Johnson Keith A, Macfarlane Matthew D, Looi Jeffrey Cl
Consultant Neuropsychiatrist and Liaison Psychiatrist, Department of Consultation Liaison Psychiatry, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
Consultant Neuropsychiatrist and Liaison Psychiatrist, Department of Consultation Liaison Psychiatry, Illawarra Shoalhaven Local Health District, Wollongong, NSW, and; Clinical Associate Professor, Graduate School of Medicine, University of Wollongong and Wollongong, NSW, Australia.
Australas Psychiatry. 2016 Dec;24(6):526-528. doi: 10.1177/1039856216654395. Epub 2016 Jun 21.
This paper aims to describe the prevalence, assessment and management of affective disorders as well as functional (non-epileptic) seizures in people with epilepsy.
This paper comprises a selective review of the literature of the common affective manifestations of epilepsy.
Affective disorders are the most common psychiatric comorbidity seen in people with epilepsy and assessment and management parallels that of the general population. Additionally, people with epilepsy may experience higher rates of mood instability, irritability and euphoria, classified together as a group, interictal dysphoric disorder and resembling an unstable bipolar Type II disorder. Functional seizures present unique challenges in terms of identification of the disorder and a lack of specific management.
Given their high prevalence, it is important to be able to recognise affective disorders in people with epilepsy. Management principles parallel those in the general population with specific caution exercised regarding the potential interactions between antidepressant medications and antiepileptic drugs. Functional seizures are more complex and require a coordinated approach involving neurologists, psychiatrists, general practitioners, nursing and allied health. There is very limited evidence to guide psychological and behavioural interventions for neurotic disorders in epilepsy and much more research is needed.
本文旨在描述癫痫患者中情感障碍以及功能性（非癫痫性）发作的患病率、评估及管理情况。
本文对癫痫常见情感表现的文献进行了选择性综述。
情感障碍是癫痫患者中最常见的精神科合并症，其评估及管理与普通人群相似。此外，癫痫患者可能情绪不稳定、易激惹及欣快感发生率更高，这些症状归为一组，称为发作间期烦躁症，类似于不稳定的双相II型障碍。功能性发作在疾病识别及缺乏特异性管理方面存在独特挑战。
鉴于其高患病率，能够识别癫痫患者中的情感障碍很重要。管理原则与普通人群相似，但需特别注意抗抑郁药物与抗癫痫药物之间的潜在相互作用。功能性发作更为复杂，需要神经科医生、精神科医生、全科医生、护士及相关健康专业人员采取协调一致的方法。目前指导癫痫患者神经症性障碍心理及行为干预的证据非常有限，需要更多研究。
