Psychiatric Controversies in Epilepsy

Description

Psychiatric Controversies in Epilepsy addresses controversial clinical issues of the psychiatric aspects of epilepsy. The book explores the reasons behind the poor communication between psychiatrists and neurologists and suggests potential remedies to this important problem, and two chapters are devoted to examining whether psychiatrists and neurologists are properly trained to recognize and treat conditions that both disciplines commonly encounter in clinical practice. Identification of the causes behind the high rate of comorbidity between epilepsy and mood, anxiety, psychotic and attention deficit disorders is given high priority in the volume, and a specific review of the evidence of common pathogenic mechanisms that may be operant in epilepsy and these psychiatric disorders is included. Recently identified bidirectional relationship between mood disorders and epilepsy and its implication in the course and response to treatment of the seizure disorder are also explored. Several chapters are devoted to rectify common misunderstandings of the use of psychotropic drugs in patients with epilepsy, including the use of antidepressant and central nervous system stimulants. Finally, one chapter explores the possibility of organic causes of psychogenic non-epileptic seizures.

Compiles into one source the important controversial issues of the psychiatric aspects of epilepsy, which have significant implications in clinical practice
Authors are internationally recognized authorities in the field of psychiatric aspects of epilepsy

Front Cover 2
Psychiatric Controversies in Epilepsy 5
Copyright Page 6
Contents 11
Preface 15
Contributors 17
Chapter 1 Prevalence of Psychiatric Disorders in Patients with Epilepsy: What We Think We Know and What We Know 19
- INTRODUCTION 19
- WHAT IS PREVALENCE? 20
- WHO HAS A PSYCHIATRIC DISORDER? 20
- GENERAL PREVALENCE OF PSYCHIATRIC DISORDERS 21
- SPECIFIC PSYCHIATRIC COMORBIDITIES 25
- REFERENCES 32
Chapter 2 Why Do Neurologists and Psychiatrists Not Talk to Each Other? 37
- WHY SHOULD NEUROLOGISTS AND PSYCHIATRISTS TALK TO ONE ANOTHER? 37

