This is a highly complex topic – epilepsy and psychiatric illness are closely related. In Japan, Psychiatrists are a “go to” doctor for epileptic patients – over half of all epileptic patients are under the care of a Psychiatrist.
Epileptic patients might first present to the Psychiatry clinic, or the substance abuse clinic, or the psychotherapist, and developmental onset epilepsy is a frequent finding in learning disability. In 2012 Andersson reported “The increased rate of psychiatric comorbidity predating and succeeding seizure onset indicates a bidirectional relationship and common underlying mechanisms for psychiatric disorders and epilepsy.”
Most of the referrals to this clinic are for treatment refractory illness. For example we might receive a referral for academic failure and anger – upon close examination and after confirmatory diagnostic testing we often find brain conditions that are most reminiscent of limbic epilepsy with co-morbid attentional defects.
In another case, we accepted the referral of a person with treatment resistant psychosis. Diagnostic testing revealed epileptic activity in the frontal lobe – once we added an anticonvulsant the previously intractable condition resolved in a most gratifying way.