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Psychopathology of Epilepsy
Epilepsy & Behavior 2, 608 – 617 (2001) All articles available online at http://www.idealibrary.com on
LETTERS TO THE EDITOR Psychopathology of Epilepsy coding would also emphasize the differences seen in patients with neurological and psychiatric disorders from those with purely psychiatric disease.
To the Editor: I read with great interest the excellent article by Kanner and Barry (1) concerning the psychopathology of epilepsy versus other disorders. I would agree with Dr. Kanner that the psychopathology of patients with epilepsy is different from that seen in purely psychiatric patients, but so is the psychopathology of patients with other neurological disorders. The current situation as regards the diagnosis of psychiatric disorders in patients with epilepsy is reminiscent of all psychiatric diagnosis before the development of the research diagnostic criteria for psychiatric disorders (1) and then DSM-III (2). What is needed now is a set of research diagnostic criteria for psychiatric disorders in patients with epilepsy that could be tested for validity and reliability. Most epileptologists have neither the training nor the inclination to treat psychiatric disorders and leave this to their psychiatric colleagues. Psychiatrists are trained to use the DSM for diagnosis and it seems most reasonable to make the psychiatric diagnoses in patients with epilepsy within a framework with which the psychiatrists are familiar. The 293 class of coding in DSM-IV (3) or the FO6/7 coding in ICD-10 (4) codes for psychiatric disorders due to other medical conditions, such as epilepsy, which would be the Axis III diagnosis. This use of this
REFERENCES 1.
Kanner AM, Barry JJ. Is the psychopathology of epilepsy different from that of nonepileptic patients? Epilepsy Behav 2001;2: 170 – 86. Doi10.1006/ebeh.2001.0192 2. Feighner JP, Robins E, Guze SB, et al. Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatry 1972;26:57– 63. 3. Diagnostic and statistical manual of mental disorders, 3rd ed. Washington, DC: American Psychiatric Association, 1980. 4. Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: American Psychiatric Association, 1994. 5. The ICD-10 classification of mental and behavioral disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization, 1992.
Jeffrey S. Nicholl, M.D. Department of Psychiatry and Neurology Tulane University School of Medicine, TB-52 1440 Canal Street New Orleans, Louisiana 70112 doi:10.1006/ebeh.2001.0265
Reply management of comorbid psychiatric disorders. To the contrary, a review of the literature of psychopathology of epilepsy reveals the very prominent contributions by neurologists. In my opinion, if neurologists were provided with a proper set of criteria to recognize these disorders they could implement the appropriate psychopharmacologic treatment in a large percentage of patients. In fact, our own studies (1, 3) and studies by Blumer (4) have shown that depressive disorders in patients with epilepsy tend to respond well to low doses of antidepressant drugs. Therefore, in many instances a psychiatric consultation may only be necessary when the patient fails to respond to the treatment prescribed by the neurologist. We look forward to future collaboration between neurologists and psychiatrists to develop diagnostic
To the Editor: I greatly appreciated Dr. Nicholl’s comments. I agree with most of his observations, particularly the need to develop a set of research diagnostic criteria of the different expressions of affective, anxiety, and psychotic disorders encountered in patients with epilepsy. Dr. Nicholl also addressed a very important point: the failure by both neurologists and psychiatrists to recognize comorbid psychopathology in these patients that, in turn, results in the failure to provide timely and appropriate treatment. In fact, various studies have documented the relatively large number of patients with mood disorders that have gone unrecognized and untreated for a long time (1, 2). I take issue, however, with Dr. Nicholl’s comment that neurologists are not interested or trained in the
©
608
1525-5050/01 $35.00 2001 Elsevier Science All rights reserved.
LETTERS TO THE EDITOR Psychopathology of Epilepsy coding would also emphasize the differences seen in patients with neurological and psychiatric disorders from those with purely psychiatric disease.
To the Editor: I read with great interest the excellent article by Kanner and Barry (1) concerning the psychopathology of epilepsy versus other disorders. I would agree with Dr. Kanner that the psychopathology of patients with epilepsy is different from that seen in purely psychiatric patients, but so is the psychopathology of patients with other neurological disorders. The current situation as regards the diagnosis of psychiatric disorders in patients with epilepsy is reminiscent of all psychiatric diagnosis before the development of the research diagnostic criteria for psychiatric disorders (1) and then DSM-III (2). What is needed now is a set of research diagnostic criteria for psychiatric disorders in patients with epilepsy that could be tested for validity and reliability. Most epileptologists have neither the training nor the inclination to treat psychiatric disorders and leave this to their psychiatric colleagues. Psychiatrists are trained to use the DSM for diagnosis and it seems most reasonable to make the psychiatric diagnoses in patients with epilepsy within a framework with which the psychiatrists are familiar. The 293 class of coding in DSM-IV (3) or the FO6/7 coding in ICD-10 (4) codes for psychiatric disorders due to other medical conditions, such as epilepsy, which would be the Axis III diagnosis. This use of this
REFERENCES 1.
Kanner AM, Barry JJ. Is the psychopathology of epilepsy different from that of nonepileptic patients? Epilepsy Behav 2001;2: 170 – 86. Doi10.1006/ebeh.2001.0192 2. Feighner JP, Robins E, Guze SB, et al. Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatry 1972;26:57– 63. 3. Diagnostic and statistical manual of mental disorders, 3rd ed. Washington, DC: American Psychiatric Association, 1980. 4. Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: American Psychiatric Association, 1994. 5. The ICD-10 classification of mental and behavioral disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization, 1992.
Jeffrey S. Nicholl, M.D. Department of Psychiatry and Neurology Tulane University School of Medicine, TB-52 1440 Canal Street New Orleans, Louisiana 70112 doi:10.1006/ebeh.2001.0265
Reply management of comorbid psychiatric disorders. To the contrary, a review of the literature of psychopathology of epilepsy reveals the very prominent contributions by neurologists. In my opinion, if neurologists were provided with a proper set of criteria to recognize these disorders they could implement the appropriate psychopharmacologic treatment in a large percentage of patients. In fact, our own studies (1, 3) and studies by Blumer (4) have shown that depressive disorders in patients with epilepsy tend to respond well to low doses of antidepressant drugs. Therefore, in many instances a psychiatric consultation may only be necessary when the patient fails to respond to the treatment prescribed by the neurologist. We look forward to future collaboration between neurologists and psychiatrists to develop diagnostic
To the Editor: I greatly appreciated Dr. Nicholl’s comments. I agree with most of his observations, particularly the need to develop a set of research diagnostic criteria of the different expressions of affective, anxiety, and psychotic disorders encountered in patients with epilepsy. Dr. Nicholl also addressed a very important point: the failure by both neurologists and psychiatrists to recognize comorbid psychopathology in these patients that, in turn, results in the failure to provide timely and appropriate treatment. In fact, various studies have documented the relatively large number of patients with mood disorders that have gone unrecognized and untreated for a long time (1, 2). I take issue, however, with Dr. Nicholl’s comment that neurologists are not interested or trained in the
©
608
1525-5050/01 $35.00 2001 Elsevier Science All rights reserved.