid with epilepsy have an iatrogenic basis, and can be induced by barbiturates, topiramate, vigabatrin, tiagabine, and levetiracetam. (13) These adverse effects are a common reason that patients discontinue drug treatment and obtain psychiatric consultation. (15)

Neurosurgical management of epilepsy carries a low risk of depression compared with pharmacotherapy because the surgery offers better ictal control. (16) Because some AEDs have mood-stabilizing properties, discontinuing one might unmask an underlying mood disorder. (17)

The incidence of adjustment disorder with depressed mood in persons who have epilepsy is 10%; with dysthymia, the incidence is 4%. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

Managing Psychiatric Illness in Patients with Epilepsy: Appropriate Treatment of Mental Health Problems Can Improve the Global Prognosis for the Patient Who Has a Seizure Disorder
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.