てんかんに併存する精神症状とその対応—精神医学的視点を含む診療構造の提言

Psychiatric and Psychological Comorbidities in Epilepsy: Clinical Features and Psychiatric Management

てんかんにおける精神医学的併存症状は，気分障害，不安障害，精神病様状態，発達障害など内容もさまざまで出現頻度も高い。また，一部の抗てんかん薬による精神症状の誘発や，外科治療後などの精神症状発現にも注意が必要である。さらに，心因性非てんかん性発作への対応も重要な課題である。併存症状への適切な対応を実践するために，てんかん治療開始の段階から精神医学的・心理学的視点を含む治療構造を構築することが望ましい。

Abstract

Psychiatric comorbidities, including mood, anxiety, psychotic disorders, and autism spectrum disorder are common in patients with epilepsy (PWE), often occurring at rates 2-3-fold or higher than in the general population without epilepsy. Furthermore, an attention should be paid to psychiatric symptoms together with those caused by antiepileptic drug therapy, epilepsy surgery, and vagus nerve stimulation because these therapies sometimes induce psychiatric comorbidities.

It is important to differentiate psychogenic non epileptic seizures (PNES) from epilepsy, and to provide patients with psychiatric treatment. We focused on the process and certainty of diagnosis and the managements of PNES.

An accurate, undistorted understanding of the relationship between mental status and epilepsy is essential to ensure appropriate therapy and avoid misconceptions and unnecessary treatment. Psychiatric and psychological states should be evaluated at the time of the first visit in every PWE and patients should be provided adequate psychiatric therapy if necessary within the overall therapeutic plan.