Front Cover 2
Psychiatric Controversies in Epilepsy 5
Copyright Page 6
Contents 11
Preface 15
Contributors 17
Chapter 1 Prevalence of Psychiatric Disorders in Patients with Epilepsy: What We Think We Know and What We Know 19
- INTRODUCTION 19
- WHAT IS PREVALENCE? 20
- WHO HAS A PSYCHIATRIC DISORDER? 20
- GENERAL PREVALENCE OF PSYCHIATRIC DISORDERS 21
- SPECIFIC PSYCHIATRIC COMORBIDITIES 25
- REFERENCES 32
Chapter 2 Why Do Neurologists and Psychiatrists Not Talk to Each Other? 37
- WHY SHOULD NEUROLOGISTS AND PSYCHIATRISTS TALK TO ONE ANOTHER? 37
- INTRODUCTION 37
- CONSEQUENCES 41
- THE NEUROLOGIST’S PERSPECTIVE 44
- WHAT CAUSES THIS LACK OF COMMUNICATION? 44
- THE PSYCHIATRIST’S PERSPECTIVE 45
- WHERE DO WE GO FROM HERE? 47
- REFERENCES 47
Chapter 3 Are Neurologists Trained to Recognize and Treat the Psychiatric Comorbidities of Epilepsy? 51
- INTRODUCTION 51
- IS RECOGNITION AND TREATMENT OF PSYCHIATRIC DISORDERS IMPORTANT IN THE TREATMENT OF EPILEPSY? 52
- WHAT TRAINING IS AVAILABLE FOR NEUROLOGISTS OR EPILEPTOLOGISTS IN EVALUATION AND TREATMENT OF PSYCHIATRIC DISORDERS? 54
- WHAT ACCESS DO NEUROLOGISTS HAVE FOR CONSULTATION OR JOINT MANAGEMENT OF EPILEPSY PATIENTS WITH PSYCHIATRISTS? 57
- REFERENCES 58
- WHAT POSSIBLE STRATEGIES EXIST FOR THE IMPROVEMENT OF PSYCHIATRIC CARE FOR PATIENTS WITH REFRACTORY EPILEPSY? 58
Chapter 4 The Challenge of Teaching Psychiatry Residents About Psychopathology in Patients with Epilepsy 61
- INTRODUCTION 61
- THE CLINICIAN’S POINT OF VIEW 62
- THE EDUCATOR’S POINT OF VIEW 63
- REFERENCES 66
Chapter 5 What Do We Know About Mood Disorders in Epilepsy? 67
- INTRODUCTION 67
- SYNDROMES, SEIZURES, DRUGS AND MOOD 68
- IS THERE AN EPILEPSY-SPECIFIC AFFECTIVE SYNDROME? 71
- THE PROBLEM OF DEPRESSION DIAGNOSIS IN EPILEPSY 74
- TREATMENT 76
- CONCLUSIONS 77
- REFERENCES 78
- INTERICTAL DYSPHORIC DISORDER INVENTORY (IDDI) 81
- APPENDIX: QUESTIONS CONCERNING THE TEMPORAL RELATIONS OF THE ABOVE MENTIONED COMPLAINTS 83
Chapter 6 Is Depression in Epilepsy the Expression of a Neurological Disorder? 85
- INTRODUCTION 85
- SHARED NEUROTRANSMITTER ABNORMALITIES IN DEPRESSION AND EPILEPSY 88
- SHARED STRUCTURAL AND NEUROPATHOLOGICAL ABNORMALITIES IN DEPRESSION AND EPILEPSY 90
- SHARED FUNCTIONAL NEUROIMAGING ABNORMALITIES IN DEPRESSION AND EPILEPSY 92
- THE TREATMENT OF PATIENTS WITH EPILEPSY AND DEPRESSION 96
- CONCLUSIONS 99
- REFERENCES 100
Chapter 7 Are Anxiety and Depression Two Sides of the Same Coin? 107
- INTRODUCTION 107
- EPIDEMIOLOGY OF DEPRESSION AND ANXIETY IN EPILEPSY 108
- ANXIETY AND DEPRESSION IN THE GENERAL POPULATION 110
- DEPRESSION AND ANXIETY IN EPILEPSY: WHAT DO WE KNOW? 112
- COMMON SYMPTOMATOLOGY IN DEPRESSION AND ANXIETY 113
- COMMON PATHOGENIC MECHANISMS IN DEPRESSION, ANXIETY, AND EPILEPSY 114
- NEUROANATOMIC IMAGING STUDIES IN EPILEPSY 116
- NEUROANATOMIC IMAGING STUDIES IN DEPRESSION AND ANXIETY 116
- PHARMACOLOGIC AND PSYCHOTHERAPEUTIC TREATMENTS FOR DEPRESSION AND ANXIETY 117
- PSYCHOTHERAPEUTIC INTERVENTIONS 120
- DISCUSSION AND IMPLICATIONS 121
- REFERENCES 122
Chapter 8 Does Psychosis of Epilepsy Differ from Primary Psychotic Disorders? 129
- INTRODUCTION 129
- WHICH TYPE OF EPILEPTIC PSYCHOSIS SHOULD BE COMPARED WITH WHICH PRIMARY PSYCHOTIC DISORDER? 130
- CONCLUDING REMARKS: PLURAL EPILEPTIC PSYCHOSES SHOULD BE UNDERSTOOD UNDER PLURAL HYPOTHESES 139
- REFERENCES 142
Chapter 9 Are the Psychoses of Epilepsy a Neurological Disease? 147
- INTRODUCTION 147
- THE PSYCHOSES OF EPILEPSY 147
- IS POE A NEUROLOGICAL DISEASE? 152
- CONCLUSION 155
- REFERENCES 155
Chapter 10 Is ADHD in Epilepsy the Expression of a Neurological Disorder? 159
- INTRODUCTION 159
- ATTENTION DEFICIT HYPERACTIVITY DISORDER 159
