Psychological treatment of psychosocial problems and psychiatric comorbidity in patients with epilepsy

Psychosocial problems in patients with epilepsy are frequently described. Several risk factors were identified including complexity of seizure type, high seizure frequency and younger age of onset. In patients with a rather uncomplicated epilepsy and low seizure frequency, psychosocial problems are commonly a minor problem. However, psychosocial / psychiatric problems reported in patients with refractory (untreatable) epilepsy are diverse e.g. lower general well-being, lower educational levels, higher unemployment rates and significant higher rates of depression and anxiety disorders. Studies on treatment of these problems often include psycho-educational programs and cognitive behavioural therapy, including relaxation and stimulus-control interventions. They have proven to contribute to an increase in experienced quality of life and a reduction in psychosocial stress. Psychiatric comorbidity is also high in patients with epilepsy. Most commonly reported problems are depression, anxiety disorders and AD(H) D. The specific symptoms reported by patients with epilepsy do not always fit DSM-IV or ICD-10 criteria. Therefore diagnosis of these disorders is often difficult and despite high prevalence rates, symptoms remain often unnoticed. Comorbid psychiatric disorders, if recognized, can however be treated trough conventional guidelines. A multi-disciplinary approach in diagnosis and treatment of patients with refractory epilepsy is important to understand the complex factors involved, which in turn can lead to earlier diagnosis of comorbidity and treatment programs adjusted to the individual patient.