- ADHD IN CHILDREN WITH EPILEPSY 160
- PREVALENCE OF ATTENTION PROBLEMS AND ADHD IN EPILEPSY SAMPLES 161
- REFERENCES 167
- CONCLUSIONS 167
Chapter 11 Are Psychogenic Non-epileptic Seizures an Expression of “Neurologic” Pathology? 171
- INTRODUCTION 171
- DEFINITIONS 172
- “NEUROLOGIC” FACTORS 174
- “PSYCHOGENIC” FACTORS 180
- CONSTITUTIONAL AND DEVELOPMENTAL FACTORS 184
- A MULTIFACTORIAL ETIOLOGIC MODEL FOR PNES 186
- REFERENCES 188
Chapter 12 Are Psychiatric Disorders a Risk for the Development of Neurological Disorders? 197
- INTRODUCTION 197
- DO PSYCHIATRIC DISORDERS PRECEDE THE DEVELOPMENT OF NEUROLOGIC DISORDERS? 197
- COMMON PATHOGENIC MECHANISMS BETWEEN PSYCHIATRIC AND NEUROLOGIC DISORDERS? 202
- IMPACT OF MOOD DISORDERS ON THE COURSE OF THE NEUROLOGIC DISORDER AND THE PATIENT'S QUALITY OF LIFE 210
- CONCLUDING REMARKS 212
- REFERENCES 213
Chapter 13 Do Peri-ictal Psychiatric Symptoms Account for the Differences between Depressive Disorders in Patients with and with 219
- INTRODUCTION 219
- ATYPICAL MANIFESTATIONS OF INTERICTAL DEPRESSION IN EPILEPSY 223
- CONCLUDING REMARKS 226
- REFERENCES 227
Chapter 14 Can Psychological Testing Replace Psychiatric Evaluations in Patients with Epilepsy? Or Can Psychiatric Evaluations R 229
- INTRODUCTION 229
- DIAGNOSTIC ACCURACY 230
- MONITORING CHANGE 233
- REFERENCES 235
- CONCLUSION 235
Chapter 15 Should the Screening for Depression, Anxiety, Attention Deficit – Hyperactivity Disorder and Learning Disorders Be Pa 239
- INTRODUCTION 239
- DEPRESSION 240
- ANXIETY 243
- ATTENTION DEFICIT–HYPERACTIVITY DISORDER (ADHD) 246
- LEARNING DISORDERS 249
- REFERENCES 252
- CONCLUSIONS 252
Chapter 16 Should a Psychiatric Evaluation Be Included in Every Pre-surgical Work-up? 257
- INTRODUCTION 257
- USE OF PSYCHIATRIC EVALUATIONS IN MAJOR EPILEPSY CENTERS 258
- SURGICAL CANDIDATES: A POPULATION AT RISK OF COMORBID PSYCHIATRIC DISORDERS 260
- IMPACT OF PRE- AND POST-SURGICAL PSYCHIATRIC ILLNESS ON POST-SURGICAL SEIZURE OUTCOME 267
- IMPACT OF EPILEPSY SURGERY ON PRE-SURGICAL PSYCHIATRIC DISORDERS 269
- REFERENCES 270
Chapter 17 Do Antidepressants Improve or Worsen Seizures in Patients with Epilepsy? 273
- INTRODUCTION 273
- WHAT IS THE EVIDENCE THAT ANTIDEPRESSANTS LOWER SEIZURE THRESHOLD? 274
- PRECLINICAL EVIDENCE FOR AN ANTICONVULSANT EFFECT OF ANTIDEPRESSANTS 277
- CLINICAL EVIDENCE FOR AN ANTICONVULSANT EFFECT OF ANTIDEPRESSANTS 278
- DEPRESSION ITSELF MAY LOWER SEIZURE THRESHOLD 280
- CONCLUSIONS 281
- REFERENCES 281
Chapter 18 Do Central Nervous System Stimulants Lower Seizure Threshold? 287
- INTRODUCTION 287
- ATTENTION DEFICIT ASSOCIATED WITH NEUROLOGICAL DISORDERS 288
- SEIZURE INCIDENCE AND CNS STIMULANTS 291
- REFERENCES 295
Chapter 19 The Psychotropic Effects of Vagus Nerve Stimulation in Epilepsy 301
- INTRODUCTION 301
- THE VAGUS NERVE 301
- THE HISTORY OF VAGUS NERVE STIMULATION 302
- DEPRESSION IN EPILEPSY 304
- THE EFFECTS OF VNS THERAPY ON MOOD IN EPILEPSY: RESULTS FROM THE PILOT STUDIES 305
- VNS EFFECTS ON MOOD AND DEPRESSION IN EPILEPSY 306
- VNS FOR TREATMENT OF DEPRESSION 308
- PROPOSED MECHANISMS OF ACTION OF VNS IN EFFECTS ON MOOD AND DEPRESSION 309
- SUMMARY 310
- REFERENCES 310
Chapter 20 Do Psychological Therapies Alleviate Epileptic Seizures? 315
- INTRODUCTION 315
- EVOLUTION OF EPILEPSY TREATMENT 316
- THE ROLE OF PSYCHOLOGICAL THERAPIES IN CONTROLLING SEIZURES 321
- EVIDENCE OF THE EFFECTIVENESS OF PSYCHOLOGICAL THERAPIES 328
- REFERENCES 332
- CONCLUSION 332
Index 337
- A 337
- B 338
- C 338
- D 339
- I 340
- G 340
- E 340
- H 340
- F 340
- L 341
- J 341
- M 341
- K 341
- N 341
- O 342
- P 342
- Q 343
- R 343
- S 343
- T 344
- Z 345
- V 345
- W 345

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